Good intentions
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The pain indicates that the material, “fat” or omentum, has already pushed through, or created, an opening. The “fat” in the canal indicates that “breakthrough” has already occurred.
The odds of intestine strangulation are low, especially if there is no intestine in the canals now. The odds of chronic pain from mesh are about one in six. Don’t get in a hurry to get this new problem behind you. Use the numbers and data available to make the right decision for the rest of your life. Mesh problems can not be “fixed”, only modified to less painful problems. Even if you schedule a procedure to get on the books continue to do research, and change your mind if you don’t feel right about it. There is very little accountability for problems with hernia repair. You will have very little recourse if you have problems. Get it right the first time.
Be very careful when listening at your consultations. Don’t get persuaded by confident words if they can’t be verified. Don’t confuse the number of implantations they’ve done with expertise in understanding how to minimize your risk of chronic pain. If your surgeon can only talk about how many operations they’ve performed but not about the long-term success rate of those procedures find a different surgeon. All surgeons should know how their work lasts, over many years. Lack of knowledge does not mean success. Mesh repair is easy and simple for the surgeon but the consequences can be huge and difficult for you. Experience in mesh implantation is not the same as hernia repair expertise.
Good luck.
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This Topic, linked below, might help your thought process. Fascinating how “mesh” has completely taken over the hernia repair field. Almost exclusively due to the Herniasurge “International” Guidelines. The result of that single effort, the meeting and the publication, is treated as gospel. The people behind it got everything that they hoped for. It’s incredible.
https://www.herniatalk.com/10885-surgeons-with-hernias-what-would-they-do
https://twitter.com/Herniadoc/status/1114246402950012930
Fascinating audience polling by @DrMicki of laparoscopic general / hernia surgeons. Here are 3 questions:
Q1: how many of you would have your minimally symptomatic inguinal hernia repaired?
A: 56% choose watchful waiting. pic.twitter.com/oZ0RCpcknH— Dr. Shirin Towfigh (@Herniadoc) April 5, 2019
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The mesh does not grow in to your existing tissue. Your body creates new tissue around the mesh fibers.
Somewhere around three to four weeks is considered the point at which the mesh has been enveloped enough by body tissue that it can’t easily be pulled free. But the body will continue to try to get back to its original “code” forever. At two months I think that most surgeons would consider your device fully “incorporated”. That is a misnomer, of course, since the mesh never becomes one with the body.
You’ve been talking to experts, I suggest asking them these questions directly. Do they see better results from early removal than late? Is there a certain length of time after which waiting is pointless? The patient will never get better? If they know the answer then they can help people get on with their lives when they have problems. It’s a difficult question because they, and we, all want to believe that the body will heal itself if given enough time. Often, I think, the reality is that the patient just accepts their new diminished life.
I was surprised in your other topic that Dr. Jacob was ready to remove your mesh right away. He is very active in the field. That is telling. He must know something, or he is just very confident in his abilities. Or he might have seen some flaws in the method or material used on you.
Good luck. Keep collecting information. Eventually an answer will come.
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Can you give more detail on the surgery? “Laparoscopic with mesh” covers many different combinations of material and method. Which side was the original hernia on? Did the surgeon find another and repair it while he/she was there?
The answer to both of your questions is yes. People have had your problem, and mesh does fold. Read through the many topics on the site, there is a recent one with a similar problem. I think that any direct contact of a nerve with the mesh can cause pain.
Get your surgery notes and there might be some clues there. The advice that you will receive is to wait and see what happens, because it’s only been three weeks. Good luck.
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Since you know what at least one type of mesh repair feels like, consider a suture-based repair on the second one. If it fails, via recurrence not chronic pain, then you can always get a mesh repair. The logical path of hernia repair is suture first, then take the risk of chronic pain frommesh if the suture repair fails.
Today’s methodology gives all patients the highest risk of chronic pain/discomfort from the very beginning. Start over from the less risky point.
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It looks like you’re taking the right approach, collecting information from the experts. Fascinating though that there are so many different opinions.
I found that over time I developed a fairly accurate idea of what was happening with my mesh problem. It was a broad-based inflamed feeling, wherever the mesh was, with a specific area that felt wrong. And that’s what was found, a folded area with nerve entrapment in the specific area and edematous tissue, tissue swollen with excess fluid, wherever the mesh was. As you learn more about how the mesh was placed and what was intended and what could have gone wrong you’ll probably understand what the root cause of your problem is.
I would still follow up on the odd parts of your notes. You might find that they are incorrect, or that they are correct and the wrong mesh was used. Parietene is not indicated for inguinal hernias. That might be a more significant reason to have the mesh removed, if he used the wrong material it might be prone to worse problems in the long-term. “Transparent” polypropylene is not the same as normal semi-crystalline polypropylene, and the anti-adhesion properties might give unknown results. You might be part of an experiment.
I hope that you find a simple solution but it’s best to be prepared for the worst.
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What was your friend’s original problem? You might be comparing apples to oranges.
