[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-

[Good intentions]

Nothing substantial on the Updates. As I have noted in two other threads, Medtronic and BD have both introduced new polypropylene products to market. Progrip Polypropylene, and Bard 3d Max MID. I think that the damaged patients and the litigation are just calculated in to the price of the products. These are not companies that exist for the betterment of humanity’s health. They’re just business ventures.

From the link in the post above –

“June 12, 2023 Update
Bard continues to struggle with product liability lawsuits. The latest is the Bard PowerPort device which provides a port for patients to receive medication without the need to start a fresh IV. Like the hermia mesh claims, Bard PowerPort lawsuits involve allegations that the device was poorly made.

June 5, 2023 Update
Bard no longer believes Stinton should go to trial. Why? Because it says the plaintiff’s injuries have escalated to the point where it is no longer a good bellwether trial. Bard is saying we want to avoid a significant verdict in Stinson because that will lead to greater settlement expectations.

This is nonsense. The first two bellwether trials were not great cases for plaintiffs, so those cases could be said to be unrepresentative. This tactic coincides nicely with Bard’s strategy of prolonging the process, which aims to hold onto their capital as long as they can, with the hope that persistent delays will persuade plaintiffs to settle for smaller settlement payouts when this ordeal finally reaches a resolution. Should the judge agree to postpone the Stinson trial – and the bet here is that he will not – that will cause even greater delay to get the next case ready for trial.

June 1, 2023 Update
As many of you reading this know all too well, mass tort lawsuits can move slowly. Some plaintiffs try to make arguments to steer clear of a class action lawsuit to pursue an independent claim. In Vaughn, et al. v. Kentuckiana Surgical Specialists, P.S.C., et al., plainitff filed a hernia mesh lawsuit in the Western District of Kentucky to the Southern District of Ohio. She asked to stay out of the Bard MDL because the transfer would cause inconvenience to them and non-Bard healthcare defendants. But the MDL Panel determined that the case shares common factual questions with those already transferred to MDL No. 2846 because the focus of the case is the claim that Bard’s polypropylene hernia mesh products have defects, leading to complications, such as adhesions, organ damage, and infections, when implanted in patients.”

[Good intentions]

SN’s recent query about the types of mesh used in hernia repair sent me out on the internet to review what’s out there, and to see who, if anybody, specifies theirs for Lichtenstein repair. Most manufacturers only distinguish between laparoscopy and open, and many don’t distinguish beyond “soft tissue repair” or “hernia repair”. You can understand why many surgeons just use whatever is in the cupboard at the ambulatory surgery center. It’s a mad-house.

Here is another absorbable that I didn’t really notice in the past. It is, somewhat ironically, from the company that makes what is probably the most stable material, the fluoropolymers. Gore Medical.

The description is kind of funny. Why would “shiny” be important? I assume that the word gives the impression that adhesions are less likely on a shiny surface.

They have two forms, one for inside the peritoneum and one for outside.

https://www.goremedical.com/products/enform

The GORE® ENFORM Biomaterial is used to reinforce soft tissue during the phases of wound healing by filling soft-tissue deficits. Typical procedures include:

– Abdominal wall reconstruction
– Hernia repair
– Muscle flap (i.e. TRAM, DIEP) procedures

The GORE® ENFORM Preperitoneal Biomaterial is designed with a textured porous fibrous web surface on both sides.

…

The GORE® ENFORM Intraperitoneal Biomaterial is a dual-sided device where one side is textured and the other is a smooth, shiny surface. ”

[Good intentions]

I had been meaning to add an update to this Topic, but as often happens, I had a minor setback that made me reconsider. I like to deliver good news, not bad.

But, the good news now is that the setback has resolved. I have been slowly and steadily expanding my range of activities over the years, walking and running farther, and working harder, with pain/discomfort being the limiting factor. At this point in time, the area of the mesh implantation and removal is still my limiting factor. It’s the weak point.

The setback a few weeks ago was that I started to feel groin pain on both sides and pressure that made me think I might be having some sort of recurrence. This was after a week of rigorous hiking, running, walking long distances, and physical effort moving heavy boxes, along with taking up some contorted positions while working on various things. Normal active life stuff. After a week of resting with no real progress in minimizing the discomfort I went back to my old standby of trying new strenuous things to see if things got worse or better. They got better and I feel very good now.

So, the message is that after mesh removal it takes a long time for things to get closer to “normal”. This might be good news for anyone who’s having problems and bad news for anyone who’s having problems. I had the last piece removed in December of 2017 so it’s been about 5 1/2 years since then.

I went back and looked at my notes, basically a diary of daily physical activities, and found that in January of 2019, one year and a month after mesh removal, I had drafted a letter to Dr. Brown about hernia repair and removal of that last piece of mesh. That is the type of pain I was having at the time. I thought that I might have two indirect hernias and pain from the last piece of mesh. But, the pain and discomfort resolved and I moved on.

Over the next year my notes show that I had periods of strange feelings in the groins and lower abdomen, like tissues were stretching and things were breaking loose and moving around exposing new tissue/nerves, with feelings of pressure when sitting, but things continued to get better. Then there are about nine months of random observations but no significant reports of problems. My last entry was in October of 2020.

Anyway five years is a long time, plus the three years before the removal. Eight years and seven months since I went in for the walk-in walk-out mesh implantation at the Ambulatory Surgery Center that was supposed to make me bullet-proof. Over 10% of my life so far, at least.

I still recommend that people keep a diary or log of what they’re doing and what happens afterward. The strangeness of constant discomfort and occasional pain really affects your thought process and memory. It is a radical shift if you’ve been healthy up to the point of the hernia repair. I look back at my notes and realize that I would not remember much of what I had written. I might not realize the progress that I’ve made.

