Good intentions
Forum Replies Created
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Generally they are classified by size, in centimeters.
Before there was mesh, all hernias were repaired without mesh. There is no certain size beyond which only mesh will suffice. Actually, if you have a laparoscopic procedure mesh is required for all sizes.
Watchful has posted in the past that Dr. Bendavid used to cut nerves when he performed a Shouldice repair. But, like mesh versus pure tissue, each surgeon will have their own opinion and preference. Also, be aware that many surgeons call what they do a Shouldice repair when it is actually a modified method.
Do you know what type of hernia that you have? A direct hernia might do better with a certain procedure than a femoral hernia.
I have seen Dr. Echo’s name before as a hernia repair surgeon. If he is open to answering questions you might ask him how many repairs he has performed and how the results have been. If he gets angry that’s a bad sign. If he doesn’t know, it could mean many things. You might also ask him if he really needs to cut the nerve if you don’t have pain now. Your description sounds like the size change is what bothers you. Why cut the nerve if there’s no pain? It might actually increase the risk of pain.
Sorry that you’re running the gauntlet of hernia repair in today’s world’s. So many choices and so little way to verify what’s best for an individual with specific symptoms. Who knows, maybe “AI” will eventually cut through the chaos.
Good luck.
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Are you taking pain medication of any type? Even aspirin or ibuprofen? I’ve found that both of those can cause constipation.
Any hernia repair method usually involves some sort of manipulation of the hernia sac. I assume that any breach of the peritoneum could expose intestine to adhesion sources. Adhesions can be painful, as I understand things. I have not heard of them as common from open hernia repair but it might be a possibility.
It might be that you have two or more problems happening at the same time. There might not be a single solution.
Here is a link to one of your previous posts where you describe the surgery by Dr. Conze. Good luck.
https://herniatalk.com/forums/topic/experience-with-muschaweck/#post-52742
herniatalk.com
Experience with Muschaweck - Hernia Discussion - Hernia Talk
Experience with Muschaweck - Hernia Discussion - Hernia Talk
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Hello @Wez27
It might help to get more fine details about the previous surgery. The range of possible materials and methods is very wide, and you might find that there are better options elsewhere. It’s been discussed on the forum that many surgeons don’t actually have a choice when it comes to the mesh that they use.
I can’t get a clear image of what you’re describing. You said that lap was used to repair an umbilical hernia, but that now you have a recurrence above the incision site. A recurrence would be the umbilical hernia returning. A hernia above the incision site would be a new hernia, an incisional hernia.
I would not assume that you have weak tissue and are prone to hernias. I don’t think that that is the primary reason for umbilical hernias, and incisional hernias are not uncommon.
The words “bigger mesh” imply that a piece of mesh already exists at the incision site. That would mean mesh at the umbilical site and at the incision site. It might be worthwhile to get a full picture of what exactly has been done in your past surgeries before moving forward. You don’t want to get on to the treadmill of mesh after mesh after mesh. Since you’re having unexpected results it is completely reasonable to get a second opinion. Your surgeon should not be offended and might even welcome it.
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You’ve been to the Shouldice Hospital for an examination?
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If you’ve had no pain and the surgeon thinks that they can repair the “recurrence” (added a comment near the end) a calculation of the odds seems to suggest going back to Dr. Conze.
Avoidance of recurrence is still the number one thing on the minds of surgeons that do hernia repair. Chronic pain and mesh complications are secondary, out of mind. It’s just the way things are. (still) Your case would lead the typical surgeon to recommend mesh even more strongly because of the recurrence, if it is a recurrence. But the odds of mesh problems are still there.
If you watch that video I posted and the others that show up on the side-bar you might be shocked at how they talk about “what they thought was working X years ago turned out to be incorrect”. There is sitll a lot of experimentation going on. SAGES just released a bunch of new videos and this is even more apparent.
You were satisified for 16 months. The new hernia is small and only uncomfortable. I’d go back to Dr. Conze.
