Good intentions
Forum Replies Created
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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/
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Dr. Mark Reiner advertises both “minimally invasive” repair (which means mesh implantation) and mesh removal. You have to click through to find the mesh removal page.
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Just a followup – don’t expect immediate results and don’t expect to get back to where you were before the hernia(s) and mesh implantation. Much depends on how bad things were for you with the mesh. Some people suffer real physical effects, others minor pain, others just can’t stand the feeling of the mesh inside them. You haven’t really described any problems so its hard to tell how you’ll do. Although if you’ve read through the posts on the forum there should be plenty to compare against.
Good luck.
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I replied to your message. One thing to be aware of is that mesh removal takes much longer than mesh implantation. So if you have somebody waiting for you make sure that they know that. It’s not the 45 minute in-and-out that implantation is.
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I don’t know enough to say. I am not a medical expert and I don’t know anything about you except that you had two pieces of Bard 3D Max implanted for hernia repair. Nothing about your physical condition or how long you’ve had the mesh or what type your original hernias were.
I knew my own information and had the opportunity to decide “on-the-fly”. I drove 200 hundred miles two days after both explantations but I could have waited. Flying has its own issues though, with the pressure differentials. I don’t know anything about flying after abdominal surgery.
I would ask Dr. B. He has performed many surgeries of many different types. I am sure that he has had people flying soon after a procedure, whether they should or not. He would have the best advice.
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Try the site’s message function if you want a private conversation. I share as little information as possible over the internet. I don’t know that I’ll have much to offer. I’ve had four surgeries under general anesthesia and they were all the same. Remove clothes, put on gown, go to sleep, wake up with no memory of what happened, surgery area hurts.
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Dr. Belyansky does seem like the best choice for you. You asked in the other thread about my situation. I had bilateral laparoscopic mesh implantation, via the TEP procedure. Two pieces of Bard Soft Mesh. It was never really right and got worse as time went on. I have written several detailed descriptions about the problems in various other posts.
I would guess that Dr. Belyansky might not need any scans. Surgeons that are familiar with mesh problems have seen the same story many times, they recognize that it’s caused by the mesh, although many won’t say it. He might make a guess or two about folding or movement or fixation, but they really can’t tell until they get in there. I went through the full scanning treatment, a full MRI and some ultrasound. Nothing showed up, everything looked fine and correct, until Dr. Billing got in and took a look.
Can you give some details on your mesh implantation? The type of surgery, the material used, the surgery notes, and the type of hernia it was supposed to repair? It’s good to keep building the evidence that these perfect mesh implantations still cause pain.
Good luck. Don’t think about the time lost, think about the time you’ll gain by getting it done.
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I think that I am the only person on the forum who had mesh removal by Dr. Billing. Many surgeons who do mesh removal laparoscopically do not attempt another repair. Most of them opt to wait and see if there is a recurrence. Often, apparently, the remaining tissue is stiff enough that there is no recurrence.
On the other hand, there are surgeons who will remove one piece of mesh and replace it with another, “just in case”. They might also perform neurectomies. There are people, some on this forum, who are stuck in a cycle of surgery after surgery, as one procedure leads to another.
In my case, Dr. Billing did not attempt another repair as he did not see any hernias, and he did not do any neurectomies. And I have been doing very well. But he spent much more time removing the mesh than many surgeons seem to do. Some surgeons are proud of how fast they can get in and get out. I think that that might be a reason for neurectomies. Easier and faster to cut the nerves than tease them off of the mesh.
If you have conversations with a surgeon make sure that you are prepared beforehand. Many of us will expect to remember all of out questions and be able to ask them once we get inside but once we get in to the doctor’s office, the doctor tends to run the conversation. You will leave the meeting with many unanswered questions if you don’t have a list before you start.
Also, many surgeons will get upset if you question what they plan to do. Despite all of the well-publicized problems with hernia repair many of them think that what they are doing is somehow different. Even though they are using the same methods and materials.
Good luck Ronnie. Keep detailed notes as you do your research. It can be very confusing especially when you’re suffering the pain. Don’t let my negativity dissuade you from your efforts. I’m just trying to shine a light on potential pitfalls.
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“Balancing Responsibilities to Patients and Society
Finally, the cost and value of new technologies, to each of the many constituents in healthcare, must be addressed. Forces impacting health care and its delivery are increasingly important, particularly now as the US transitions to a national health care system. (30,31) At times however, a physician’s responsibility to advocate for individual patients on the one hand, and honor the responsibility to society for stewardship of finite resources on the other hand, may be competing considerations. Physicians do have responsibilities to both, as pointed out by the ACS in its “Code of Professional Conduct” and by the American Board of Internal Medicine (ABIM) in its Physician Charter on “Medical Professionalism in the New Millennium”. (32,33) To guide physicians struggling with conflicting responsibilities, the ABIM establishes the following principle: “Principle of primacy of patient welfare…Market forces, societal pressures, and administrative exigencies must not compromise this principle”.
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I can understand owning intellectual property. I have had the thought that if the individual doesn’t own it that a large corporation can take it and bury it. I am fairly certain that their are much better mesh-type prosthetic materials possible but the mesh-making corporations are fine with the their existing product line. Chronic pain is the cost of doing business for them.
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Dr. Krpata at the Cleveland Clinic.
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Dr. Yunis might be worth contacting.
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Look at the description of the first three pictures in the paper linked below, and the picture in Dr. Towfigh’s tweet. The ProFlor plug was removed due to recurrence after three years (how did that happen if the repair was “finalized” and the defect obliterated?). The plug looks just like the Perfix plug that Dr. Towfigh removed. All contracted and filled with new tissue.
It’s almost like they are showing that their claims don’t match the reality. The ProFlor ends up just like the other plugs.
Many doctors don’t use the term “scar tissue”. It’s all just tissue in different stages of regeneration.
Anyway, I think that the key issues are return of function and quality of life. That’s the reason that people let any kind of plastic be inserted in to their body. Time will tell on Proflor. Insightra has been bought by a venture capital company and they will promote this product until they sell the company to a larger medical device company or until they package it up for a public offering to the market. That’s what venture capital firms do. It’s all about the money. They have to generate excitement. Tela Bio followed a similar path with their Ovitex products.
https://www.mdpi.com/2079-4983/13/4/253
https://twitter.com/novitskyyuri/status/1021596087600271360
plugs are evil and should not be extrapolated as all things "mesh"
— Yuri Novitsky (@NovitskyYuri) July 24, 2018
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I had relatives in the area so did not stay in a hotel. Kirkland is in the Seattle-metro area though so I’m sure you’ll be able to find one fairly close.
You’ll need to have a person available to pick you up after the surgery. It’s the one major flaw I’ve found in all surgeries in the US. You have to know somebody, lone surgeries are not allowed. “Ambulatory surgery centers” are designed to reduce the costs of surgery, allowing the patient to walk out after the procedure. But the concept overlooks the lone person who needs help. They won’t let you walk out alone.
p.s. I don’t know what you did but your profile has a new name and a picture of a go-kart.