Good intentions
Forum Replies Created
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You should talk to Dr. Brown. It looks you might have been on his web site reading his description of his repair method.
Mesh is not an acceptable method to repair a “sports” hernia. Do you have a true hernia that you got playing sports, or do you have athletic pubalgia, pain from the wear and tear of sports but not a true hernia?
There used to be a pinned Topic about the subject but the site has been changed. It’s gone.
Be careful. It looks like you’re just starting with your problem and once you get in to a doctor’s office the urge to relax and accept whatever is offered will be great. That’s why many of the people are here.
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The fact that over all of these years of reports of chronic pain and discomfort, and all of the lawsuits, and the incredible growth in the number of law firms entering the mesh litigation field in even just the last four years, that not a single mesh maker or surgeon has made the effort to show that they have a better product or method, implies very strongly that all of the mesh products are bad. They all have significant problems.
The essence of the “free market” is that the good products make the bad products obsolete. There are scores of variations of mesh products and none of them have risen above the others, by even a small margin. Even the newest ones like the Onstep method and material had flaws almost immediately.
Sorry to keep intruding on your Topics alephy. The only mesh material that I thought might be “better” than others in terms of chronic pain was the Progrip material, based on anecdotal internet information (because that’s all of the information that a patient has). But, as you’ve seen over just the past year many people are reporting chronic pain with ProGrip also, to the point that they are having it removed.
On top of that there is the growth of the “pain management” industry to send the chronic pain patients too. And the mesh removal industry, supported by the advancement of robotic surgery.
I still search for success stories from the world of professional sports. I see surgeons saying that they use mesh in athletes but there are no good stories. Only the bad ones, like Dai Greene’s. The only success stories from the world of sports are about non-mesh repairs.
I apologize again alephy, but there really does not seem to be a mesh product that will give a better chance of successfully avoiding chronic pain. It’s like cancer and cigarettes. Some people make it through without cancer, but quite a few die a horrible death as the result of cigarettes. I think that the business model is very similar also.
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That is a very disappointing survey Dr. Towfigh. It seems to have the aim of learning how to make patients feel more comfortable about having mesh implanted.
None of the questions will produce any information that will actually improve the outcome of a hernia repair. The survey seems to be for the sole purpose of making the surgeon’s work easier. It’s not for the patient’s welfare, it’s for the business of mesh implantation. For surgeons that implant mesh. I don’t see any other purpose for it, I couldn’t even pretend.
Is this what the “Hernia Collaborative” is about? A collaboration of surgeons trying to make business easier?
Where is the survey about the results from mesh implantation, and mesh removal, and quality of life after mesh implantation? The one that determines which products are bad and which might actually be good? A collaboration that actually makes life better for future patients, and, coincidentally, doctors too.
Let’s see that survey, please. That would be meaningful.
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That would be called a”posterior” repair via an anterior approach. Mesh placed behind from a hole in the front. Any open repair that talks about “preperitoneal space”, is also behind the abdominal wall.
Here are some examples.
https://www.jnjmedicaldevices.com/en-US/product/prolene-polypropylene-hernia-system
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-hernia-system
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Robotic surgery is growing in to the mesh removal field. It is well suited for the fine work that needs to be done to get all of the mesh out without causing damage.
Fortunately, ironically, as surgeons look for places to use the robotic tools, both mesh implantation and mesh removal are seeing growth of the robotically assisted surgery tools. Find a surgeon who does robotic surgery and they’ll probably know how to remove the mesh. Due to the size of the piece of mesh that was probably used on you, laparoscopic removal will probably be the best removal method.
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The Vincera Institute is the right place to be. Did they offer the five options, or have you collected the five options from different places?
I’m not sure how you can get better advice than from Dr. Meyers. I would do what he recommends.
There are many Topics on the site about problems with Ultrapro mesh specifically, and mesh in general, and also many comments about how the use of mesh is not recommended for athletic pubalgia. Mesh is not used by experts to solve the athletic pubalgia problem.
