Good intentions
Forum Replies Created
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You should just read through the posts on the forum. There is nothing new today that wasn’t the same ten years ago. Your odds of having problems are the same. It will be tempting to think that the stories from many years ago are the past, and that “there’s no way they would not have solved these problems by now”. But that is not the case. Everything is the same, actually getting worse, as they increase the area of dissection and the size of the implant.
Be very careful. Do as much reading as you can. Remember that the various clinics and hospitals need customers to survive. Business.
There is nothing special about robotic as far as the final result for the patient. It is a different form of laparoscopy. The same meshes are used and they are placed in the same areas.
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Wow, that is a scary story. What happened? Was it supposed to be a routine hernia repair? Was the orchiectomy part of the plan or the result of an error?
Normally, the function of the penis should not be affected by a hernia repair. The don’t get near any of the critical parts for erection. Your pain medication might be causing problems. If they are only for the pain from the operation you might ask about getting off of them. Sometimes they prescribe them for other reasons though, so ask your doctor.
As I understand things, pain is the sign that there might be problems with swelling. If “no sensation” means numbness that might not help you.
Are you doing anything different to try to reduce the swelling? It’s a difficult area. It seems like submerging the lower half of your body might help due to hydrostatic pressure. Pool walking or swimming. Just a guess. After two weeks your external wounds should be healed.
Good luck.
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Thanks for posting Colin. Parents with children would get great value out of your experience with the Shouldice repair. 20 years, and passage through puberty to adulthood, with no problems, is a success and what any parent would want for their child. Even many of the mesh proponents in the community of surgeons recommend against mesh for adolescents, but there are probably thousands of kids who get it anyway.
And the experience at Gibbeum Hospital is one more verification of a non-mesh option. I have the same question as mitchtom6 about your lifestyle and activities, and also how long it’s been since the Kang repair. Are you a runner or biker, do you play sports, physical labor, etc.?
Good luck.
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Any surgeon who tries to justify the use of mesh based on equivalent chronic pain rates needs to also consider the damage done in relieving the patient of the chronic pain. The damage from mesh removal as compared to whatever methods are used to cure non-mesh repair chronic pain.
Which hernia repair method gives the patient the best odds of a pain-free life, in the long-term, considering also the damage done in trying to cure the chronic pain, if it occurs.
No matter how you talk around it, a non-mesh repair is the right first choice of repair. It is the best long-term potential solution for the patient.
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Here is the abstract of the paper that seems to be the foundation for Dr. Orenstein’s conclusions. Dr. Orenstein is, apparently, a research scientist. This is a very shaky foundation for any conclusions. A single paper put together from databases which do not accurately define or quantify chronic pain.
The work in the paper seems to have been done with a goal already defined. To imply that non-mesh repairs cause just as much chronic pain as mesh repairs. Dr. Andresen is the developer of the Onstep hernia repair system, which uses a mesh product sold by Bard. Dr. Rosen also consults for Bard.
The major flaw in the paper is so obvious that it’s almost ludicrous. The pain has to be reported, and defined, as chronic pain.
“The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. ”
https://www.sciencedirect.com/science/article/abs/pii/S0039606017308905
Background
Chronic pain affects 10%–12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain.Methods
For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included.Results
A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5–10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%–16.2%) versus median 2.9% (0%–27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs.Conclusion
Mesh may be used without fear of causing a greater rate of chronic pain. -
I was trying to make you aware of the potential problems with any mesh at all. I am saying “avoid mesh if you can”.
If you do choose a mesh repair, make sure that you know the details of the material and the method. It is more complex than just “open” or “robotic”. There is a very wide variety of mesh products that can be implanted, and whether or not all are the same or not is not known. Also, ask your surgeon if he does a preventive neurectomy. Some surgeons cut nerves, just-in-case, sometimes leading to problems after surgery.
Open mesh could be a plug and patch repair which is one of the materials most difficult to work with if there are problems. Open repair could be a Lichtenstein repair. It could be an Onflex repair. It could be a PHS repair. These are all different, but all “open” hernia repair methods.
Robotic repair is just a form of laparoscopic repair. The same mesh is implanted as a non-robotic laparoscopic repair. So, anything that you read about laparoscopic TAPP repair will apply to robotic repair.
Sorry. I wish it was as simple as choosing “open” or “robotic”. But it is much more than that. Robotic repair is the “new thing”, there is still much discussion about its true value.
Most surgeons are going to tell you to just choose a good surgeon and take their advice. Good luck.
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The internal conflict, possibly even fear, for Dr. Jacob must be incredible. Here is a video showing a TAPP removal of mesh by Dr. Jacob. The video ends at about 4:30 but the audio continues. There is no follow-up information about how the patient did in the long run. This might partially explain the watchful waiting.
I feel like I am “piling on” but this situation is one in which a well-respected expert is forced to truly and objectively (hopefully) face the same fears and results that his patients do. At the least, he will gain a true understanding of what a mesh repair feels like along with an awareness of what happens n the long run.
