Good intentions
Forum Replies Created
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I had also suggested that in the past. A brand new member sounded a lot like an older member, the same tone and the insinuations, but better grammar and spelling. I think that I might call them clones or doppelgangers.
What can you do? I stopped replying to both of them.
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I see. There was one of those new accounts with a new Topic on the forum for a short while this morning. Looks like it’s been removed. Obviously not related to the forum’s goals.
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Bumping this thread from the past. More food for thought on considering what you want from your hernia repair. If you live a fairly sedentary life you might be fine with a mesh implant. If you are very active, you might have problems. I think that the vast majority of surgeons don’t even ask about their patients’ activities. Mine knew that I played soccer and he even had a former patient who was a semi-pro soccer player, as I recall, who had problems with his mesh implant and eventually went to another surgeon for help (like I did). I learned this after I had my own problems. He told me himself. He put the mesh in me anyway.
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What is a sock puppet? Is that an internet slang word? Haven’t seen it before.
I’ve found that it is pointless to try to correct people’s behavior on internet forums. I just stop reading posts from certain people.
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Sensei, just posting here to add to your recent post on Chuck’s other thread. Post #35483, for anyone wondering. Another option for mesh removal in Florida.
https://herniatalk.com/forums/topic/dr-twofigh-chronic-pain/#post-35483
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It looks like Dr. Sheen used the “sportsman’s hernia” diagnosis as the premise to do surgery. His observations once he got in and could see and poke around were some combination of direct and indirect hernias. In a TEP procedure a large piece of mesh is used to cover both areas.
In sum, he felt confident that surgery would help, and it did. But there was a recurrence. Recurrences are known for laparoscopic mesh implantation, even with large pieces of mesh. 15 x 12 cm = about 6 x 4 3/4 inches.
The large pieces of mesh that have been encapsulated by your body are part of the new decision. Mesh removal could cause new problems. Overall, an open mesh or open pure tissue repair seem to make the most sense. Leave the 5 year old mesh in place if it has not been bothering. Fix the recurrence by another method. The 5 year old mesh is probably tied up with other critical nerves and vessels. It’s how “incorporation” works.
Don’t fret over what has already happened. You’re in a new situation. Listen carefully to the surgeons, take a list of questions with you and don’t commit to anything unless you really understand what is being proposed. You’ve already had one failure by a top well-known expert in the field using the most publicized repair method. Dr. Sheen is one of the HerniaTalk surgeons, listed at the top of the page. Good luck.
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That is unfortunate that his “Main findings:” don’t match his “Inspection:”. Some surgeons cut and paste their reports using parts from past reports.
The thing about mesh implantations though, is that it doesn’t really matter. The mesh will cover the same area, for either direct or indirect hernias. Since you had good results from the first mesh implantation a new surgeon will probably just do the same thing over again.
For what it’s worth, Parietex mesh is a brand name for a series of polyester (PET) meshes. I would guess that he used the Parietex lightweight monofilament flat mesh, since he did use fixation with the Tisseel fibrin glue. The monofilament Parietex is the polyester analog of the common polypropylene flat meshes, which are very commonly used for TEP procedures.
https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html
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Here is a search page about treatment of athletic pubalgia, with fairly recent results. Opinions have changed over the years.
https://scholar.google.com/scholar?hl=en&scisbd=1&as_sdt=0%2C48&q=treatment+pubalgia&btnG=
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I don’t know if this will help you or not but Dr. Sheen seems to run counter to prevailing opinion on treatment of athletic pubalgia. Many surgeons say that they do not use or recommend mesh for its treatment. But there also seems to be some discussion about how to define the problem.
You are in an odd spot, since Dr. Sheen is a firm proponent of mesh. He publishes often about mesh implantations. You might consider getting away from the mesh repair experts and see what an open repair surgeon thinks.
Here is a fairly recent paper by Sheen et al trying to show the efficacy of the TEP mesh procedure compared to open repair.
https://academic.oup.com/bjs/article/106/7/837/6092871
Here is another paper describing an open repair method on young athletes. It has some good diagnostic methods based on where the pain is that might help you understand your condition.
https://kosovajournalofsurgery.net/wp-content/uploads/2023/03/D-Litwin-2-KJS7_merged.pdf
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Did the pain return suddenly after a specific action? Or more slowly, like days/weeks/months? Have you been very active over the five years or more sedentary?
