Good intentions
Forum Replies Created
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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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Sorry Pinto but I can’t understand what you’re saying in your account in the other thread. The writing style is strange, from first person to third person and there are details missing. It seems to say that you had intense pain immediately after the first surgery and lived with it for two years. My memory was that you had the pain but it was addressed soon afterward. Maybe it did take two years, I was uninvolved with the forum for a while as I was dealing with my own issues.
If you could just write a simple description, from the realization that you had a hernia all the way through the diagnosis and imaging and first and second repairs it would help people understand. You seem to be saying that prior imaging showed a sliding hernia and that Dr. Kang would have known this. Is this the case? It implies that Dr. Kang’s initial thought about how to repair a sliding hernia were not good enough or that he missed the sliding hernia. Did he say which it was?
Here is your account of “a” surgery. Doesn’t identify it as from Dr. Kang but I assume it was. Not clear.
“Overall, I had a painless surgery and quite pleased with my hospital experience. However there were two difficult post-op aspects in the first four days: immense pain getting out of bed and immense pain walking. After one-day hospital stay, I was discharged but only after requesting crutches. Bumps during my taxi ride back to my hotel were pure agony.”
Then you describe a second surgery two years later. By the writing, you had an attempted repair at the Gibbeum Hospital, had immediate pain and lived with it for two years, then went back to Gibbeum Hospital and had another repair. You’re implying that your “recurrence” happened immediately, probably from just getting out of bed. That’s what the words say.
“Given that Pinto followed the surgeons guide for a safe post-op, he believes if he was able to stay in the hospital in a motorized bed for at least three days, recurrence might not have occurred. It might have even proved the surgery was done flawlessly. He subsequently had a successful operation by the same surgeon two years later without any trouble—- without need for crutches or motorized bed.”
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Good luck Oceanic. Could you describe the experience in broader terms? Where you stayed, the facilities, languages spoken, type of anesthetic used, any notes from the operation?
Also, when you say you could barely walk, what type of pain were you experiencing? Not much is known about Dr. Conze’s work, on the forum.
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Actually, the point is that the expensive meshes are really no different than cheap mosquito netting. Your statement should really have any “petroleum-based mesh currently on the market” in place of “mosquito netting”. Except that the one you recommended is probably petroleum-based after the absorbable component disappear. It’s the same as mosquito netting.
Synthetic meshes are well-known for stiffening and shrinking very soon after implantation. The “replication” of abdominal wall movement disappears and the mesh becomes something completely different than when it was implanted. All hernia repair surgeons know this.
Most of the marketing that you read for any medical device is designed to make the sale. I hate to use the word “lie”, disingenuous is probably the best word for it.
“50% volume dissolvable and have multidirectional tensile stretch to replicate the way the abdomen moves”
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I thought that pinto’s case was one of a missed sliding hernia. Not a recurrence. People keep calling it a recurrence like it happened months or years later. It happened within hours or days, as I recall. As I understand things sliding hernias are unusual and often missed. It’s one of the reasons that Shouldice dissects the cremaster muscle. So they don’t miss anything.
https://herniatalk.com/forums/topic/pintos-2nd-surgery-with-dr-kang/
Pinto makes a good comment about being a lifer once you have a hernia. Besides the fear of future hernias, it really opens a person’s eye to how messed up the medical field is and how machine-like it is in treating patients. It’s actually very industrial and getting more so, with robotics and ambulatory surgery centers. The surgeon can walk in and perform the surgery without actually seeing the body of the patient on the table. It can all be done by video screen and control panel.
On various posters on the forum – there is a lot of “recency” effect happening here. Taking something they read on another web site, or heard from some guy down the street, within the last few months as indicative of the probability of success in the future. And very poor understanding of numbers overall, or willful misstatement. All of the decisions we make in life have a possibility/probability of being wrong or going wrong. If a surgeon has done 1,000 hernia repairs and had 20 pain or recurrence cases, that would be worse than a surgeon with 5,000 repairs and 20 pain or recurrence cases. A rational person would choose the 20/5000 surgeon over the 20/1000 surgeon. People are comparing only the 20 cases that they heard or read about, within the last few months, as indicative of the probability of a successful repair, without considering the successful repairs from the same surgeon. Numbers don’t work that way.
In the end it’s an educated gamble. Watchful went about his research in the right way. But he ended up as one of the 20. That doesn’t mean his decision-making process was wrong. It means he had poor information to work with or he just ended up as one of the unlucky ones. Not much different than getting killed by a drunk driver, or bitten by a shark, or struck by lightning. Don’t drive after midnight, don’t swim in shark-infested waters, don’t go outside in a thunderstorm. It can still happen though. Nothing is certain.
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An older article about mosquito netting. What’s really interesting is that they don’t raise the larger more obvious question of why cheap mosquito netting shouldn’t be used everywhere. There seems to be no reason to pay the extra money for the products of the big medical device makers.
https://onlinelibrary.wiley.com/doi/abs/10.1111/ans.17174
REVIEW ARTICLE
Inguinal hernia repair: a global perspective
James O’Brien MBBS, BMedSci, Sankar Sinha MS, MEd, FRACS, FACS, Richard Turner MBBS, BMedSc, PhD, FRACS
First published: 22 September 2021 https://doi.org/10.1111/ans.17174“… Conclusion
We postulate that the most cost-beneficial method of hernia repair for implementation in LMICs is using open-mesh procedures with sterilised mosquito net under local anaesthetic. Further cost–benefit research is required in this area. “ -
Here is what I had originally tried to post. I pulled out the two links above so it should work this time.
