Good intentions
Forum Replies Created
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I asked Dr. Billing if he could do both sides at the same time and he said “I just can’t last that long”. An example of taking the time and effort to do things the best way possible versus trying to fit what can be done in to a time slot, I think. Plus, it’s not good to be under general anesthesia for extended periods of time.
Another thing I thought about was to be aware of the difference between a surgeon at a large practice versus one at a small practice. The surgeon at a large practice will probably have time constraints, trying to do as much as they can within the time allowed, fitting the work to the time. The individual or small practice surgeon will have more freedom, making the time fit the work. And, in the same vein, surgeons at large practices sometimes use interns or surgeons-in-training to do the work, under their guidance. Dr. Ramshaw’s story comes to mind.
It would be good for you to find out what type of mesh was used in your implantation. There is a very large variety. It will give you an idea of how straightforward the removal might be. Get the surgery notes, they should still be available. Even in 2015 there is still a wide variety of possible materials and methods that might have been used. Area of dissection, size of mesh implant, shape of implant, fixation, etc.
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I think that mesh removal is the industry’s “dirty secret”. People don’t want to talk about it because the natural follow-up questions are about why and how much the problem occurs, and if there are alternatives to mesh. The mesh industry will not even create a standardized mesh repair registry to track the quality of the implantations. They don’t want to know.
When choosing a surgeon for mesh removal make sure that you find one who will take the time to tease out the various nerves and vessels that have become entwined with the mesh. Neurectomy is often used during mesh removal, supposedly as a way to remove the source of pain, but I suspect that it is also faster. Quicker to cut the nerve than to properly dissect it from the mesh. In other words, if the surgeon says that they can have all of the mesh out in just an hour or two, that’s probably bad. My surgeon took 2-3 hours on each side.
Of course, all mesh can be removed. The question, as you’re asking, is what is the quality of life after mesh removal. Unfortunately, in today’s world, forums like this one are the only way to learn about that. There is no registry for mesh removal, with names of surgeons and results of their efforts. There is no industry support for such an effort, because it will just shine a light on a problem that they don’t want exposed.
The lawsuits are still working their way through the courts. As the financial costs to the industry become more clear there could be an effort to reduce mesh complications, But it will probably not help at all with mesh removal. Ironically, as I just posted about, the efforts of the robotics industry will probably do more for mesh removal than anything the mesh makers do.
Sorry for soap-boxing in your Topic. There are several Topics on the forum about mesh removal. Dr. Peter Billing of Kirkland, WA might still remove mesh (he removed mine), and Dr. Andrew Wright of UW Medicine, if you are in the northwest. Both are good possibilities, I think.
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It must be stressful to implant mesh using today’s state-of-the-art technology, knowing that the same technology might be used to remove it. The next step, obviously, it to plan for removal as the the mesh is being implanted. Like a surgeon using a screw to set a bone.
If you know it might have to come out, do certain things to make it easier. Do certain things that won’t result in more damage during mesh removal.
It’s good that this conflict is being shown. It just seems very strange.
Here is another article from the references of the article above giving instructions for mesh removal. It’s rare to see the cause and effect relationship stated so clearly by experts in the field.
https://link.springer.com/article/10.1007%2Fs00464-018-6558-5
Excerpt –
“Conclusions
As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.” -
I did just notice one thing about the article that is very disappointing. The first reference is the “International Guidelines” which have been called in to question by professionals, and are generally suspect since the effort was sponsored by mesh makers, and started with the premise, stated in the publication, that mesh was the preferred method of hernia repair. An example of how the framework for mesh usage persists, despite much evidence suggesting that it causes more harm than pure tissue repairs.
Laparoscopic/robotic methods need mesh for hernia repair. Without mesh those businesses will suffer greatly. The authors had to show that mesh was “preferred” by citing the “Guidelines”.
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Thanks for the reply MarkT. My comments are meant to be more rhetorical and general, about how the typical patient does not have easy access to the knowledge necessary to be “informed”.