Good luck. @drbrown
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That is a poorly done study. They, apparently, had the intention of showing that the “biomesh” would not cause any problems. But they did not compare the use of the BM to any patients without it. No control group. It looks like a typical “this is possible” paper that will be used to justify using BM, whether it has a benefit or not. It’s just bad science.
The “pure tissure” repair that they used is “continuous suture of transversalis to transversalis fascia”. I’m not sure what name that method falls under, but that’s the “pure tissue” part of the repair.
“underwent 104 IH repair with a continuous suture of transversalis to transversalis fascia repair reinforced with BM of porcine intestinal submucosal origin (Surgisis, Cook) ”
https://www.cookmedical.com/surgery/the-path-from-surgisis-to-biodesign/
https://www.cookmedical.com/products/e94eb360-1d48-44ed-b944-5872c9d50bfe/
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Hello JLEE. I wrote a long post but it got disappeared.
I think that it is very possible and probable that your daughter’s problems are caused by the mesh. Typically the mesh is placed close to the bladder, due to the size of the piece that is implanted. Today’s implantation surgeons implant very large pieces. Read through the many posts on this site to get a better understanding.
Make sure that you find a surgeon who removes mesh as you try to solve her problem. The mesh industry is a very closed and protective group and you will waste a lot of time talking to surgeons that implant mesh, but do not remove it. They are educated and trained that mesh does not cause problems.
Good luck. Get her medical records so that you know exactly what you are dealing with. There are many many different types of mesh.
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Alephy if you have not read the story in deeoeraclea’s thread, linked below, I think that you should. He is one of the rare cases of a person who has had both types of repair and can attest directly to the differences. Everybody should read the story.
Don’t relax and “accept your fate”. If you end up as one of the 15% after all of your efforts to find a good solution that would be terrible.
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With the shrinkage that the mesh causes activities that stretch the mesh area can cause discomfort. And/or pain. There has been much discussion over what is actually “pain”. You’ll see a lot about “debilitating” pain, or chronic pain, but accounts of chronic “discomfort” from feeling the mesh implant and the tightness of the tissue, and the inability to be as active as before the repair typically gets discounted. Because it’s not “pain”. A formerly active person can avoid the pain or discomfort by not being active anymore. Which, ironically, is the very reason that is used to recommend a hernia repair.
So a doctor can honestly say that the odds of pain are not high while not addressing the chronic discomfort. You’re alive and you don’t have a hernia anymore.
Even so, the odds of chronic pain are generally accepted as about 15%. This number is even used by surgeons who recommend mesh repairs. About one in six, like Russian roulette. This could be considered a low number.
I know that you’ve seen all of this before Alephy, but it is still true. Nothing is really different today, than last year or five or ten years ago. That’s where the 15% comes from. Things are the same.
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You were 28 when you had the hernia repair? Do you know what type of mesh and how it was used? There is a very wide variety of materials and methods, even in open repair. 12 years ago is probably a plug or a Kugel patch or the Prolene Hernia System. The details of the procedure will be useful.
There are some recent posts from jnomesh about IBS and mesh. Search for those. You need to find a hernia repair expert, that also removes mesh. Most of today’s “specialists” only know how to implant mesh.
Spend some time reading through the many years of posts on the forum. There is a lot here. Your situation does not sound surprising, although the spasming is a bit different. But if these things started right after surgery then the odds are that the material or method is the cause. Good luck.
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That’s a shame Spanish, but maybe it’s best in the long run. What if you had complications? Would Dr. Koch help then?
It’s interesting that Naholm appears to monitor and read the posts on this forum, and keep his surgeons informed. But does not participate even though he and his company have been discussed in depth.
https://herniatalk.com/forums/topic/biohernia-hernia-surgery-without-mesh/
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You are in a difficult spot for finding good information. If you read through the posts on the site you’ll see how healthcare has moved almost completely to mesh implantation for hernia repair, even doing repairs for asymptomatic hernias, under the premise that potential strangulation is a risk, and that mesh is completely safe and almost foolproof.
The best thing that you could do at this point is to read as many of the posts on this forum as you can. It’s all been described here, and there is no easy answer. Today, “specialist” just means that they focus on one thing. It does not mean that they are experts.
