Good intentions
Forum Replies Created
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quote nickpma:In October 2018, I had an abdominal wall repair surgery for multiple bulges around the belly button area.
This surgery was done with mesh, and fortunately so far I had no issues around the belly area.Do you know if a preventive neurectomy was done at the same time as the mesh placement? It’s not recommended, generally, but, apparently, quite a few surgeons do it anyway. Maybe to delay the onset of pain. Somebody recently posted about muscle imbalance and problems after neurectomy.
[USER=”3027″]Julian[/USER] [USER=”3088″]nickpma[/USER]
https://www.herniatalk.com/14029-laparoscopic-neurectomy-and-internal-external-obliques
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Dr. Muschaweck is known for removing mesh. https://www.fortiusclinic.com/specialists/dr-ulrike-muschaweck
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[USER=”2580″]DrBrown[/USER] might have some thoughts. He works on professional athletes.
Was the umbilical hernia repair done with mesh or suture? Since you have a “pooch” it might be that you’ve had a recurrence. Surprising that your doctors refuse to deal with your problem but it seems to be a trend in the profession, generally. My cynicism. If your problem isn’t on the list, with a code attached to it, they don’t want to deal with it. Hopefully things will swing back to a more patient-focused system.
Good luck.
[USER=”3085″]Chaney[/USER]
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You said the repair was 15 years ago, but the pain has been 20 years. Do you think that the pain is the same, exactly, and that all of the procedures since then have had no effect, good or bad? Might be easy to get distracted by the other procedures, and the doctors might be defending the procedures that have been done, not realizing that the original cause of the pain was never fixed. Was the umbilical hernia fixed because of the pain or for some other reason?
Good luck.
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[USER=”935″]drtowfigh[/USER] has extensive experience in this area. I would not consider all “meshes” as mesh. “Pig” mesh is not actually a mesh, as I understand things. Good luck.
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[USER=”2987″]dh305[/USER] second try
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quote dh305:[USER=”2580″]DrBrown[/USER]
I did request my operative notes like many on this board suggest, and it said that my right side was a direct hernia, left side was an indirect hernia and umbilical was “incidental“. Prolene mesh 3 x 6 used on both inguinal hernias.
You didn’t mention the other hernias and the use of mesh in your first post. The mesh will cause the areas it contacts to shrink and stiffen. This most likely puts abnormal stress on the umbilical area. So, even though no mesh was used for the umbilical hernia repair, the other two pieces of mesh are probably affecting it. The size of the mesh looks like you had a laparoscopic procedure done.
What was your original reason for seeing a doctor?
Your case might be an example of how the secondary affects of a surgery can be worse than the original problem. Good luck.
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quote andrew1982:Hi Everyone,
i am a 37 year old male in good physical condition. I was suffering from a reflectively small right side inguinal hernia for approx 1 year that caused no pain but needed to be pushed back in regularly so I decided to have it repaired.
I had open surgery (non-mesh) 2 weeks ago, details of which are as follows:
–neurolysis of the illionguinal nerve
–neurolysis and neurectomy of the genital branch of the Genitofemoral nerve
-hernioplasty (minimal repair technique)
-pre-peritoneal lipoma resected.
Hello andrew1982. I just created a new topic including an article about post-surgery pain, and your topic drew my attention as a result. It is really surprising to see that your surgeon performed neurolysis as a prophylactic measure, in other words, to prevent a future problem, that did not exist at the time of surgery. It has been expressed by the professionals on the site that this is not “standard of care” for a hernia repair.
Since the damage is done, all you can reasonably do, I think, is try to let things heal completely then try to work back to your desired level of fitness and activity.
Beware the pain management programs, they most likely do not have specific regimens for people who have had their nerves cut already. Neurolysis is supposed to be a last resort, not a prophylactic measure. So you are not a typical pain management patient.
Here is a link to the paper I just posted about. It might have something useful in it. Good luck.
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And the conclusion:
” Conclusion
Although tension-free procedures are considered as the gold standard of hernia repair, persistent postoperative pain continues to be reported after mesh implantations. Management of patients with chronic NP is a common and challenging problem after IHR. The complexity of mechanisms, wide variety of causes, and heterogeneity in clinical presentation require meticulous assessment and special investigations to recognize the NP, and multidisciplinary approach to produce effective treatment. More clinical trials are needed to identify patients who are at high risk and to develop preventive treatment strategies of chronic NP following hernia surgery.”
