Good intentions
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[USER=”2580″]DrBrown[/USER] inquired recently about CBD products and got some good responses. It was a couple of months ago, maybe he’s seen some results.
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As I understand things, both Dr. Brown and Dr. Kang understand groin anatomy and the various named techniques well enough to produce appropriate variations as they see fit. They asses each situation as they go and choose the most appropriate way to solve the problem.
Also, as I understand things, the “Marcy” technique is used for indirect hernias. So the type of your hernia will matter.
Both Dr. Brown and Dr. Kang have seen the damage that mesh can cause and have made a conscious and informed decision to avoid using mesh if possible. Named techniques, by their nature, are self-limiting. I would choose a surgeon who knows all of the techniques, and understands the basis behind them, and uses them in the way that is best for the patient..
Good luck.
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If you’re traveling to Shouldice Hospital you might as well consider [USER=”2580″]DrBrown[/USER] or [USER=”935″]drtowfigh[/USER] . Worth talking to for sure.
https://www.sportshernia.com/sports-hernia-specialist/
Good luck.
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That would be a fascinating position from a sports-based physician. It’s been stated that professional athletes get mesh for hernia repair and they would probably be more core-strength focused than anyone, besides maybe a construction worker. Seems contradictory, how would they train?
Chiropracty though, no offense intended, is thought of by many, for whatever reasons, as “fringe” medicine. You should get more specific information if you can. Offhand comments should be backed up by research. He or she should have some data behind their statement. It might be firsthand experience with athletes, who knows.
Good luck.
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quote allj:New surgeon is going to put in a heart skin muscle from a pig covered with a plastic mesh. He wants to cut the inguinal higher and thinks the sensations that are being picked up are from the iliohypo nerve and wants to cut that up. If I understood him correctly he said the new mesh and skin will make it difficult if not impossible to do the ilihypo later if that is causing a problem.
Good luck Alan. You are far in to the realm of experimentation. As has been written on the site by real surgeons, the various nerves are not distinct and separate. There is “cross talk” and interconnectivity.
Why is he planning to implant more mesh, for a pain problem? Do you have another hernia? I would be worried. Consciously or subconsciously, older people are seen as not worth as much time and effort as younger people. There was an article very recently in one of the major publications, the NY Times I think, about it. Your surgeon is planning to use a new and unproven (in humans) material and cut nerves that he is unsure of, creating a situation that will, by his own words, be permanent and unfixable. I don’t see any good coming from his plan. Lots of guessing and hoping.
Read mamadunlop’s stories and plan carefully.
https://www.herniatalk.com/5197-6-hernia-surgeries-6-months-post-op-new-pain
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quote allj:Dr. Towfigh – The surgeon wants to re-cut the inguinal nerve higher up and the iliohypo at the same time. He said if it isn’t done during the lap procedure it will be buried in the mesh and difficult to impossible to do later.
Hello Alan. Did you mean scar tissue when you said mesh? Your first post said you’ve already had a mesh removal.
I would get a second and third opinion. If your first surgeon gets offended then they probably don’t really have your best interests in mind.
I think that cutting nerves is in the same category as amputation. Just cut the offending body part off and the problem is gone. But new ones will appear. It’s a simplistic approach to a complex problem.
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Your mesh removal surgeon would know best. The great irony of mesh removal is that it is not taught in medical school or residency, but mesh implantation is. Mesh removal is a problem that only brave and conscientious surgeons take on. So there is no “best” procedure that has been agreed upon. I think that surgeons who do mesh removal talk to each other, because it is such a difficult and tedious procedure, but not discussed much at the big meetings. You should really ask your surgeon what they plan to do, before surgery.
Good luck. Be aware that the recovery from mesh removal can be slow. The body has been fighting it for as long as it’s been there, and much of that will be undone over time.
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quote Herr87:I have had pain for the past three years following lithotripsy for kidney stones in both kidneys. I have been put on antibiotics, spasm meds, amitriptyline and cymbalta for nerve pain, had physical therapy..but still have intermittent pain, especially with bowel movements or sitting too long or being on my feet too long.
