[Good intentions]

To be clear, I posted this mainly as a discussion point about the fact that pure tissue techniques are still a major area of study. The work itself in this paper is obviously of little value except that it reintroduces an old technique to the community of hernia repair surgeons, and shows that some surgeons have not accepted the view that mesh is the best starting point for hernia repair.

[Good intentions]

Six weeks is not very long. One month ago would be two weeks after the surgery, correct? That is right at the edge of the usual time for being released for activity after surgery.

Do you know what the “sports hernia repair” method was? Mesh is not typically recommended for athletic pubalgia (aka sports hernia). Was it a sports hernia repair or did the surgeon just call the problem a sport-based hernia? Good luck.

There are many possible causes, but no simple solutions. Since it’s so early your best bet might be to avoid running for a while until the pain resolves then try to slowly work your way back in to it.

[Good intentions]

Rejuvenating this Topic from the past. There is a link to a bodybuilding forum that has a long thread about hernia repair in it, in one of the posts above. Some of the bodybuilders report good results. Overall, sometimes I think that activities that are high in repetitive exertions, like running or playing sports, cause more problems than extreme exertions at low repetition, like weight training. I was way out on the high repetition and extreme effort end of the activity scale.

I haven’t read back through this thread but there might something of value in it.

[Good intentions]

Two fairly young men (in their 30’s) just posted on the forum looking for advice on hernia repair. They both sound like active people, one mentioned deadlifts, a weightlifting term. So, a node on their decision tree might be “will I be able to exercise like I used to?”. That might then lead to defining the degree of exercise. High intensity track work versus weightlifting only, for example. If it’s high intensity track work or running, they might look to Muschaweck’s work on soccer players or Dai Greene’s story to help decide on a method or a surgeon.

Of course, the stories linked below are stories of problems. I created a Topic quite a while ago looking for good mesh stories. If somebody has found a story of a professional athlete who got a mesh repair, or any repair for an inguinal hernia and regained their health and abilities, please post it. There might be materials and methods that actually work. In an ideal world, the good would rise up and the bad would be allowed to fade away.

https://herniatalk.com/forums/topic/pro-soccer-player-ruined-by-hernia-mesh/

https://youtu.be/akkp0fApJDI

Pro soccer player ruined by hernia mesh

[Good intentions]

Generally, for hernia repair, seeing a hernia specialist is recommended. Hernia repair is not simple surgery, although many doctors make it sound easy. You don’t want to get the wrong surgeon for hernia repair. The results are permanent.

There is a Topic on the forum about hernia repair in Germany. It might be worth reading.

https://herniatalk.com/forums/topic/can-we-mention-the-germans/

Can we mention the Germans?

[Good intentions]

If you just want to get the surgery method of the day by the most capable surgeon in that technique, then Jacob, Dalkin, or Novitsky are good candidates. Sbayi has expertise in the Shouldice method. Podolsky publishes about robotics so he might be doing a TAPP mesh repair. Actually Jacob, Novitsky and Dalkin might be also.

You said that once you choose you’ll be locked in. So, you kind of have to decide what matters most to you, the repair method itself or the surgeon’s knowledge of a certain type of repair method.

At your age you certainly have a lot of life ahead of you. Whatever you choose, the results will be with you for the rest of it. Doctors can think about the 85 patients that they helped (as far as they know) and ignore the 15 that they hurt (those are mesh repair numbers). It’s just the reality of their lives. Try not to be one of the 15.

You’re doing the right thing by researching options first. Things just aren’t very clear at this time. Even the “International Guidelines” of hernia repair are being revised, and they seem to be having difficulty deciding what should be in the updated document.

There really is a lot on the forum. Not much has changed in the last 15 years, except for the advent of robotic surgery. It’s the latest new thing. The materials and methods are all about the same. So the odds are too.

[Good intentions]

To be clear, in my post above I was combining recurrence and pain, as “problems”. Both are bad, and even the experts aren’t sure how to avoid either. The factors involved in controlling the problems are still unclear.

[Good intentions]

Spend some time reading posts on the forum. This is not a typical “what’s best?” forum. Is your hernia direct or indirect? The description sounds indirect. Why do you want surgery? Is there pain, or does it hinder your activities? Hernia surgery is very risky, both in the probability of problems (10 – 20% chance [guesstimate] of recurrence or some sort of pain) and the difficulty of fixing those problems if they occur. Surgery involves permanent changes.

