Good intentions
Forum Replies Created
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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.
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Contact Dr. Peter Billing, in Kirkland, WA. https://transformweightloss.com/
He moved to Kirkland, from Shoreline. He does laparoscopic TAPP removal. I have had very good results after his removal of the Bard Soft Mesh that I had originally implanted for “repair” of a direct right side hernia. Two 6×6 pieces, ~ 60 inches squared I’d guess, after trimming to fit.
https://www.google.com/search?source=hp&ei=h7sXXdC1NeKCk-4PvYKS-Ag&q=site%3Aherniatalk.com+peter+billing&oq=site%3Aherniatalk.com+peter+billing&gs_l=psy-ab.3…956.21271..21528…1.0..0.60.1604.40……0….1..gws-wiz…..0..0j0i131j0i10.QtRjlFT27Dc
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Dr. Heniford is one of the few surgeons that vocally questions what is happening in the hernia repair industry. He has asked “who are we protecting” about what is happening. I think that he sees that the device makers have too much influence.
He used to be part of the Carolinas group but has apparently moved to a different practice. Good luck. [USER=”2845″]lkdivers[/USER]
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[USER=”1438″]jzinckgra[/USER] I saw your post of today that contained the records. Apparently it’s been removed or unapproved for some reason, since I saw it this morning.
But I noticed that the records implied that the new hernia was on the same side, the right, as the old one. It might just have been a typo in your medical procedure notes, my medical notes had significant errors also, with metal tacks mentioned, which were not seen by MRI or found during later mesh removal, and also referring to me as “she” in one instance.
Anyway, if you can get the records from your first surgery that would help you understand why the mesh was there, possibly. I still think it’s possible that you had bilateral repair, but just did not realize it.
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An excerpt from the article, at the end.
As to which approach and materials are best, again, there is no consensus. “When we look at all the ventral hernia repairs in contaminated fields—randomized to suture, synthetic and biologic—we find little difference,” Dr. Moran-Atkin said.
There tend to be fewer surgical site infections associated with suture repairs, and recurrence and reoperation are seen less frequently in patients who receive synthetic mesh, but no approach appears to be statistically significant to another. “Really, just do whatever you can to get it closed.”
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Here is an interesting article indirectly related to incisional hernias.
You can register for the site pretty easily to view the full article. It’s worth doing.
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[USER=”1438″]jzinckgra[/USER] My notification did not work the first time.
jzinck, do you have a copy of your medical records? They would be worth examining. Actually Dr. Reinhorn probably should have examined them also, but I think that some doctors just work with whatever they find once they get in there.
All patients should get copies of their medical records so that they can be as informed as possible if problems occur.
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quote drtowfigh:Interesting that you had a recurrent hernia repaired in anterior open fashion after laparoscopic surgery (that is standard) BUT they chose a repair technique that involved the same posterior space as the laparoscopic repair (not as standard, but I’ve seen it done).
What do you think Dr. Reinhorn did to make space for the Onflex device? And how do you think the mesh from one side got over to the other? That is quite a distance. Did it migrate or was it improperly placed?
Or did jzinckgra actually get a prophylactic placement on the right side also and was unaware?
[USER=”935″]drtowfigh[/USER]
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Here is a previous discussion about all of the variation in materials and method. Who can say which combination is best? Nobody tracks results and most patients only know that they got “mesh”. Most of the new devices are attempts to increase market share of this multi-billion dollar industry.
https://www.herniatalk.com/8126-types-of-mesh-now-being-used
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quote drtowfigh:Let’s not conflate chronic pain after inguinal hernia repair with that of incisional abdominal hernia repair. Two different animals with two different outcomes.
Remember that not all mesh are the same. There is a wide variety of mesh options and surgical techniques, each with their own risk for recurrence and pain.
If inflammation is the cause of the chronic pain/discomfort then location should not matter. It’s localized to the mesh placement itself. Transvaginal mesh and hernia repair mesh have similar problems.