Is the pain similar to the pain before the lithotripsy? Maybe you had two conditions at the same time. In other words, the pain might not be related to the lithotripsy.
If your medical plan allows it try to find a specialist in hernias. Beware the possibility of getting a “repair” for a hernia that does not exist though. Mesh implantation is very popular and very close to being used in a prophylactic manner.
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quote NoMorePain:I had a mesh patch placed in ab in 2011 in Texas. It was to cover an umbilical hernia that happened after natural birth.
A pelvic exam with contrast showed a small amount of fat escaping from the side of the repair/patch. Medical team suggests thats the cause of my discomfort. They also advise another patch placement for that..
The general term for the “fat escaping” would be recurrence. You’ve had a recurrence of your original hernia, a failure of the original repair. You should seek out a hernia expert, since the “standard of care” in 2011 did not work for you. You don’t want to get in to a cycle of repair and failure.
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What part of the world are you in? And what type of surgery the first time, open or laparoscopic?
Some people’s physiology does not actually behave like it is proposed that everyone’s does. The ideal s that the body becomes “one” with the mesh, creating an abdominal wall stronger than ever, with no discomfort. My mesh was constantly inflamed. Constant inflammation means constant weak tissue. More mesh seems like more problems.
You’re in that situation where the surgeons are trying to “salvage” the mesh procedure without really understanding what happened. You might be better off to go back a proven suture-based repair method. There are so many variations of mesh and method that nobody really knows what will happen in any individual patient. Your body didn’t “incorporate” the mesh as planned, no reason to expect better results on the second try.
There are people on this forum who have stories of multiple mesh implantations, with a string of failures. Be careful.
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quote Mariel:just hoping for some reassurance that this is all normal for small person and will eventually go away (?)
Only time will tell. The possible combinations of mesh type, surgery type, mesh placement, and individual physiology is incredibly large. Nobody really knows what each patient’s results will be. I felt like I had a sponge inside me for months. Lifting heavy weights at the gym seemed to squeeze the fluids out and tighten things up. Keep track of what you do and what happens later, and let those correlations guide you.
You’re still very early though. Probably have not even been released for normal activity yet. Good luck.
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quote PeterC:My physical therapist at the time worked closely with surgeons/doctors who work for a NHL hockey team and somehow got me to speak to them because I was on the front page of the newspaper and it got them excited. They had me do an ultrasound with a doctor
who specializes sports hernia. His findings were: Partial adductor tendon tear, partial oblique tear but nothing near the original site of pain. As my situation wasn’t getting better and I was
distressed – I finally agreed for them to do an open surgery on my right groin (because I just needed to get back to dancing asap). they found a tear over my inguinal canal – placed a mesh and voila[USER=”2580″]DrBrown[/USER] is an expert in athletic pubalgia (AKA sports hernia), and also in diagnosing pain sources.
It might help to know exactly what the surgeons found and exactly what they did by getting your surgery notes from the surgeon or the facility where the surgery was performed.
Letting the damage heal and getting back to dancing ASAP sounds like original damage might never have healed. The Vincera Institute in Philadelphia also specializes in athletic pubalgia and they repair the damage then have the patient do specific PT activities.
It sounds like your surgeon(s) found something that they were’t looking for, “fixed” it, but didn’t fix the source of your real problem. The foamy urine might be a red herring also, not related to the pain.
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Both are interesting surgeons, who remove mesh, but also use it for hernia repair. They both have significant involvement at the big surgery meetings, and in the hernia repair societies, and are well-known there.
You will most likely be offered a mesh-based repair by both. Almost certainly laparoscopic, probably robotic. Quiz them on their success rate, in real percentages, don’t accept “most” or “majority” as answers, including length of time that they stay in touch with their patients, and percentages of chronic pain after many years. Reasonable questions for any hernia repair surgeon to address.