Removing mesh is just described as another procedure to be performed, like some sort of natural occurrence to be dealt with. Imagine the doctor describing how the same tools used to implant the mesh can be used to remove it, at a hernia repair consultation. That would be an awkward conversation.
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Two weeks is still early. Are you active or working, or just waiting to feel better before doing things?
Do you know what type of mesh and procedure was used? There is a large variety out there. Lichtenstein, two-layer “systems”, Onflex, plug and patch, and variations of these.
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The first comment to the GSN article is interesting. The doctor missed the opportunity to describe the method and materials that have worked over the years for him though. But his point is valid.
“Rafaellugomd wrote on: 1/11/2022 3:21:02 PM (EST) 2 days ago.
I looked at the numbers and what stands out to me is that in 23 years doing inguinal hernias in the same city and practice, I have never removed a single mesh and this group has all these patients to remove meshes. The question I have is why? Why so many? Is there a problem with the technique when these are placed? “ -
Here is a publication by the authors on the subject. More good places to consider for mesh removal. Dr. Towfigh is a co-author.
Unfortunately, despite the efforts to make patients responsible for being “informed” so that they can take responsibility for their decisions, the main article is a pay-per-view article. Everything comes back to money.
https://link.springer.com/article/10.1007/s00464-021-08963-4
Three of the authors are from Cedars-Sinai Medical Center, and two are from the Beverly Hills Hernia Center.
Here is the head author’s address:
Desmond Huynh, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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I found an old video of a scene I remembered from a TV show. It seems scary but it’s an example of how the intestines will just keep working no matter where they are. You can find pictures around the internet of much worse cases. I think that if something extra ends up in your scrotum you will know it.
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Dr. Ponsky would be worth a call or message. There might be a hidden network of non-mesh hernia repair surgeons if Ohio is too far. Who knows.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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I have had talks with surgeons who describe that the hernia defect is actually intact tissue that has stretched beyond its elastic limit. Sometimes it stretches so far that is almost disappears, it’s so thin. In other words, it’s not an actual hole but just a very over-stretched area that will try to regain its original shape. But, it will still be weak and easily over-stretched again.
That fits with what I remember about the early stages of my hernia. I would get the odd effects but they would resolve with rest. Then come back again at the next exertion, typically a soccer game. Maybe if I had just stopped playing soccer the problem would never have come back and I would say that I had healed. I did have some longer periods of time off between games where I did not feel the effects and felt “healed”, but the effects kept coming back when I played soccer, until I realized it was a hernia. I wanted to maintain my active life so chose a mesh repair, which produced a worse effect than living with the hernia.
In short, I think that many of the hernia healing stories are actually activity reduction stories. Accepting a diminished lifestyle in order to avoid the aggravation of the hernia. Which makes sense. But the typical surgeon tends to promise that the former life will be restored with a mesh repair. I think that many people with “successful” mesh hernia repairs have actually just accepted their new diminished life. There’s nothing wrong with that, but promising a restored life when it’s known that it isn’t likely is wrong.
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The Search function on the site works now, it has not for a couple of weeks. It is in the upper left corner of the home page. Put Desarda in the search box and many results will come up. This forum does not have many members that participate on a regular basis but there are years worth of past posts that are still relevant. Don’t mingle short-term pain with long-term pain in your thought process. Better to suffer short-term pain and very little long-term pain than vice-versa. Good luck.
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Here’s another example, on a much larger scale, of how the medical industry is focused on market share and revenue, at the expense of the broader good of humanity.
For those who wonder why mesh is so popular, when cheaper, equally or more effective, procedures are available. The same types of executives are making the decisions. Everyone below, with a few exceptions, just does what they are told to do.
We should all hope that more people like this step up and persist in their efforts.
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Here is a link with a good illustration. Medially means toward the middle. In my case a very distinct bump appeared when I was standing. I am low body fat, but high BMI. In other words, there’s not much between my skin surface and the abdominal wall. I can still feel the spot now, it is more sensitive than surrounding tissue.