I would also get more information on the new hernia. Is it really a “recurrence”, a failure of one of the repairs, or is it a new hernia in the same location? If it’s a new hernia then the two original surgeries might not really be failures. Dr. Conze can probably explain in detail what he thinks occurred. Might help you make your decision.
Of course, you’ll want to consider also if your activities put unexpected strain on the area. It’s not a simple mesh or no mesh decision.
And finally, remember that I am very biased, as somebody who had a terrible laparoscopic mesh implantation experience. All of the boxes were checked for an excellent result – surgeon, method, and material – yet the mesh was removed three years later.
Good luck.
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Could you give some details on the past tissue repair? One year is not long. I tried to look at your Timeline but when I click on what looks like a description I get taken to a completely different thread. The new forum is still terrible for learning what people have experienced in the past. I saw an extract that said double Shouldice but can’t figure out who did it. Have you talked to the surgeon that did the first repair?
The type of hernia and type of recurrence are important. One of the big problems today is that all mesh types are called “mesh” and all laparoscopy methods are called “minimally invasive”. And Shouldice is used to describe anything that is “Shouldice-like”. Even the professionals that try to do studies on past results can’t really tell what is what.
If you do decide to get a mesh implant (that might be what really terrifies Oceanic Dr. Towfigh) be aware that the latest fad is the absorbable synthetic mesh. “Short-term results look good!, let’s go with it”.
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I would focus more on reducing body fat and making sure that your body chemistry is right. Adrenal insufficiency is a serious conditon, that you can’t exercise your way out of.
And, heavy lifting, with increased abdominal pressure can make the hernia worse, stretching already weakened tissue. So, trying to work out extra hard to get strong in a short amount of time could be counter-productive in the long run. Good luck.
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Dr. Towfigh can be contacted directly at the Beverly Hills Hernia Center. I don’t think that she does any evaluations through the HerniaTalk forum.
https://beverlyhillsherniacenter.com/
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It’s been quite a while since I added anything to this thread or others. I’ve found that my plan to avoid pressure on the area of the mesh remnant so that it could heal and shrink as scar tissue is known to do, is working very well. I stopped wearing the suspenders a few weeks ago and am back to wearing a belt. I am also working out more vigorously and have started running again, trying to get some speed and endurance back (I had a goal of running a 5K in under 18 minutes. I don’t think it’s going to happen but at least I can train without pain).
The main message is that it takes the body a long time to adjust to the damage that mesh and mesh removal causes. If you’re in a situation like I’ve described in past posts try some new things. Track what works and what doesn’t. And give your body the chance to fix itself. I still have it in the back of my mind that the last piece of mesh might need to come out. But, progress is sitll being made without it so I’m just going to keep going.
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Why would you take a second opinion from the internet over an in-person opinion from a world renowned expert in hernia repair who has worked on world famous athletes?
“She proposed me to have a bilateral groin revision. I would like to have this confirmed by a second opinion before moving to a revision surgery.”
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Thanks for posting, with the updated details about changes at the Hospital. I have Dr. Kang as my next option if I have problems with the remaining piece of mesh inside me or any type of hernia recurrence. Good luck. Healing takes time, even with the best repair methods. Don’t rush it.
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There is a surgeon who has posted on the forum, who is now averaging over $400,000 per year, over the last three years, “consulting” for a device maker. It’s incredible. And the device results are unproven in the long-term. The device makers are running the hernia repair show.
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I’m sure that there are parallels with mesh implantation in general.
“Earlier this year, Dr. Blatnik fixed a bad component separation surgery where the original surgeon had cut into the wrong muscle plane. The patient’s intestines were bulging out of her sides, another Mickey Mouse hernia.
Dr. Blatnik said he immediately recognized the name of the surgeon who had operated on the patient because that he had seen that surgeon teach component separation at a course sponsored by a device company. The surgeon has received more than $130,000 in payments over the past decade from companies including Intuitive and Bard, which manufacturers hernia mesh, The Times found. “
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Apparently there has been a settlement of some kind in the Bard mesh case.
It is interesting that, unlike most class action defective product lawsuits, these products are still on the market and in use. I think that the suit is the Perfix plug lawsuit.