Good luck. I think that you’ll find that most of the surgeons that you talk to don’t really know if their patients are doing well, years after their surgeries. It will be difficult to get direct information about the main issue of chronic pain or discomfort.
Don’t overlook the difficulty in fixing the results of each type of surgery if things don’t go well. Even within the mesh repair category, some methods and materials are easier to fix than others. The more they use the harder it is to get out.
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Good luck [USER=”2882″]Colrie87[/USER] . Healing can take a while so don’t worry too much in the first few days. It would be interesting to know what he found and what technique he used.
Take care.
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When I had my exploration and mesh removal, the surgeon, Dr. Billing, noted that both sides looked normal, from inside, using TAPP. This was noted in my notes from surgery. I had the mesh implanted via TEP. It wasn’t until he peeled the peritoneum back that he could see that one side was folded. He did the most painful side first, and the other side a month later. The other side did not have any folds, it had moved downward but otherwise was flat and well-placed. But both sides had looked the same on the first examination, from inside. That might be what you’re reading about, the fact that you can’t see mesh problems from inside like you can see a hernia. Apparently, a hernia will cause a depression that can be seen from inside.
On the second removal he tried to take a look at the first removal site but reported that he couldn’t because there was an adhesion. I got the impression that it’s not uncommon. But I’ve been fine with the adhesion, no complications. He also noted the second side, which was placed properly and had not folded, was edematous. It was inflamed and surrounded by fluid. That apparently did not show from the other side of the peritoneum either.
The peritoneum is an interesting thing. Apparently it can react almost as a whole to try and reform and protect the intestines. It seems like it’s a race between the peritoneum and the other healing response that causes adhesion. I think that adhesions are also possible with open surgery if the peritoneum is breached during removal. One advantage of TAPP, I think, is that the surgeon can see the work that’s been done before allowing the intestines to make contact with the peritoneum again. With open surgery maybe not so easy. But I am no expert.
Good luck.
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Not everybody has the resources to travel the country or the world to find the very best option. Let’s hope that [USER=”2882″]Colrie87[/USER] does well with the best she can do in her situation. Good luck Colrie87.
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OHSU would be a likely source. Dr. Martindale and Dr. Orenstein are there and both are students of hernias. Plus it seems like there is a link to Kaiser.
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Sorry [USER=”2854″]localCivilian[/USER] I can’t find the reference. It’s just something I’ve read in the past, about absorbable sutures. They don’t always dissolve at the rate that they are expected to. I think that I read it in a report about what surgeons have found when they were entering an area that had had previous procedures. It might have been a video. Sutures that should have been gone were still there.
If I find something I’ll post it.
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quote Informedpatient21:You might be surprised to hear that I’m over two years out since my Ovitex repair and seven years out from my mesh repair. They were both direct hernia’s. I’m currently 280 lbs and consider myself still an athlete however clearly in a lot poorer shape than I once was, which makes this an even more interesting “experiment”.
Again, the main difference I notice, is that there is noticeably more restriction sensation and occasional pain on the synthetic side that I have learned to deal with over time.
Aside from our discussion about the mesh market in general, the details of your first hernia repair (type/brand of mesh, method of placement, etc.) would be very useful, along with your reasoning against using a synthetic mesh again, and for using a new product with no long-term human results. I can’t remember the details of the 31 patient paper, but I wouldn’t be surprised if none of them knew that Ovitex was used. Many patients have their hernias repaired and have no idea that any mesh device was used at all. You’re one of the few people who can supply a device to device comparison.
Those details could identify a “bad” mesh device, and show potential for a new device. Allowing people to at least avoid one device, and maybe choose Ovitex.
Ovitex’s difficulty in marketing the new device will be that they are competing against all of the bad products that have almost identical marketing data on their web pages. Internal results, IHMR results, labels like “gold standard”, etc. Looking at marketing literature alone, they all look amazing. Real world anecdotes like yours might be the best true information that a patient can find.