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The abstract is a bit misleading if not read carefully. He reports that 31% of patients who have “persistent postsurgical pain” develop neuropathic pain. Not that 31% of all patients develop pain. To be clear. He does not attempt to compile or estimate the actual chronic pain rate.
” Incidence
The reported incidence of chronic pain following IHR varies widely because of the nonstandardization of follow-up period, the diversity of pain-assessment methods and pain descriptors, and multiplicity of surgical procedures (open vs. laparoscopic repair and mesh vs. nonmesh repair). In a relatively recent systematic literature review, the prevalence of NP was 31% among patients with persistent postsurgical pain after IHR”
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The comments up to this point have been rational and reasonable. Numbers based. The message is – be very careful, do your research, it’s easy to take the easy decision but there is a well-defined risk to that decision.
Ad hominem attacks, attacking the person instead of addressing their words, are what is used when the argument is failing. There is no “zealotry” here. Just people supplying numbers to accurately describe the risk. For the sake of future patients, so that they will realize that there is undisclosed risk.
Don’t feel guilty or offended because people think that you are lucky. You did not control your fate with your efforts to find a good surgeon. You increased your own personal odds of a bad surgery, but the overall odds of a mesh reaction are still the same. An ~one in six chance of pain or discomfort. If you can find data that shows certain products have been confirmed, over the long-term, to cause less chronic pain, please show them.
Here’s a sample of one surgeon’s actions. He is in the middle of the whole mesh device scene, developing new products and methods for sale on one end, then suggesting pain management methods on the other. A person would think that stopping the action that causes the pain would be the first decision, but, somehow, creating the pain then managing it, is the new norm. I can’t imagine what it must feel like to be in the middle of this mess, as a physician.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896652/
https://www.ncbi.nlm.nih.gov/pubmed/24756905
Here is his attempt to fix his product that was delivered to market with no long-term testing. The patients were, effectively, the test subjects, apparently.
https://pdfs.semanticscholar.org/345c/018e3c2e7c54e723ca8e6d6f99b74a696501.pdf
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There is quite a bit on the forum about incisional hernias. Including some very recent comments in relevant threads. Nothing has changed much over the six years since this forum was started.
Since you have a large incision it would probably be very difficult to find a surgeon who will know how to close it effectively with sutures. If you decide to go with a mesh procedure, do extensive research on the types of mesh, and how they are used, ,and what the benefits are of each. Many clinics and hospitals have their “meshes” chosen by their purchasing departments. Lowest bidder mesh. The purchasing departments lump all mesh products in to one category, despite the device makers efforts to differentiate their products.
In other words, you need to become an expert in mesh devices and how they are supposed to work, if you want to increase your odds of success. There are at least four distinct polymer fibers used to make mesh, and many many different knit patterns. There are coated meshes, mesh-like biological materials, degradable meshes, and composite meshes. Supposedly they all have distinct pros and cons but few surgeon wills probably be able to describe well what they are, or why they believe in any certain product.
Take your time and learn. You’re at high risk of developing a persistent problem. You might also consider that you should not have acquired an infection from your original surgery. That clinic might be dirty, and best avoided.
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Was the repair of the recurrence a mesh repair or a suture repair? It sounds like you’re saying that they did an open mesh repair on top of a laparoscopic mesh repair. Creating a “sandwich”, with mesh on the inside and the outside of the abdominal wall.
Get the details of your surgery and their might be a clue. But you’ve had a lot of trauma in the last few months, 4 months since the lap repair and 4 days since the recurrence open repair. Mesh does not generally tear or break. It sounds like some nerves were damaged, causing referred pain.
Good luck. Get the details.
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[USER=”3035″]T. Johnson[/USER] Find a surgeon who removes mesh to talk to. They will be open-minded and consider all of the possible causes and solutions to your problem.