BD is still “fighting” it. The settlement summary report shows though, how they have just rolled the damages payouts in to their financial balance sheets. Just part of doing business. They can now calculate the percentage of future patients who might sue and use the estimated payout number to set the price of the products. It’s not a healthcare company, it’s a medical device company. They are not the same thing.
Also funny how the term “vast majority” appears in the text. Like surgeons discussing mesh results with their patients – “the vast majority do not have problems.”.
https://news.bd.com/2024-10-02-BD-Reaches-Agreement-to-Resolve-Vast-Majority-of-Hernia-Litigation
news.bd.com
BD Reaches Agreement to Resolve Vast Majority of Hernia Litigation
No admission of liability or wrongdoing; settlement structured to eliminate uncertainty for all stakeholders related to settled cases. Settlement amount within current product litigation reserve...
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I am only suggesting that you take extra time and care before deciding to go ahead with another surgery, with the same surgeons. Your gall bladder removal should have been a simple laparoscopic procedure. From what you wrote it seems that it is the cause of your problems today. Maybe the surgeons are not as skilled as others might be. It is well-established that surgeons need a large number of “practice” laparoscopic surgeries before they become proficient. Maybe you are one of those “training” cases. It is a subject that is not well-discussed. Was your gall bladder removal done via open or laparoscopic methods? You didn’t actually say. It can be done both ways.
Your surgeons might be considering extreme measures to avoid the shame of another failed surgery. In other words, they might be suggesting something that is more for their benefit (avoiding a recurrence) than yours. One obvious question is “why do they suggest open surgery when normal laparoscopic procedures should work?” I had two TAPP procedures to remove mesh within 5 weeks, and have had no problems in the seven years since. An open abdominal surgery actually increases the risk of incisional hernia. Reducing that risk is one of the real benefits of laparoscopy. What they are suggesting increases your risk of future hernia. I linked to a recent paper about it below. A 15-20 percent chance of incisional hernia after laparotomy (open surgery).
In short, they have failed once so seeking the advice of other experts makes sense. They will certainly keep trying to help you but they might not have the ability.
As I went through my own hernia and mesh problems I was surprised at how many different opinions there were about the best path forward. People at high levels in their own organizations were more concerned with their own welfare than mine. It’s just human nature.
Be careful. It’s very tempting to just give in and trust the surgeons. But there are good ones and bad ones. You have to find the good ones and avoid the bad ones
“Despite advancements in techniques for abdominal wall closure the incisional hernia rate following laparotomy is as high 15% to 20%.”
https://www.ncbi.nlm.nih.gov/books/NBK435995/
https://my.clevelandclinic.org/health/procedures/21614-gallbladder-removal
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Actually, from a different perspective – Dr. Conze is considered an expert in hernia repair. Why did he not recommend a mesh repair after the “failed” modified (what was the modification?) Shouldice repair? Is he one surgeon among thousands with this opinion?
It might be that he is aware of a specific weakness of his method and knows how to fix it.
And, to add complexity, we’re still referring to all mesh types and procedures as “mesh”. Recurrences should be repaired with “mesh”. Which one, which method, after a pure tissue recurrence? PHS, TREPP, Onflex, Progrip, Insightra, plain old Bard “gold standard” mesh … pick one.
Sorry Oceanic, this probably doesn’t make your decision easier. But there might be some clues that will help.
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When did you ask? And did you ask specifically about repairs after Shouldice procedure recurrences? I have a faint feeling of competition in the discussion. I have not proposed a conspiracy, or collusion, regarding corporate influence promoting mesh. Just a focus on a profitable business venture and the efforts to keep the revenue flowing. It might look like a conspiracy in my descriptions but it’s really just large corporations with a common interest. And the corporate money controls the discussion and research.