[Good intentions]

Here is an opinion, from a non-expert –

If the pain is the same as before the repair it seems most likely that the defective area is being stressed in the same way. This could be because you’ve had a recurrence as Dr. Towfigh suggested, or because the mesh has come free from the abdominal wall in that defect area and is allowing the stressed area to to be pressurized/distorted again.

Since Dr. Sheen implanted mesh via the TEP procedure, there really are only a few options. Pain treatment, which could involve various pharmaceutical agents. Neurectomy, which has its own hazards. Open exploratory surgery and either a pure tissue repair to tighten the herniated area or a mesh repair to do the same. Mesh on the outside and inside. TAPP (the other laparoscopic method) exploratory surgery, probably with full or partial mesh removal and some other method of hernia repair.

Often though, as I understand things, the peritoneum looks fine from the viscera side during a TAPP exploration, even though problems exist on the anterior side. Before my mesh removal surgeon opened the peritoneum and removed the mesh, mine looked as it should, smooth and distortion free, but my surgeon found a folded area and movement of the mesh plus much edema. So if you get the wrong lap surgeon they might not see anything and just leave everything alone.

Your dilemma, I think, is choosing between mesh removal or another type of hernia repair. Since your pain is the same as it was with the hernia it seems like another repair should give similar results. My mesh pain was completely different from my hernia pain. I knew absolutely that the mesh was the problem and that removal was probably the best solution. Your case is different.

It is not uncommon to have mesh on both sides of the abdominal wall, if, for example, you got an anterior mesh repair by open surgery. The Prolene Hernia System (PHS) is designed that way. But I don’t know much at all about the repair methods used for female anatomy, it might not be appropriate.

Frankly, I would find an expert in female hernias. The ratio of female to male hernias is about 2 to 25. There are probably surgeons out there who have never repaired a woman’s hernia. Even those that have do not have much experience. They can’t, there just aren’t enough cases.

If Dr. Towfigh comes back maybe she can recommend an expert in your area. Since Dr. Sheen is apparently not available.

[Good intentions]

Polypropylene Progrip is not indicated for laparoscopic repair by Medtronic. So you can only really compare Bard 3D Max with polyester Progrip.

Unfortunately, you can find supposed “studies” around the medical research world that will support either over the other.

Also, many of the studies are not actually comparisons of the materials but studies of fixation versus no fixation. Even though BD’s own literature says that fixation in not necessary for 3D MAx.

Sorry. There is no simple answer.

https://www.bd.com/en-us/products-and-solutions/products/product-families/3dmax-mesh#overview

[Good intentions]

I mis-wrote above. Dr. Lorenz seems to be one of the newer members of the HerniaSurge group. His name is not shown on the 2018 list of members that were involved in the Bard and Ethicon sponsored meeting that bumped the Guidelines up to the “International” label.

https://link.springer.com/article/10.1007/s10029-017-1668-x

HerniaSurge in 2018 –

“The HerniaSurge Group
M. P. Simons, M. Smietanski, H. J. Bonjer, R. Bittner, M. Miserez, Th. J. Aufenacker, R. J. Fitzgibbons, P. K. Chowbey, H. M. Tran, R. Sani, F. Berrevoet, J. Bingener, T. Bisgaard, K. Bury, G. Campanelli, D. C. Chen, J. Conze, D. Cuccurullo, A. C. de Beaux, H. H. Eker, R. H. Fortelny, J. F. Gillion, B. J. van den Heuvel, W. W. Hope, L. N. Jorgensen, U. Klinge, F. Köckerling, J. F. Kukleta, I. Konate, A. L. Liem, D. Lomanto, M. J. A. Loos, M. Lopez-Cano, M. C. Misra, A. Montgomery, S. Morales-Conde, F. E. Muysoms, H. Niebuhr, P. Nordin, M. Pawlak, G. H. van Ramshorst, W. M. J. Reinpold, D. L. Sanders, N. Schouten, S. Smedberg, R. K. J. Simmermacher, S. Tumtavitikul, N. van Veenendaal, D. Weyhe & A. R. Wijsmuller”

[Good intentions]

Here is a cross-post to a recent interview with Dr. Lorenz, one of the newer HerniaSurge members.

https://herniatalk.com/forums/topic/dr-ralph-lorenz-hernia-talk-6th-june/#post-35821

Dr Ralph Lorenz Hernia Talk 6th June

[Good intentions]

I did not watch the Lorenz interview. Did Dr. Towfigh ask Dr. Lorenz about the HerniaSurge Collaboration’s release of the “International Guidelines for Groin Hernia Management” update that is almost six month’s behind the promised release date? Dr. Towfigh vouched for the group in the Topic I created about HerniaSurge, so she was/is aware of the delay. It was an opportune time to ask, especially since Dr. Lorenz is becoming known for non-mesh repairs but was also one of the original authors of the mesh Guidelines. Maybe she could follow-up with him?

Choose HerniaSurge Collaboration from the side menu if the link below does not take you directly there.

https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11195/full#h7

“HerniaSurge Collaboration
F. Agresta, F. Berrevoet, I. Burgmans, D. C. Chen (AHS), A. de Beaux, B. East, N. Henriksen, F. Köckerling, M. Lopez-Cano, R. Lorenz, M. Miserez, A. Montgomery, S. Morales-Conde, C. Oppong, M. Pawlak, M. Podda, D. Sanders, A. Sartori, M.P. Simons (former EHS secretary for quality), C. Stabilini (EHS secretary for Science), H. M. Tran (Australasian Hernia Society), N. van Veenendaal, M. Verdauguer, R. Wiessner.”

https://herniatalk.com/forums/topic/herniasurge-what-happened-to-it-no-updates-no-contact-points/

Herniasurge – what happened to it? No updates, no contact points