Good intentions
Forum Replies Created
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Still nothing. Running out of time.
All there is are updated incisional closure guidelines. Or singular “guideline” as they label it.
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Hello Matt. Good to hear that you’re doing well after mesh removal. I looked up your last post on the forum and linked it below.
Can you tell who removed the mesh? People often query the forum looking for good options. Also, any details you could offer of your story, from implantation to explanation, would help others looking for solutions and things to avoid.
Good luck.
https://herniatalk.com/forums/topic/can-mesh-be-removed-from-laparoscopic-inguinal-hernia-repair/
Can mesh be removed from laparoscopic inguinal hernia repair?
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Here is a Google search of the site that might help. I pulled out the top two results.
https://www.google.com/search?q=site%3Aherniatalk.com+mesh+removal+canada
https://herniatalk.com/forums/topic/mesh-removal-in-bc-canada/
https://herniatalk.com/forums/topic/hernia-mesh-removal-surgeons-canada/
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I don’t know much about him. His education and publications suggest that he is at the forefront of hernia repair technology.
Today’s hernia repair centers are starting to include mesh removal as a normal part of their repertoire. They will put it in and they will take it out.
If you do get deeper in to consulting with a surgeon about your problems be aware that there will probably be a long path ahead before any surgeon will agree to remove the mesh, unless they have seen similar problems themselves and resolved them with removal. Your complete medical records from start to finish might be enough for a surgeon to make the decision though.
Unfortunately, today’s medical practitioners are pretty well siloed. Each doctor is very narrowly focused. For example, several forum members have had urological problems that resolved with mesh removal but hernia repair surgeons generally refuse to consider ufology and urologists claim ignorance about mesh complications. It can be very frustrating.
I wish that I could be more positive. But it is a lot of work to find solutions after a mesh-based hernia repair. You have to find the right surgeon.
Dr. Belyansky is another possibility. He is also at the forefront of technology, and speaks at the big conferences.
https://www.luminishealth.org/en/find-a-provider/igor-belyansky?language_content_entity=en
Dr. Jacob also.
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I don’t think that laparoscopic removal of mesh should damage a Shouldice repair. The laparoscopic procedures would be on the other side of the abdominal wall, the inside. The peritoneum would be pulled back and the mesh peeled off of the abdominal wall and critical vessels and nerves. The Shouldice repair should be untouched.
You really should try to get your medical records. There is a wide variety of laparoscopic repair methods. For example, one advantage of TAPP over TEP is that TEP avoids contact with the intestines, and also minimizes the chance of adhesions. If you had a TAPP repair it might help explain why you’re having problems. “Lap with mesh” really means very little.
Also, “robotic” is still laparoscopic. The instruments are just mechanized. But they move in the same spaces and do the same things. There is a powerful effort to promote robotic methods, around the world. It’s the latest new “tech”. But there is little evidence that robotics are better than a skilled surgeon using hand tools. You can find many publications on the subject.
Dr. Iacco did a residency at Beaumont but is now in Michigan.
https://michiganherniasurgery.com/about-us/our-team/anthony-iacco/
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Another surgeon with much experience in gut problems is Dr. Peter Billing of Transform Weight Loss. He has heard many stories and removes mesh. But he also uses (or at least used to use) mesh for laparoscopic hernia repair. So he has a certain type of objectivity. He will talk to you over the phone, somebody on the forum is scheduled for surgery with him this month.
It seems like, at the least, an open-minded surgeon would want to perform exploratory surgeon to look for physical problems and/or inflammation.
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Do you have your surgery records? It might help to know exactly what material was used and how.
Dr. Krpata at the Cleveland Clinic is leading an effort to understand chronic pain. While you might not define what you’re feeling as pain his center will still have the collected cases of many people with mesh problems.
Search “krpata” on the internet or use the link below (it is specific to krpata on herniatalk). I have also included a link to Google Scholar if you want to focus your research on professional research.