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This would or will be a fascinating story, from a psychological perspective. Dr. Jacob is aware of the damage that mesh can do and the pain that it can cause, as a surgeon who removes mesh. He must also be aware of the general recommendation that watchful waiting is a waste of time, and could be life-threatening due to incarceration. He seems intelligent and able to determine the pros and cons of complex decisions. He is a major proponent of mesh repairs, very similar to Dr. Felix, who had his own hernia repaired with mesh.
As a person with the financial means to choose the safest route of pure tissue first, then mesh if pure tissue fails, I wonder if he will place his faith in the technology he has been benefiting from, and just go directly to the mainstream mesh repair.
I hope that he shares the details of his hernia journey as it progresses. It is not clear why he is waiting, he must have an opinion about the best possible repair method, as an expert in the field.
https://www.nychernia.com/sages-2011-inguinal-hernia-laparoscopic-vs-open-debate/
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Take your time and do lots of research. You’re worried about money but if you get a bad result money will be meaningless.
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You should just spend time reading the posts on this web forum. Nothing has changed at all over the years since the first post on the site. The materials and methods are the same. There is no special method, or level of skill, that changes the way your body will react to mesh. People that are very physically active seem more susceptible to problems.
The posts on this site are from real people discussing real experiences. The things that you will find on the medical institution sites and the device maker sites are not focused on the things that you said you are worried about. They will talk about getting back to work quickly, and recurrences, but not chronic pain.
The decision that you are about to make will probably be one of the most important decisions of your life.
Here is an abstract from a very recent paper describing the “state-of-the-situation” for mesh implantation. Good luck.
https://link.springer.com/article/10.1007/s10029-020-02297-1
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A recent article about long-term changes.
https://link.springer.com/article/10.1007/s10029-020-02297-1
Here is a link to a related topic for anyone who comes across this one in the future.
https://herniatalk.com/forums/topic/mesh-removal-training-a-new-field-of-study/
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Here is the Hernia website abstract with the payment link.
https://link.springer.com/article/10.1007/s10029-020-02297-1
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Here’s a recent and interesting article suggesting that mesh problems need to be monitored for at least 15 years to truly understand the source of the problems. An old name, Dr. Robert Bendavid, was involved before his death, along with some other well-known names like Koch, Petersen, and Grischkan.
It’s from researchgate.net so finding readable portions takes some work. Published in Hernia , a pay-per-view publication.
You can use CTRL + to blow up this preview.
Here is an image from the article.
And an excerpt.
“Purpose: Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. Methods: Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. ”
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“Conclusions: Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks.”
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More laparoscopic removal.
https://www.sages.org/video/laparoscopic-removal-of-infected-incisional-hernia-mesh/
Making the “best” of a bad situation.
https://www.sages.org/video/reoperation-for-recurrence-with-pain-being-a-significant-complaint/
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Laparoscopic removal
Losing a testicle, I assume (lysis of spermatic cord), to solve mesh-related chronic pain.
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Humor does help, I suppose.
https://www.sages.org/video/ouch-my-groin-tips-for-safe-excision-of-inguinal-mesh/
I chose this one just because it seems to show a large piece of explanted mesh.
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I searched “mesh” on the SAGES Educational video site, then browsed through the pages. I found a few videos about mesh removal, also called mesh “excision”.
The SAGES site is slow to load a new page and does not restart at the top of the page after the new page loads, so click the page number then wait, then move the cursor up to the top of the page. Or just put the next page number at the end of the url.
https://www.sages.org/video/?fwp_video_search=mesh
I have not watched each video so can’t say how relevant they might be. There are some good shots of migrated mesh though, just in the first images.
I’ll post two links per post so that my posts don’t look like spam. Posting just to fill out the Topic.
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Thank you for the reply Dr. Towfigh. I think that you might have misunderstood the point of my post. It’s about mesh removal, not mesh implantation.
Surgeons are trained in how to implant mesh, but, apparently, mesh removal is not an “official” subject. It seems that learning about it is something that surgeons have to choose to do on their own. I think that the subject is in the same vein as the fact that there is no “mesh removal” code for reimbursement purposes. It’s something that people, apparently, don’t want to acknowledge as a problem.
I would guess that any surgeon who has done a few mesh removals would say that there are definite well-defined techniques for entering the abdomen, identifying structures, and peeling away the mesh, just like there are for mesh implantations. As the article I linked suggests, there is a need for standards of care for pelvic mesh removal but they do not exist. I think that the same is true for hernia mesh removal.
We’ll know that things are changing for the better when there is a SAGES session about mesh removal at one of the big meetings or when it’s included in their Education programs.
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I imagine that if mesh removal was a true area of research that professionals could dig in to all of this. It’s probably hard to talk about the need for research on mesh removal though. Run away.