The labels of direct and indirect seem backward to me. In an indirect hernia the material actually enters the canal directly, through the same opening that the spermatic cord does. In a direct hernia it enters the canal from the side, which seems indirect to me. But, somewhere in the past, those labels were determined. Part of the mystery of medicine and what all of the words mean.
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It’s not clear if you are a skinny low body fat person with defined musculature of the abdomen or if you have some coverage by fat. On a skinny person the signs of a direct hernia are very clear, a pyramid shaped bump appears in a certain area of the abdomen, medially to the crease of the groin. You can find illustrations around the internet showing the location. It’s what I had. As material pushed in to the canal, my right testicle would twist and behave abnormally. This would be after rigorous activity. A physical exam at that point might look like an indirect hernia because there is material pressing on the spermatic cord.
I would think the imaging would be more likely to be correct. It’s not clear what criteria the doctor who did the physical exam was using to make his/her determination.
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That’s expensive. Too bad.
When you are doing the calculations, don’t overlook that your insurance will probably not cover all of the costs that you assumed it would. You might pay a percentage of some procedures, there’s probably a deductible, some things just don’t get billed to insurance, they’ll bill you directly first, some things just won’t be covered at all, like maybe they had to use an outside the system anesthesiologist. All of my surgeries were more expensive than I expected/calculated, and I had good insurance plans and tried to figure out the cost beforehand. There will be many uncovered small charges that add up to a large number.
It’s very difficult to know how much a procedure will cost before it’s done. In short, don’t assume that going with your insurance coverage will be substantially cheaper than paying directly. Especially if you have the procedure done at a large clinic or hospital. The health care “system” is made up of inflated costs and negotiations/agreements between large corporations. Even just a small percentage of those inflated negotiating costs applied directly to the patient can add up to a large number.
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Here’s the page about repair methods.
https://vincerainstitute.com/core-muscle-injury-treatment/mesh
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The Vincera Institute would be worth a look. I think that they avoid working directly with insurance companies but will provide the information needed to make a claim. They do their own imaging, and avoid mesh if possible.
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A failed Shouldice repair would result in a recurrence of the hernia. I don’t see that described. I only mention that for clarity. The description sounds like a guess that a suture pulled free, or impinged on a nerve, or something. They don’t know.
Do you know what type of mesh will be used? I know of somebody that had a synthetic mesh removed and a biologic mesh implanted to replace it, on the assumption that biologic was better. The biologic mesh caused pain and had to be removed also. Beware of surgeons wanting to try the latest thing on you.
Also, laparoscopy surgeons are experts in laparoscopy and tend to believe that it is the “best” way always. There would be no “ripping open” of the Shouldice repair if an open operation was done. It sounds like you will be having a TAPP procedure, with some dissection and a mesh implantation. If they have to remove the sutures from the Shouldice procedure it will probably have the same basic effect as if they were removed from the front. Removing scar tissue is a different issue though. She will be able to access all of the areas that the second mesh implant was contacting and all of the areas that were previously dissected. So that looks promising, if her premise is correct.
I would offer words of hope but they won’t really help anything. It sounds like you have done the work and are already scheduled. Stay in touch.
Good luck.
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I will just follow those posts with a reinforcement of the warning to beware the 3rd surgeon who is discounting everything that happened to you and wants to start over again with another mesh implantation. One of my comments in a previous post to your early problems was about a surgeon I saw for mesh pain who did not read any of my history before my visit, but had already assumed that I had had a recurrence, and was ready to get right back in there and fix it. I spent 15 minutes explaining to a confused mesh-implantation surgeon that I did not have a recurrence, I just had pain and specific physical symptoms that something was wrong, caused by the mesh. All he saw was another mesh procedure sitting in front of him.
I’m sorry that your problems are persisting SFIrish, it seemed like you were on a path to success. I think that they might be beyond the abilities of the common surgeon, especially the odd popping and clicking that continues. I would really consider finding a true expert in abdominal/core problems.
Dr. Meyers would be my first choice. The people at the Vincera Institute are very considerate. Marcia Horner was the one I corresponded with when I was having problems. I sent them a letter, and my images, and received a reply soon after.
Good luck.