Here is an article that demonstrates how chaotic the mesh business really is. All of the big manufacturers have promotional material describing the advantages of their products. But, at the end of the day, it’s really simple fish net or mosquito netting material. Might even be made at the same factories.
Pretty crazy. It’s just a letter to the Editor of the BJS. Links below. The time frame is 15 months.
Link in post above –
Fully extraperitoneal laparoscopic inguinal hernia repair using conventional mesh versus tailor-made mosquito mesh: a randomized controlled trial from Cameroon
B. Essola, J. Himpens, A. Limgba, J. Landenne, D. D. Tamchom, E. Ngaroua, P. Lingier, E. T. Mboudou, J. Souopgui, M. P. Hermans … Show more
British Journal of Surgery, Volume 108, Issue 9, September 2021, Pages e294–e295, https://doi.org/10.1093/bjs/znab188“… In this prospective study, the authors found no difference between the groups in short-term complications and medium-term outcomes. The perioperative financial benefit of mosquito mesh is clear, as are the economic value and clinical non-inferiority, with low-cost mosquito mesh 1/1000 the price of commercial meshes …”
Here’s the about page for BJS.
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Here is a link to Medtronic’s Progrip pages. They just introduced a polypropylene Progrip to complement the polyester.
https://www.medtronic.com/covidien/en-us/search.html#q=progrip
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Six months, 1/2 year, past the committed-to deadline and still not a word about the update or the delay. Five years since the original commitment of update every two years.
It’s really looking like there’s either conflict behind the scenes or that they are just going to pretend that the commitment was never made. It must be disappointing, and embarrassing, to be a part of the whole fiasco.
The law firms certainly must be aware of the Guidelines, and should be aware of these statements about updating them to keep them current. If I was a law firm I would dig in to what is happening with this group, which now seems to be called the Herniasurge Collaboration. The whole foundation of the Guidelines was built on it being supported by a professional organization, with a contact point, and known members, with regular updates to the Guidelines. All of that has changed, in strange ways, with regular names changes and dead web sites and Facebook pages, and the commitments have not been kept.
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Another update from the Lawsuit Information Center web site. The number is huge and it’s just a single person. And the foundation of the case was built on the material used, so it could be used for suits involving all devices made using that material.
It’s not polypropylene and it’s not an inguinal hernia repair device but still interesting that juries believe that the damage is real and that Bard bears responsibility.
I pulled a few of the past reports together. PET is polyethylene terephthalate, called “polyester” in a typical knitted hernia repair mesh. Polypropylene and polyester are the two main materials used in the meshes.
“May 25, 2023 Update
The Rhode Island judge in Trevino took $250,000 off the verdict but left $4.55 million intact in post-trial motions. It is hard to understand the logic behind reducing the jury’s award by even a penny after all that plaintiff has been through based on the evidence offered at trial. But in the big picture of things, the judge’s ruling is a win because leaves the lion’s share of the award intact and affirmed the key rulings that Bard had opposed.…
August 29, 2022 Update
We have a verdict from Rhode Island: $4.8 million. Paul Trevino’s lawsuit alleged that C.R. Bard’s Ventralex hernia patch eroded into his bowel because they chose the materials they used based on price instead of safety. The jury agreed, finding both that the design was defective and that Bard to failed to warn of the risk. I’ve been saying all along I have no idea why Bard let this case go to trial. But the settlement value of Bard hernia mesh cases just went up.
August 26, 2022 Update
We could have a Rhode Island state court verdict today in a Bard Ventralex patch case, Trevino v. Bard …. stay tuned.In Trevino, the plaintiff claims that the defendants knew or should have known that the PET ring, a component of the Ventralex Mesh, was prone to breaking or buckling, thereby increasing the risk of severe, permanent injuries. Despite these risks, the defendants intended for their product to be implanted for the purposes and in the manner that the plaintiff and her implanting physician used it.”
Here is the link.
https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html
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Watchful was probably referring to the words below. The notes imply that it was problematic/unexpected, and had occurred recently, but “nonetheless” they got things done.
“bulky intact transversalis muscle that had just separated from the inguinal ligament. Nonetheless, we were able to get good reapproximation of the floor and reinforcement with mesh.”
It looks like you had a normal Lichtenstein repair. You can find quite a bit about it on the internet, and Youtube.
On the pain at night, of course, there are normal bodily functions that happen at night for men. It might be related to that. You say that you have to take ibuprofen but I wonder what would happen if you just walked around for a bit. It seems odd that a pain would appear for no reason and remain.
Anyway,as Watchful said, it’s early. Tissues got stretched out of shape when you had the hernia and then got stretched back to where they were supposed to be when you had the repair. You might try adding some things to your walking routine. Weights or stretching. See what happens. Good luck.
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Some of the open mesh repairs extend all the way down to the pubic bone. That could cause pain/sensations much lower than the external incision point. There is a variety of methods and materials described as “open mesh”. That’s why I asked for details. Good luck.
One example –
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What type of activities have you been doing during the day? I have found that sometimes more activity is better than less for pain after surgery. It’s counterintuitive.
Can you share the details of the repair method? Lichtenstein, plug and patch, PHS? And the type of hernia that was repaired.