Spend some time educating yourself. Don’t be in a hurry to get “fixed”.

A typical surgeon will tell you that the “vast majority” of patients don’t have problems. That doesn’t tell you the whole story. There are many references to professional publications on the site. Read a few and learn the real numbers. Good luck.

[Good intentions]

It is a topic of study in Japan. Here are some links. I assume that “rescue analgesics” might be a term for “pain-killer”.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=japan+inguinal+hernia+mesh&btnG=

https://link.springer.com/article/10.1007/s00595-012-0153-5

https://journals.sagepub.com/doi/abs/10.1177/17504589211054371

[Good intentions]

Somebody just asked about “Chinese substandard polypropylene” in a different Topic. It reminded me of the Progrip polyester (PET) – based mesh. PET and PP are the two main polymers used in meshes. They both seem ot have similar problems.

The MAUDE database is a good place to look for information about complaints about specific products. It is not easy to use though. I created a Topic about it. Some of the files contain detailed descriptions, others are very short.

https://herniatalk.com/forums/topic/maude-manufacturer-and-user-facility-device-experience/

Here is an excerpt from the article I linked in the first post of this thread.

“…
Laparoscopic Progrip
Although not intended to be used for laparoscopic surgery some surgeons started using the flat Pg-PET mesh during laparoscopic groin hernia repairs. Probably, Dr. Dieter Birk was one of the first surgeons starting to use Pg-PET mesh in laparoscopy in 2008. Favourable results during a follow-up period of 23 months were published in 2013 [5]. Muysoms et al. also started using Pg-PET mesh in laparoscopic groin hernia repairs in November 2009 [6]. Sofradim Production later produced a mesh dedicated for laparoscopic groin hernia repair, Progrip™ Laparoscopic Self-Fixating Mesh.
…”

MAUDE – Manufacturer and User Facility Device Experience

[Good intentions]

Avoiding “Chinese substandard polypropylene” will not remove the risk that the use of mesh carries.

I am not “against mesh”. I am against its overuse and the apparent acceptance of its major flaws by the medical community, plus the obscuring of these flaws when the mesh product is promoted to the patient as a cure. Any surgeon today that implants mesh without clearly explaining the potential problems with its use is participating in a fraud. The literature, from the scientific journals all the way down to the simple trade journals, has produced a constant stream of studies showing that there is a substantial probability of chronic pain if mesh is implanted in the body for hernia repair. The pain is not easily resolved if it occurs.

Nobody should be fooled by the premise that the bulk of mesh problems are caused by counterfeit products or “substandard polypropylene”. Polyester meshes have similar problems. The knitted fabric pattern and the nature of the textile itself seem to be the cause. Not the chemistry of the polymer used to make the fibers.

[Good intentions]

I miswrote in my post above, I was a month early. Now, today, it has been 6 months past the promised update time. The year is half gone.

The EHS has changed their main web page and I found that they do refer to updates as being in progress but do not give an expected date of publication. Considering all it would be surprising if they made any firm statements suggesting that mesh of any type is not the first recommendation for repair of any hernia type. Maybe they will release something before 2024 gets here.

Ten chapters is kind of specific. What could the holdup be?

https://europeanherniasociety.eu/international-guidelines-for-groin-hernia-management-2/

“…
The guidelines were developed by The HerniaSurge Group and have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. The guidelines were published in 2018 in the Journal Hernia. Ten chapters are in the process of being updated.

Reference: HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12. PMID: 29330835; PMCID: PMC5809582.
…”

[Good intentions]

So you’re just over one year in to your ordeal. Is there any way to find out what the mesh was, the brand and trade name, that was implanted? Mesh is known to move over time but to have it move “all over the place”, far enough to apparently impinge on some nerves, within four or five months seems very unusual. There is a huge variety of meshes out there.

If you don’t have the energy I get it. I just wonder about all of these new meshes that keep appearing with essentially no data to support their use in humans. The 510(k) process of the FDA allows it but the FDA’s purpose is to assess toxicity of materials, not suitability of devices. The whole medical device industry is kind of corrupted, as far as new device approval is concerned. Almost anything goes.

Did you get your medical records from Surgeon #1? There might be something notable in them that explains the failure of his procedure.

[Good intentions]

Well, that is a bummer.