Listen carefully to what the professionals tell you. Your description, “barely touching it produces 10/10 pain”, suggests that you have direct contact with a nerve. I am just a guy on the internet but I see just one factor, not a vague “multi-factorial” problem.
There is still much that is odd about your story. Odd mesh, odd procedure. Get a second opinion from a respected hernia expert. It’s too soon to be taking advice from friends with non-specific problems.
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quote Lee_2019:Hi, I’m in my mid 40’s and had laparoscopic mesh repair 8 weeks ago for an inguinal hernia.
Should I be concerned that I’ve compromised my hernia repair?
Your body will be adapting to the hernia repair mesh for years, actually for the rest of your life. It is a “foreign body”. As the body reacts to it, it and the tissue around it will contract. Then your activities will restretch those tissues, causing damage and more shrinkage. The cycle will continue until you hit a stable point if you are lucky.
Browse through the topics on the forum and you’ll get a feel for what to expect.
Good luck.
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quote inguinalpete:A bunghole named Dr. Daniel vargo of university of utah did a triple nerve removal on me during a sports hernia operation after saying none would be removed. The only Ill effect has been some skin numbness. The progrip mesh is the problem for me.
The insults won’t help to find a solution, although the urge is understood. Objective analysis is the way to go, I think.
Mesh is not typically used for sports hernia repair. I don’t think that neurectomy is either. It looks like you might have had a misdiagnosis from the beginning, and your “sports hernia” was actually an inguinal hernia. Mesh has no place in athletic pubalgia repair according to surgeons who understand the problem.
[USER=”2580″]DrBrown[/USER] [USER=”935″]drtowfigh[/USER]
Still not right to perform a prophylactic triple neurectomy. Seems like mal practice.
Good luck. Start a topic specific to your problem and people might have some advice.
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Joshio, your method actually looks like a “modified” Lichtenstein method, by the descriptions in the video below. You can find people touting the benefits of mesh but still experimenting. Lichtenstein’s method is perfected but needs more perfecting. The usual comments about tension and avoiding nerves, even though tension is created during the healing process, pulling on the nerves. The use of Parietene is still odd.
Do some research on the nerves that are described and you’ll probably find the one that affects your pain. The mesh is probably rubbing on the nerve or a suture has pulled free. You have a difficult problem ahead of you. Pain management will treat the symptoms but leave the cause. And there are very recent studies confirming that NSAID’s are even worse for people than has been disclosed in the past. Long-term use of pharmaceuticals is not really a solution.
Good luck.
3:00, 5:30, and 8:45 are interesting points.
https://www.youtube.com/watch?v=YG_9bv2A-UM
NSAID’s
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772
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You have a strange situation Joshio. Parietene is not, apparently, designed for inguinal hernia repair. It’s a composite mesh, designed to reduce adhesions. And your surgery notes say some things that seem unusual, although I am not a surgeon so might be wrong. It seems like he did quite a bit of suturing. Overall, it looks like you’ve had an unusual material used in an unusual way.
If I read the notes right, you had an indirect hernia. The surgeon basically reformed your internal ring, using mesh, but used a lot more mesh than seems necessary. All the way to the pubic tubercle. Your report reads oddly so getting a second opinion from another hernia expert still seems advisable. Surgeons can do whatever they feel is appropriate. It looks like yours had some unique ideas.
Although his method might be the latest and greatest, for open with mesh. It’s hard to tell. Good luck.
[USER=”935″]drtowfigh[/USER]
[USER=”2580″]DrBrown[/USER]
https://www.medtronic.com/covidien/en-us/products/hernia-repair/parietene-ds-composite-mesh.html
“Parietene™ DS composite mesh is part of our commitment to offering solutions that can help you advance patient care.
It’s made from a transparent macroporous polypropylene that’s easy to work with because it’s not too soft or too rigid.1,2
Plus, on one side, we’ve given it an absorbable synthetic film to help minimize unwanted tissue attachment.3,†
The result is a balanced mesh that’s been designed with you — and your patients — in mind.
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It sounds like one of your main nerves is in contact with the mesh or has been damaged, or is bound up in scar tissue and being stressed. It’s not uncommon. A hernia specialist will know. Beware the runaround that often happens when there are problems with a mesh repair. You can spend a lot of time and money while “they” send you from specialist to specialist, hoping that you just learn to live with the new problem. Waiting for you to give up. The referral to a urologist is typical, urologists generally know very little about mesh repairs except that the mesh is in the way for prostate surgery.
It looks like you might have had your surgery at Dr. Wright’s place of practice. Can you share the details of your surgery notes?
https://www.uwmedicine.org/locations/general-surgery-harborview
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Get a copy of your medical records. “Open with mesh” is not enough information. There are many many types of mesh devices that are implanted via open surgery, or anterior approach, as they say.
The low testicle is probably due to irritation/inflammation/swelling of the spermatic cord and cremaster muscle, although testicular pain is not normal. That could be a sign of a more serious problem.