I mention often the cognitive bias that revolves around mesh. The investment in its use is enormous. Good luck.
https://www.google.com/search?q=site%3Aherniatalk.com+krpata
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The study is fairly small. I thought it was significant that they felt the need to call out the potential for outside influences, industrial companies, affecting the conclusions. It implies that they think some of what’s out there is influenced.
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Here is a web link. You have to click the dropdown arrows to see the full text.
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Here is an easier way to search the Herniatalk forum.
https://www.google.com/search?q=site%3Aherniatalk.com+umbilical&rlz
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Here are a couple of recent Topics. Not much has changed in hernia repair except the growth of robotics-assisted surgery.
https://herniatalk.com/forums/topic/pain-after-10-days-of-umbilical-hernia-laparoscopy/
https://herniatalk.com/forums/topic/umbilical-hernia-best-course-of-action/
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I don’t know that it’s true that a recurrence after a pure tissue repair is going to be bigger. As you read through posts on the forum you’ll find that many things are said about hernias that are actually not very likely. You might die, you might end up in the emergency room, etc. A recent poll of surgeons showed that most of them would wait if they had a hernia.
You said that your body does not like foreign materials. What do you mean by that? Have you had reactions to sutures or some other foreign material? That would be important to consider.
When you are talking to surgeons or reading what they have to say or watching their videos remember that they can understand recurrences. Because they can see them. They do not understnad chronic pain and discomfort because the cause is not clear. Much time is spent by the hernia repair community discussing whether or not the patient’s pain is primarily mental. In their head, and not actually physical. All surgeons learn this in medical school and during their residency and at many of the meetings that they attend. Even surgeons that run large pain clinics will wonder aloud why patients don’t want mesh after they have mesh removed for chronic pain. They are all taught that mesh does not cause pain.
Also be aware that if you have a pure tissue repair and it fails you can always get mesh. But if you have mesh problems it’s a whole new world.
There are several Topics on the forum about umbilical hernias. Try to find them and read all of them. Good luck.
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Laparoscopy surgeons can work on the whole of the inside of the abdominal wall. They are very familiar with umbilical and incisional hernias because those are the entry points for their laparoscopy tools.
I reread your post and it’s not clear that mesh removal is the solution. The explanation that “the diastasis has recurred above the bellybutton and the mesh that was placed was probably too big. Both suggested an abdominoplasty but said that removal of mesh is not an option” doesn’t really make sense. The mesh was too big but you had a recurrence?
If you’ve had a recurrence that is a big deal. I think that one issue you have is whether the discomfort is from the recurrence or from the mesh. Even though you found top surgeons in Belgium it really seems like you need to just find a better surgeon than those two. Good luck.
@drtowfigh probably knows somebody who can help.
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Here is a possibility in The Netherlands. G. D. Slooter. He authored a paper with others about mesh removal, very recently published.
https://www.mmc.nl/specialisten/slooter-dr-g-d/
The other authors would be good possibilities also. They are all at the Maxima Medical Center.
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I don’t want to minimize your concerns or the problems you’re having. But from a scientific perspective you are an outlier, and pretty far out, I think. This would be important for the surgeon to consider, before surgery and especially after surgery, if he/she is planning a second operation. Ideally, they would consult with a more experienced surgeon who has seen similar cases. Might be hard to find though.
It’s reasonable to assume that your body had completely adapted to living with the hernia. Growing up from a baby, through puberty, and in to adulthood. It follows, I think, that it will take quite a while to adapt to removal of the hernia. The inguinal canal and the internal ring are in a completely new environment. Tissue that used to be in contact with intestine is now in contact with tissue it’s never seen before. The spermatic cord is especially sensitive, as I understand things. My mesh implant surgeon joked about an “angry spermatic cord” when I presented with problems. It wasn’t funny, of course.
Just offering a more cautious view. The normal decisions for pain after a Shouldice repair might not apply to you. Most surgeons will start from what works for the bulk of Shouldice patients. But your case is unique.