Sportsman’s hernias (athletic pubalgia) pain usually happens during activity, not so much afterward. While running or sprinting, for example.
If the pain is the same as before it seems reasonable to suspect that the same nerves are being affected. Not sure how a surgeon would address that since mesh has already been implanted. Mesh is known to shrink over time, so one possibility is that the mesh moved far enough that the previous weakness has been exposed. It is also known to fold and bunch up as it shrinks.
I am not an expert or a surgeon or a doctor but a TAPP procedure to view the abdominal wall from behind, followed by adjustment and/or placement of new mesh seems possible. I can imagine a surgeon recommending that as a possibility.
Just some ideas. Good that you got five pain-free years though. Hopefully the next will last longer. Good luck.
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Here is an interesting description of all of the mechanisms that occur when abdominal pressure is increased and the muscles are activated. There are more than I had realized. I would imagine that the disrupted tissues from any type of repair need to be worked in order for new collagen to form/align correctly and to resist the natural tightening of the scar tissue. It seems like a balance between too much and too little, in order to get the complete and correct healing process.
https://worldsurgeryforum.net/2017/07/surgical-anatomy-of-inguinal-canal.html
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I have had a recent experience that might give you guys some ideas. I recently had some persistent discomfort around the area of the original hernia and scrap of mesh that remains after mesh removal. This was after several days of long walks and hikes and some somewhat strenuous physical work. It seemed like a nerve problem since there was some referred pain that seemed to originate from the mesh scrap area.
I decided to try doing more and heavier weight lifting and more pushups on the thought that the pain was from a small irritated spot on the nerves in the area and that stressing/straining/stretching the abdominal wall might pull the damaged spot to a new smoother area where it could heal. It seems to have worked.
So, maybe try some things that are counterintuitive.
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I don’t think that your doctors will take requests for the diagnostic methods that they should use. In other words, they will tell you what they think has happened but will not take the advice of a non-professional. It wouldn’t make sense to let the patient decide the diagnostic methods.
The best that you can do is to learn as much as you can about your hernia and the first repair attempt so that you can assess whether or not what the doctors are suggesting fits with what you know. At least find out what type of mesh was used. Ask them how a new hernia could appear if the mesh was supposed to cover all potential hernia sites.
Unfortunately, when problems occur after what is supposed to be a simple procedure there is a tendency to try to avoid the reality of a failed procedure and suggest that something new has happened. For example, in this case it would not be a surprise if the group that did the first repair calls what happened a “new” hernia, while a different surgeon, a second opinion, calls it a failed repair.
If it was me, I would go to the appointment with the group that did the repair, listen to what they have to say, then decide whether or not to get a second opinion. It won’t be surprising if they try to get you to commit to a second surgery to fix whatever has happened without doing any imaging at all.
Sorry to be so cynical.
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I would get the notes from the surgery to see what was found and how it was addressed. Tell them you want them for your records. You should be able to get them directly from the front office, either by phone or by filling out a form online.
To summarize what you wrote – you had a mesh implantation in March, felt better, but in May you had problems and had an ultrasound, which identified a hernia. It’s only been 3-4 months since the implantation. A recurrence after the repair of a “small” hernia seems odd.
Take time before making a decision to undergo more surgery. Make sure you have the right people to get it right. Every surgery is very traumatic to the body. Get a second opinion from a different group if you feel like something is not being disclosed.
Also, beware of working with people within the same group. In other words, make sure that you understand what happened and what they plan to do to make it right before you commit to more surgery. Many of these “groups” are actually partnerships, where each member has a vested interest to protect everyone else in the group. You could end up on an assembly line of people promising to try to help. Be careful. Good luck.
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Chuck, it would probably help your decision-making if you categorized and ranked the types of repair and the surgeons separately. Rank the methods, rank the surgeons, look for overlap.
So far it looks like you’re leaning toward a Lichtenstein repair. Dr. Chen seems to be the most rigorous in his thought process about how to do one. He also is learning about the many other various techniques and does mesh removal. Overall, he seems like the best person to consult with, to start. Since you have time, no urgency, you can schedule an appointment as far out as Dr. Chen’s calendar requires. Since he removes mesh he has probably seen cases of mesh sensitivity. He might know whether or not what you experienced was from the mesh or from some other factor. He probably has seen or heard of cases like yours or can have staff research it for him.