I had a thought about these multilayer repairs and recurrence. Each interface between layers offers a place to form a pocket in to which abdominal contents could be projected. This could form an uncomfortable bump, but due to the layered structure the contents are stopped before they get in to the inguinal canal. It’s been my impression that any deviation from a solid repair that results in discomfort is often called a “recurrence”. But is it really? Or is it some new phenomenon that is actually “safer” than a recurrence but still uncomfortable. Remember that the common scary fact used to influence hernia patients is incarceration and possible death or emergency room visits. Is a “recurrence” after Shouldice as likely to incarcerate?
Besides that, if it’s not a true recurrence then maybe a reoperation without mesh is a rational choice. Much of what you see in the hernia repair field is an attempt to make things black and white – hernias all need surgery, mesh is the best repair for the majority of hernias, any recurrence should be repaired with mesh, etc. The world just does not work that way. It’s worth exploring the in-between situations.
Anyway, even though Oceanic is in the U.K. I would guess that Dr. Krpata would converse with him as he did for you, Watchful. It is definitely difficult to put all of this extra effort in to fixing what was supposed to be fixed by the surgeon but sometimes you’ll get lucky and find somebody with answers. As I did when I was able to reach Dr. Billing after several attempts.
There’s nothing to lose by trying. Otherwise you’re just another patient on the conveyor belt.
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My point about Dr. Krpata was that he runs a pain clinic focused on hernia pain. He has probably seen and considered all of the typical problems from hernia repair. He is not avoiding the issues and might have insights that a typical surgeon would not. He could probably answer the question about performing pure tissue surgery again.
And, before mesh repairs were promoted as the be-all end-all repair I am pretty sure that pure tissue repair after a pure tissue repair was the common method for a recurrence. Because mesh did not exist. Somewhere out there is a surgeon who can imagine, or who has studied, what they did before mesh took over the hernia repair field. I doubt that there is any reliable data about the efficacy of mesh or pure tissue repairs after a recurrence from a pure tissue repair. But there might be old data, pre-mesh, probably in better researched studies than today’s, about the best method of repair after a pure tissue recurrence.
For what it’s worth, I still get occasional pain from the remaining piece of mesh in my groin. And there is still a bump there, which is, I think, the ball of mesh, nerves, vessels, and stuff left behind. But, so far, it has always resolved after a day or two. If your bump is not getting bigger I would wait, as Watchful suggests. If you start getting other signs of canal intrusion like testicular torsion then reconsider.
Good luck.
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I don’t think that there are hard and fast “rules” to go by.
You’re in a tough situation. The odds have not changed. Dr. Towfigh has described one risk, nerve damage,. The mesh risk has been well described also, even by the professionals like the Editor of Hernia.
You’re basic dilemma is comparing what Dr. Towfigh said, below, to mesh risks. And I think that Dr. Towfigh’s comment is focused on recurrence, not mesh-caused chronic pain.
Dr. Towfigh : “Going back in open, after prior open repair, is asking for trouble. There are nerves that risk being injured as they are already involved in scar tissue.”
Another question you might ask is – will this surgeon be around to help if I have mesh problems? That is the other aspect that doesn’t get attention. If you do decide to go for lap mesh ask them directly. If they avoid the issue, move on to the next surgeon. I hate to be the bad news guy but Pain Clinics and Mesh Removal are real businesses that have grown dramatically in the last few years. You might try contacting Dr. Krpata to see if he has an opinion.
Again, I hate to keep posting these kinds of videos, below. But this one is from a very well-known clinic, The Cleveland Clinic. It involves Dr. Krpata. If I had to choose lap mesh I’d probably try to have Dr. Krpata do it. He’s seen real cases and deals with them. He should have insights on how to aovid problems. Or he might just agree that it’s a gamble and nobody knows how to avoid problems. But he should be there for you until resolution of any problems is achieved.
She was fine for seven months after implantation, then wasn’t. 2019 was not that long ago.
my.clevelandclinic.org
Woman Relieved from Chronic Groin Pain After Hernia Mesh is Removed
Discover how Jody Lynn, finally got relief from a complication related to her hernia surgery after traveling to Cleveland Clinic and meeting with Dr. David Krpata.
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What type of repair was performed, and who did it? I assume that you meant Cottbus, not Cottbud.
12 days is not long. Good luck.