Good luck.
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Hello Scott. @tigerpawn
I was referred to a urologist when I was having mesh problems and he made a comment about how they had to cut through the mesh to do prostate surgery, sometimes. He made it sound like mesh made his job more difficult. I would see or talk to a urologist to get their opinions.
As far as choosing a repair procedure, I say this often, but if a suture repair fails you can always get mesh afterward. The odds of problems from mesh are higher, I think, and much more difficult to deal with.
I don’t think the Shouldice or Desarda are deep enough to interfere with prostate surgery, since they are focused on the groin area alone. Laparoscopic mesh implants today though, are much larger than the actual hernia defect. They try to cover as much area, all the way to the midline, as they can. They can get in the way,as my urologist said. But an open mesh repair might not, depending on what type it was, onlay, or Lichtenstein, or Kugel, or pre-peritoneal, or Onstep, or PHS. There are many many types of mesh repair. You really have to distinguish between them, you can’t group them all together as “mesh”. Especially for your question.
Good luck.
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@Forest According to Gore’s literature, the PTFE mesh should be fully surrounded by vascularized tissue and the absorbable portion of the mesh should be gone, absorbed by the body. There will be some shrinkage, because all of the mesh products do that.
The PTFE mesh used in this product is fairly new for Gore. Their old products were based on their Goretex technology, stretched/expanded material with microporosity. A smooth film with very tiny holes, essentially. Your mesh is a knitted mesh, just like the polypropylene and polyester products, but made from polytetrafluoroethylene, PTFE. Same product as the old meshes just made from a different polymer.
Start a log or diary. Keep track of what you do that makes you feel better and what makes you feel worse. At eight months out the mesh should be close to as strong as it will get. There’s no point in waiting. Good luck.
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The Shouldice procedure does not remove the mesh. A surgeon performing the Shouldice procedure might remove mesh, but there is nothing specifically “Shouldice” about mesh removal. There is no “Shouldice mesh removal” procedure.
Removing mesh and repairing hernias are really two different specialties.Most surgeons that remove mesh do not “repair” a hernia during the surgery. The hernia is often closed already by the scarring that has occurred from the mesh. I had one direct hernia on my right side, and one supposed lipoma on my left side. Neither side was “repaired” when the mesh was removed and I have had no signs of a recurrence. The scarring and stiffening of all of the tissue around the mesh, and the tissue buildup itself, was enough, apparently. I would imagine that even the healing that occurs after the mesh removal binds the hole closed.
I would separate mesh removal from worries about hernia repair. Find a good mesh removal surgeon first.
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TEP has a lower chance of intestinal adhesion because the peritoneum is not breached. Totally EXTRA-Peritoneal. Meaning completely outside of the peritoneum, where the intestines are.
TAPP surgeons like TAPP because they can see more before they decide to open the peritoneum and place the mesh, I think. There is a series of SAGES educational videos that describe the methods, with some comparison.
Don’t overlook that many laparosocpic surgeons like the method because it leaves fewer scars. If you search “minimally invasive” on the internet you’ll find “scar-free” used as a selling point. TEP surgeons go in through the navel so when they ‘re done the abdomen looks almost untouched from the outside. But on the inside the peritoneum is peeled almost completely from the abdominal wall to make room for the mesh. Blunt dissection is a peeling or splitting of the two layers to create that space for the mesh.
The small entry points do heal faster and I think that there is less chance of the incision splitting open later, leading to an incisional hernia. It seems like a fantastic method for gall bladder removal or appendectomy, which is where it saw a lot of development, as I understand things.
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That is a shame, and bizarre. Could it be someone from the bodybuilder.com forum? I know that you post over there also.
I bet that Dr. Koch himself might understand what happened. You have been talking to someone in the front office. It might be worthwhile to try to get past them.
Good luck.
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I don’t think that Dr. Koch reads the herniatalk.com forum. There is no route to Dr. Koch’s office from here. How would they know what was written on the forum?
Maybe somebody has been on your computer or phone. Good luck.