Even so, Dr. Chen is a believer in the mesh Guidelines even though he must know that they are suspect. So that’s a dilemma. He is toeing the party line. But, maybe, he has the mental capacity to realize that mesh can be wrong for some people.
In the end, even the experts are just normal people, susceptible to major marketing campaigns, like you are. Just like your anti-vax stance, most hernia repair surgeons are pro-mesh. They’ve been trained to believe in it and the message is reinforced throughout the educational and post-education fields, and the professional news media that they learn from. Similar to your opinions many have taken the absolute approach – mesh is always good. As you think that vaccines are always bad. Peas from different pods. Realizing that might help you communicate with the various hernia repair surgeons.
Dr. Chen’s web page looks pretty impressive. If I was starting over I might have tried to consult with him first.
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I can’t make a recommendation for you Chuck. It’s not clear that you actually have a problem. Your original problem was prostatitis. You have not confirmed that the prostatitis is gone now. You haven’t reported problems since the mesh was removed, just a fear of recurrence.
At the moment, my main issue seems to be irritation from the remaining piece of mesh. It is what limits the duration of any activities. So, my future planning is focused on that, if it gets worse or if I decide to take another chance on improving my situation. It is tolerable now but I feel limited. Dr. Kang does remove mesh but I don’t know that there aren’t state-side surgeons who could do the same, since mesh removal is now becoming big business. I have even considered contacting Dr. Billing again to see what he thinks since he knows what was left behind.
If you’re considering a Lichtenstein repair then Dr. Chen seems like the best option if you can get in there, or ask him for a referral to a surgeon he trusts. But, if you look around you will find that Dr. Chen seems to be leaning toward laparoscopic mesh repair. The marketing is very powerful. He might recommend another mesh repair or he might recognize that you have a sensitivity to mesh and should not get another mesh repair. You haven’t provided enough follow-up about your mesh removal to even guess at what might be best for you. If mesh caused your prostatitis then I would certainly avoid all mesh repairs.
You need to understand where your original problems came from and avoid doing that again. Good luck.
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What type of hernia?
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The 0.5 % is his “complication rate”. Not chronic pain. He doesn’t talk about his own chronic pain rate. He does mention that the overall rate is “realistically” above 5%. Which is certainly a disingenuous statement, especially for a person in his position. He must know that the vast majority of studies show a rate of ~15%. They just can’t help defending what they do. It’s human nature.
He still seems like a good person, but he is also still captured by the industry talking points. He tries to downplay the real numbers and can only get from 15% to 5%. Which is actually good, he uses real numbers, just not the right ones.
He must realize that his statement about the benefits of lap are muddled. Lower than 5%? Or lower than 15%? Disingenuous.
” Chronic pain rates, realistically, are over 5%, affecting patients’ quality of life. Minimally invasive laparoscopic and robotic techniques have matured to provide excellent outcomes with benefits of early recovery and lower rates of chronic pain.”
Why is he talking about “our personal risk”?
” In inguinal hernia repair, our goal as surgeons is to lower our personal risk for complication to less than 0.5%, but that number can and will never be zero. Whatever can happen in surgery, will happen.”
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“. While I am still below my aspirational 0.5% complication rate for inguinal hernia repairs”
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Thanks for the reply Pinto. The description of immediate pain after the first surgery was a distraction, it was not clear to me that you had apparently healed and been okay for two full years after the initial pain of the first repair. My new understanding is that the pain resolved and you were fine for two years. Then you had another hernia.
I have noticed that some surgeons will refer to a new hernia after a previous hernia as a “recurrence”. But, literally, recurrence means the same thing happened again. Was your second hernia the same, original, sliding hernia reappearing? Or a new type of hernia. This is an important distinction.
“Recurrence” implies a failure of the original repair. The appearance of a a different type of hernia could be a side effect of the original repair, from abnormal distribution of tension, or just a naturally occuring follow-through of weakening tissue.
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sensei I was wondering about your second surgery. It’s good to hear that other surgeons are getting involved in the mesh removal business but, of course, also bad to hear.
Are you saying that everything was good after the first left removal until the second right removal? It reads like you’re saying that the left side felt good until the right side was removed.
Not trying to defend Dr. Billing just trying to understand overall. Dr. Parra-Davila is a new name in mesh removal. Good luck going forward. My views on hernia repair keep evolving. The latest is that TREPP makes a lot of sense.
Good luck and stay in touch.