Could you possibly summarize your whole experience here in this thread, from implantation to today? I went back and looked but can’t find what type of mesh you had implanted or how long ago it was. Plus the umbilical hernia/pain. How long did you live with the mesh before deciding to have it removed? I had mesh in me for three years. I wonder if there is an optimum time to wait before mesh removal.

On your removal, from past posts, it seems like the left was removed first by Dr. Billing but a small piece of mesh ws left behind, similar to my case on the right. Too tangled up with critical structures. Things seemed to be healing well, but your umbilical pain started increasing. You went to Dr. Parra to have the right side removed, and he also went to the left side and removed the small piece left over. Then, within four months you had both sides recur and still have umbilical pain.

Thanks for contributing your story to the forum. I think it helps people to see what is involved once you start to have mesh problems. They are very hard to solve. I am certain that there are people out there suffering who just don’t trust the system to fix their problems, so they just live with it.

[Good intentions]

Weird though that the content still comes through when the Tweet is embedded. They’ll probably figure out how to block that soon too.

[Good intentions]

The right side is apparently the weaker side for most men. The right side usually herniates before the left.

It would be interesting to know the difference between what Dr. Billing did and what Dr. Parra did. Just like hernia repair, mesh removal has its own methods.

Here is your other post where you describe going to Dr. Parra. I’m not implying that Dr. Parra caused a problem, just noting that you had two different surgeons. Did Dr. Parra use robotic methods? Doesn’t really matter, just curious.

Good luck. At least you still have a path to follow and the means to do it.

https://herniatalk.com/forums/topic/dr-twofigh-chronic-pain/#post-35483

Dr. Twofigh – Chronic Pain

[Good intentions]

I think that his story has been unclear because Pinto joined the forum when he was trying to get through to Gibbeum Hospital to talk to Dr. Kang.

#30011

https://herniatalk.com/forums/topic/newly-diagnosed-and-loads-of-questions-im-terrified/

Newly diagnosed … And loads of questions. I’m terrified

[Good intentions]

Did you get the Shouldice repair at the Shouldice Hospital?

Reading your account I got the impression of somebody that is not letting an injury heal completely before testing the injured area again. I have been that person myself with other types of injuries.

The other impression I get is of somebody who is really pushing their body to its limit. That might, in the end, be a choice that you have to make. Giving up the extreme exertion exercises in favor of living a healthy and comfortable life. I tried to get my high end performance back and ended up much worse off than where I would have been if I had just realized my high intensity life had run its course.

But those are just opinions. You might start by assuming that you do have a sportsman’s hernia (athletic pubalgia) and following the guidance for properly and completely healing before getting back in to training. Athletic pubalgia is basically an overuse injury, not a physical defect like a groin hernia.

Here is one very basic description of it. It’s a complex area of study like all groin pain problems.

https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/

You can also search the terms I mentioned above in Google Scholar.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=athletic+pubalgia&btnG=

[Good intentions]

I created this Topic yesterday SN. It might be worth watching. Dr. Chen is a well-established expert in the field and gives presentations around the world. He relies on the Guidelines created by the HerniaSurge/Collaboration/EHS, which are pretty vague, only using the words mesh and pore size to describe the prosthetic material.

Unfortunately I think that you will find that the mesh makers all have good things to say about their products but the surgeons do not really know which mesh is best.

Specific to your question, polypropylene mesh is used for both lap and Lichtenstein. But so are many other types. There is no single material tied to any procedure.

https://herniatalk.com/forums/topic/youtube-video-about-the-lichtenstein-repair-by-dr-david-chen/

Youtube video about the Lichtenstein repair by Dr. David Chen

[Good intentions]

It’s not clear what you are asking Gale. Dr. Conze is saying that you probably have the same problem that you had in the beginning – pressure on areas in the groin that cause pain. The mesh worked for five years and now it has stopped working. Disappointing that he did not offer a plan of action to solve the problem. Maybe you can ask him about that.

“Pseudo-recurrence” just means something that has the symptoms of a recurrence but is not an actual recurrence. Physically, if this is true, you are in no danger of incarcerated viscera, because everything is where it should be. You are in the category of “physically healthy patient with pain”. Dr. Sheen can say his procedure is and was perfect. But the pain is a new situation. Unfortunately, even though your case is different, the path forward is very similar to that of a typical chronic pain patient. You’ll need to find a doctor that believes that chronic pain is real and has ideas about how to solve it.

https://en.wikipedia.org/wiki/Pseudo-