Seek a second opinion from a hernia expert. Find one yourself, don’t get stuck in the referral cycle. The staff at many places will just use the internet like you would to choose a referral. There is a surgeon at the University of Washington who seems conscientious, involved, and aware. Dr. Wright, I believe.
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Thank you Jnomesh, and I wish you the same. It still shocks me to realize how insulated the medical community is, in general, from the true welfare of their patients. They perform “procedures” based on instructions generated to facilitate smooth processing of the patient, including payment for service rendered, pay by the code, but have little idea what the results of their work really are, beyond a few weeks after the procedure. Get ’em in, get ’em out, somebody else’s problem. There must be some significant psychological denial involved, and some confusion about how the work they do is not the work that they had thought it would be. By sharing our true stories, hopefully a few surgeons can become more aware, and generate the energy to change, and become more true to their oath.
Good luck.
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quote Hiway40blues:Hi-my first post here. I had an IH open-with-mesh repair last Fall (October) on my right abdomen. I decided on ‘open’ for various reasons, including a strong fear of general anesthesia. Anyway it went well, still have occasional tenderness, etc.,
Mesh causes tissue shrinkage and also makes the area around the mesh less flexible. This causes distortion and pulling on the other side. I think that it’s reasonable to assume that mesh repair on one side actually increases the risk of getting a hernia on the other side.
If a study was done comparing 2nd hernias after repair, mesh repairs would probably show a higher rate. Another irony of mesh repair.
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You seem to be letting the “system” decide what to do rather than deciding yourself and finding a way to make it happen. No offense. For example, local anesthetic is commonly preferred for open hernia surgery, not general anesthetic. So your surgeon seems off-track from the start. You should easily be able to find a surgeon who does open repair under local anesthetic. And, the right surgeon will leave very small imperceptible scars, even with open surgery.
Also, you said that you “pretty much” have to have open mesh repair. Why? Research the best method for you and find a way to get that repair method.
Taking control of the situation will reduce your anxiety.
As far as waiting, a recent survey of surgeons at a large meeting of surgeons revealed that the vast majority of them would wait to have hernia surgery. They would avoid rushing to fix something that might not need fixing right away. Ironically, possibly, some of them were probably the same surgeons who would tell their patients scare stories about dying from strangulated intestines due to hernias.
It sounds like you have a direct hernia that is easily reducible. Also that you are not a senior citizen. So, waiting and researching, to find the best method for you seems advisable. Don’t hurry to try and “get it over with”. It is a major decision in your life and could affect it in major ways. It’s a simple and easy procedure for the surgeons, but can have devastating effects for the patient.
Good luck.
Here is an article that addresses many of your concerns.
https://pdfs.semanticscholar.org/99f5/b4859c34312687effcef2d38697b1f9c73f2.pdf
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quote jzinckgra:Turns out the mesh from the lapro repair extended over to the side of the new repair. The Dr. questioned why my larpro surgeon used such a large (4×6″) patch for what was a pretty small hernia.
Had I gone back to the lapro surgeon, would he have also been challenged by needing to remove and/or make room for the new patch on the right side?
Since the Onstep procedure does extend down to the pubic symphysis I guess it does make sense. Both procedures go deep and toward the midline.
What is kind of surprising is that Dr. Reinhorn was not aware of the trend toward implanting the biggest piece of mesh that will fit, for laparoscopic mesh implantation. He should have seen “laparoscopic mesh” and thought “there’s going to be mesh in my way”. He should not have been surprised because that’s been “state-of-the-art” for many years.
The surgeon who implanted the mesh that I later had removed actually overlapped the two pieces at the midline by about a 1/4 inch. I don’t know if it’s in the “Guidelines” to do that but I guess that he was planning for shrinkage. If you had gone back to your same surgeon he probably would have just laid it down as close as possible, maybe even overlapping it. That’s how the lap procedure works, just lay it down, close things up, and let whatever happens happen.
He does not report any fixation, so it’s still possible that it moved.
“The mesh extended lateral to the internal ring,deep to the Coope/s ligament and to the midline. CO2 was then evacuated under direct visualization as the trocars were removed. The mesh maintained good position and trocar sites were hemostaiic.” ”
Whatever the reason, good luck.
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It’s all short-term short-sighted thinking, and staying with the herd. Anyone who thinks as an individual, objectively, can see that the old ~5% recurrence rate from open suture repair, has been traded for about the same recurrence rate with laparoscopy, but a much higher ~15% chronic pain rate. All for a smoother, less costly procedure in the short-term. Get ’em in, get ’em out. Being a doctor in today’s era is not about healing individuals anymore, it’s about tending to the masses, apparently.
You’ll probably have to travel. Don’t try to beat the bureaucracy, you’ll waste too much time and effort. It has the power of the medical device industry behind it also. That’s where the Guidelines originated.
Good luck.
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Yes, there is something off with the overall description. Either the original mesh was placed incorrectly or moved immediately, or it moved quite a distance before it was “incorporated”, or it migrated over a longer time, or jzinckgra actually had a bilateral mesh placement. The notes from the first surgery would tell something. Without those it’s a mystery.