“I had my hernia since birth, and it got worse over the years. The right time to fix it was when I was a baby.”
“Also, my hernia was not run-of-the-mill. It was a large indirect with a scrotal component.”
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Congratulations on being able to find enough information to make an informed decision. I’m sorry that your experience was not as smooth as the other patients you encountered. But, on the other hand, you are probably one of the best people to objectively describe the downsides of the Shouldice Hospital experience. From my own experience I suggest that take daily notes, like a diary, over the coming days, if you really want to retain how you felt and what you went through. The brain doesn’t recall stress-filled memories well when the stress is gone.
You said “recently” but can you give a time estimate? Maybe you don’t want to tie yourself to a specific date at the Hospital, which is understandable. But maybe you can fudge it to within a few days.
The comments about the variance from the standard procedure are interesting. Are you saying that individual Shouldice surgeons have leeway to modify the Shouldice procedure within the Shouldice Hospital?
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Here’s an example of the tendency to downplay or take the least offensive approach to describing mesh-caused groin pain. Dr. Krpata clearly showed the 15% chronic pain rate for patients who undergo inguinal hernia repair, in his video. But, on the front page of the Cleveland Clinic Pain Center page, of which Dr. Krpata is the Director, it says 10%. It makes you realize how hard it is to describe the reality. Choose the smallest number possible. But at least there are some professionals acknowledging the problem openly.
https://my.clevelandclinic.org/departments/digestive/depts/hernia/chronic-groin-pain#overview-tab
“Overview
The Cleveland Clinic Center for Chronic Groin Pain is a multidisciplinary clinic where patients are evaluated for pain following inguinal hernia surgery. Chronic groin pain is an unfortunate potential side effect of having an inguinal hernia repair than can impact up to 10% of patients. …” -
You’d expect that somebody, somewhere, maybe one of the law firm lawyers, will notice that the same people implanting mesh are also removing it. How can that be? It’s like having cigarette vending machines in a doctor’s office. Or Monsanto owning a cancer clinic.
On the positive side, the next step from popularizing mesh removal is mesh-caused-chronic-pain prevention. Eventually, also, somebody, hopefully one of these high volume mesh removal surgeons, will call out the fact that the mesh that they are removing has nothing inherently wrong with how it was placed or how the expected “incorporation” process occurred. The product was implanted properly, there was no infection, there was no folding, nerves and new vessels and tissue granulation was happening, but removing the mesh removed the patient’s pain. It doesn’t fit the story.
It has to happen. It won’t be the mesh producers that make it happen though, the business is too safe at this time. It should be the FDA or the professional societies leading the effort but that is unlikely also. There is a lot of money involved.
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Dr. Towfigh has mesh removal spelled out on the front page, and a link to click. But the description on the page when you click through seems outdated. Blaming the pain on folded mesh or mesh infection, when the collected data clearly shows, even in Dr. Krpata’s recent Cleveland Clinic video, that perfectly placed uninfected mesh can cause pain. Mesh reaction is the prevalent cause of pain, not very rare. The page needs updating, it is perpetuating a myth. Even the plug removals are not improperly folded mesh, the “meshoma” is a result of perfect plug placement. Just clearly express when mesh is bad. Softening the description helps nobody except the mesh producers. Some mesh is definitely just bad.
https://beverlyhillsherniacenter.com/
If you click “mesh removal” on the first page you end up on the mesh complications page.
https://beverlyhillsherniacenter.com/hernia-surgery/hernia-surgery-complications/
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Here is Dr. Repta’s web site. He has been mentioned in the past on the forum. I think that he used to be found by word-of-mouth or by exposure on web sites like this one but now he advertises. He is in the category of Dr. Brown and Dr. Kang though. He does removal and non-mesh repairs.
https://www.drrepta.com/body/hernia-repair/mesh-removal-after-hernia/