From my own experience and research I’ve found that most surgeons who repair hernias with mesh will go to extreme lengths, mentally, to believe in the mesh solution. They will waste your time and money sending you to various other specialists, who will not have experience with mesh problems. They will deny, deflect, and dissemble until eventually they give up and stop responding to you. The situation has been this way for many years. The hernia repair field is essentially owned by the mesh device makers. They sponsor the conferences and support the institutions that train future surgeons. They sponsor research designed to show the benefits of mesh but do not show the benefits of non-mesh solutions. The “International” “Guidelines” are the example of these things.
Sicily and myself followed very similar paths. He, so far, has a good result. I had a bad result. My surgeon for the Bard Soft Mesh implantation is well-known and respected in the field. But he is still captured by the device makers’ control of the hernia repair field. To his credit though, he was in the process of finding me a mesh removal surgeon when I found Dr. Billing instead.
Good luck. Don’t trust the “system”. It is designed primarily for the masses, the average patient. You are outside of the norm so need to think that way.
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I think that Dr. Brown will know best. I don’t think that there is anyone out here who could second-guess what he advises.
Good luck.
[USER=”2969″]Gab1949[/USER]
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It was the insidious and persistent degradation of me, physically, mentally, and emotionally. I could not get out and be physically active without suffering, or “paying for it” afterward, for days at a time. I was spending so much time trying to define the very small cage that I was living in that I was neglecting personal relationships. I was no longer “available’ to family members that had been used to my help in the past. They suffered too as a result. My whole life was revolving around trying to manage my messed up abdomen. Even though this was enough to warrant removing the mesh, to my thinking, more serious issues started to develop. My penis was affected physically, in ways more than just erectile. My digestive system did not work the way it had when I felt healthy. Physically, the degradation seemed to be getting worse.
Overall, I felt like I was just waiting to die. Life was not enjoyable anymore. There was no hope of managing the mesh problem back to some sort of life worth living. the decison to have the mesh removed was easy. Ffinding the right person to do it still took a lot of work. It has been almost two years since the mesh was removed and the more time that goes by the more I realize that Dr. Billing is very skilled at mesh removal.
Since having the mesh removed, all of those problems have resolved. I’m still damaged down there, my abdomen is still abnormally flat, but all of the normal bodily functions have come back. As a result I am also “back”, involved in life, and looking forward to better things. Having mesh implanted to fix a hernia was the worst decision I ever made. Having it removed was the best.
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What did your surgeon say when you asked them?
They should have deep knowledge of possible side effects of their method and materials. There are so many variations that only the surgeon who does the work can really know what might go wrong, or what has gone wrong in the past, with their method and material.
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Got blocked –
You are parroting the talking points of the mesh repair industry. By insinuation, blaming chronic pain/discomfort on the lack of skill of the surgeon. That plays directly in toe pockets of the mesh makers.
Here’s a question for you – who are you trying to convince, and why? You pulled the trigger and hit an empty chamber. Why hand the weapon to the next guy, assuming that they will hit an empty one also? The odds don’t change. There’s still a chronic pain bullet in the weapon.
You should really just be happy that you are one of the lucky 5 of 6. There is no way, yet, to predict who will be lucky and who won’t.
Read ajm222’s post, from his first to his last, recently. He went through the identical process you describe. But he, apparently, is not one of the lucky ones. Same situation, different result. https://www.herniatalk.com/member/2051-ajm222
You put some good research, but, in the end, it’s still luck. I hope you stay lucky, but I don’t think that you should be trying to convince people that they can control the outcome of their decision. The evidence says it’s not possible, where mesh is involved.
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Sorry Julian, I thought that Dr. Brown would have some thoughts on how the nerves affect the muscles around them. He often recommends injections to determine which nerves are affected and is known for working on athletes. Maybe he missed my notification.
[USER=”3027″]Julian[/USER]
[USER=”2580″]DrBrown[/USER]
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quote Sicily63:It was repaired by Dr. Brian Pellini at Doylestown Hospital in Pennsylvania. He used a laparoscopic TEP repair and polypropylene mesh with no fixation.
And, the actual brand of mesh would help, if type of mesh is actually a factor. Polypropylene is just a polymer that is used in many different knit patterns. the word does not really help make a decision, there are many device makers that use it. The brand and model of mesh might be important.