And, as I’m sure you’ve seen and possibly discussed with colleagues, many hernia repair “specialists” just use whatever mesh their purchasing department provides. They consider all “mesh” to be essentially the same. Or they choose their device based on their relationship with the sales rep from the device makers.
(Click “cancel” inthe print window and the article will show) https://www.generalsurgerynews.com/Article/PrintArticle?articleID=34826
So there is the heart of the problem for any new hernia patients. Who really knows what they’re doing and what the potential problems are, and has the patients’ best interests at heart? Everybody needs to be very careful, the opinions about best practice are widely varied, there are many ways to go wrong, and the oversight of the industry is very poor. If you make the wrong choice, fixing that mistake might be impossible. “Get the mesh” is a terrible way to approach the problem.
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My view is that every effort should be made to avoid mesh. Mesh products should be the last resort, due to the high probability of chronic pain.
I’m not a surgeon so don’t know the numbers on incisional hernia repair hernia recurrence if a suture repair is used. They are probably out there somewhere though.
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It is still amazing how many doctors and surgeons just don’t seem to be aware of the potential problems of mesh implantation, and the very high odds that a patient will have problems. 1 of 6 seems to be the number of patients that will develop chronic pain or discomfort.
Read through the Topics on the site and you’ll find much about the dangers of mesh implantation. Find a hernia expert, not a general surgeon who does mesh implantation. It might take some looking because many of the surgeons who implant mesh feel like they are well-trained in a mesh implantation method, but are not really experts in hernia repair.
Unfortunately, in today’s environment, you can’t just trust the title of “surgeon” or doctor. You have to dig deeper. Your mother’s greatest risk is getting a bad mesh implantation and developing chronic pain or discomfort, it’s not the risk of recurrence.
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It’s called Onstep, and Bard makes a device for it called Onflex. You can search those names and find a lot about it.
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Onstep is another new method of mesh placement, introduced to the market with little long-term data. Bard is the device maker behind Onstep. They’ve branded their mesh as “Onflex”.
https://journals.sagepub.com/doi/full/10.1177/1457496914529930
http://ugeskriftet.dk/files/b5467_onstep_repair_of_inguinal_hernias.pdf
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In the center picture you’re pointing at the location of a direct hernia. That’s what I started with, a small painless bump that disappeared. But then I tried to live with it and still play soccer at a competitive level and it got bigger. Typically it didn’t hurt when I played but did for a few days after ward. The bump also got less defined, more diffuse.
If I could start over I’d get a suture-based repair, aka “pure tissue”, then if that didn’t work consider an open mesh repair.
The “standard of care” recommended in Johnson & Johnson’s “International Guidelines” is a laparoscopic mesh repair, TEP if possible, with maximal placement of mesh, even a prophylactic placement on the other side if there is a hint of a hernia there. Ask your surgeon what they would do and that’s probably what he/she will say. Once they get the mesh in it’s essentially impossible to get it out without damage if there are problems.
That is how I read the current mesh repair situation. Good luck. Be careful, and remember that the trend in healthcare today is standardization. One method for everyone, some win some lose. Your odds of losing are about 1 in 6.
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Sorry ajm222, that’s my negative view, the other side of the argument.
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I think that most surgeons don’t think out the full cycle of damage and healing. or they do and just pretend it doesn’t exist. When we exercise we damage tissue, very small tears and cell damage. Normal healing results in stronger muscle and other tissues like ligaments. They get thicker and stronger. With mesh the damage reinvigorates the foreign body response, plus, since the polymer fibers of the mesh are essentially inelastic, any pulling inward of the mesh that happened with activity gets locked in by the new healing response as more “healing tissue” is added on. You can also easily imagine how the edges of the mesh can get pulled inward and folded, since there is no mechanism except the fibers’ stiffness, to push the edges back outward.
Most of the problems of mesh are easily explained by standard physics, mechanics, and material properties. I think that most of the success stories out there are really stories of people drastically reducing their activity levels.