Good intentions
Forum Replies Created
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Good luck Colrie87.
These really are strange times. Don’t be surprised if he tries to talk you in to mesh.
Since you’ll be having open surgery you’ll probably be awake while he’s doing the work. Be prepared to resist if you really do not want it. Know what you want before things get started.
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Thanks [USER=”2856″]mitchtom6[/USER] . Looks like you had Medtronic’s Progrip mesh secured with what are essentially absorbable staples. J&J’s (Ethicon) Securestrap. There is a drawing in the second link. It looks like your hernias were small.
Odd that he used fixation on supposedly self-fixating mesh. That’s the big selling point of Progrip, self-fixation. But after 4 years the tacks should have been absorbed so it seems unlikely that that would be part of your problem. Although, I have seen studies that suggest absorbable tacks often don’t degrade and get absorbed, they get encapsulated instead. Of course, I’m not an expert.
The surgeon did not note the size or type of the device. That should be recorded, with serial number, at the facility where the work was done. Generally they use large pieces though, to allow for shrinkage. It looks like they might also have a “3D”product. “Anatomical”.
Here are some links describing them. J&J’s “International Hernia Mesh Registry” is really just a study of J&J products, apparently to generate marketing data.
https://www.jnjmedicaldevices.com/en-US/product/ethicon-securestrap-absorbable-strap-fixation-device
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That looks like TEP. I am not an expert but the notes are similar to mine, and the balloon is used to bluntly dissect or split the layers, then inflated to create space for the mesh and work on the hernias.
Is there more information about what they found and the type of mesh used? There should be notes about fixation also.
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quote Victim73:I had a left inguinal hernia surgery with mesh 2.5 years ago. After surgery (8 months)
Can you give details on the type of hernia (direct/indirect), the type of surgery (open or lap), the type of mesh (plug and patch, flat, lightweight, etc.), and the method of removal? Without those details there is not much that anybody can act on. No way to avoid what happened to you.
Nobody can really know/say that all “mesh” is bad or that all “mesh” removal is bad. There are too many combinations of materials and methods, and success stories that show it can work. It’s the details that will allow the bad to be weeded out.
Sorry that you’re having problems, and good luck in finding a solution. Eight months is still a bit early after mesh removal. If things are still changing, it might be best to wait longer. Repeated operations cause more trauma.
Thanks for sharing, the stories are important.
[USER=”2883″]Victim73[/USER]
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quote Colrie87:Idk what to do. I am a mom of 7, 31yr old and I have an inguinal hernia. I’m overweight but got the hernia from lifting at former job. Here’s where I’m at. I’m due to have surgery tomorrow as my husband got let go from job and we have insurance up until the 31st and we have met all out of pocket deductibles, and with 7 kids and him taking some time before going back to work (we have a couple younger kids) I feel it is best time.
On the spectrum of fixing problems after hernia repair, the laparoscopic procedures are the most difficult, I believe. In your case, as a woman, an open repair, even with mesh, seems reasonable. No spermatic cord or such sensitive structures to worry about. One benefit touted for lap procedures is small scars. If you’ve had a C-section or two, then scars might not be a big deal for you. No offense. Make sure that you understand why, exactly, he wants to use that technique.
Also consider that if a suture-based repair fails you can always get mesh. But if you have mesh problems you can’t undo them. There’s no easy next step for mesh repair problems.
And it’s odd that your surgeon is choosing to use a somewhat sophisticated and new technology on you. Using robotic lap for a routine hernia repair makes me think that somebody wants to get some time on the robotic equipment. It doesn’t seem like a proper use of the robotic equipment, considering the patient’s benefit. It’s probably more expensive for the institution also. Something is off there.
With no spermatic cord to worry about a simple open repair and sutures, or even mesh, seems like what would have been suggested.
Overall though, it seems like you’re making and hurrying your decision for the wrong reasons, the deductible on your insurance plan and your husband being out of work. You’re too young to suffer a mistake and have too many kids to take care of. Consider the cost of finding out that you were right about the use of mesh. It will affect you for the rest of your life. Easier to fix a financial problem than a mesh problem.
Good luck. At the least, see if you can delay for another week, to be sure you’ve thought everything out. Search for other surgeons under your plan.
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I think that there are injections that you can try beforehand that will tell if a neurectomy will help. [USER=”2580″]DrBrown[/USER] is familiar with them.
Can you give more detail on your activities since mesh removal? I found that, while healing from my own mesh removal, certain pain was resolved by being more active. Running or hiking, even though it seemed counterintuitive. Rest did not help at all. There seemed to be dead zones that needed help to get fluid moving, to promote healing. Dr. Bendavid’s work on a potential reason for mesh-induced pain was illuminating. Nerves need good blood supply to be healthy.
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I just heard another commercial, on one of the more obscure networks, setting the year at 2005. Any complications requiring more surgery, after 2005. Not sure what it all means, but the parameters are getting broader and vaguer. Almost like somebody has noticed signs of a larger problem.
We can only hope that the results of these litigations will benefit everyone. The law firms don’t get involved where there is no case.
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quote Arkj93:Hello everyone, and thank you for taking the time to read my post.
My name is AJ and I am a 26 y.o male who had a left inguinal laparoscopic (TEP) hernia repair with Parietex polyester mesh in May of 2018 at Kent Hospital in Rhode Island.J
[USER=”2580″]DrBrown[/USER] might have some thoughts on your situation. He has removed a lot of mesh, I believe. One thing that might make it difficult to remove is that, for TEP, it’s possible to lay the mesh all the way over to the linea alba. The centerline of your abdomen. And all the way down to the pubic bone. It’s easy to put in but difficult to get out. My surgeon overlapped the two pieces in the center.
It wouldn’t be a surprise if your original surgeon had a different procedure used to place his Parietex mesh. If he is older it was probably an open surgery, with a small piece placed in two separate surgeries. There seems to be a thought process in the field that because the mesh is supposedly inert and FDA approved, you can put more in with no consequence. TEP allows the maximum amount to be implanted, I believe.
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Choosing a mesh removal surgeon is certainly difficult. One thing to be aware of is that, just like there are “guidelines”, formal and informal, for mesh implantation, there are also guidelines for mesh removal. And, therefore, just like for mesh implantation, you can’t just trust any surgeon who uses the guidelines. In a way, you are starting over, essentially in the same spot you were when you had the hernia, but with fewer choices, and much less real-world information to use to make a choice.
That’s one reason to choose a surgeon who has removed a lot of mesh. They should know what works and what doesn’t. They should have their own guidelines from real-world experience.
It seems like your big decisions are when to have it done, if you decide it needs to be done, and how to pay for it. I waited a full year after I knew mine needed to come out and I think that the tissue around the mesh was getting thicker and stiffer during that time. I had a situation where I had to do a lot of hard physical work, getting a home ready for sale. So, I think that sooner is better, once you make the decision. As a student, I would guess that your summer might be free. You should be back to reasonable functionality within a couple of months. After that, if you are like me, you’ll have a long slow period of constant adjustment. Probably a few weeks or months along the way where you wonder if you’ll ever get better. But, again, if you’re like me, the great positive will be that you’ll be getting better instead of worse.
That was my decision point, in choosing to have the mesh removed. I knew that I was very slowly getting weaker and less healthy, and that there was no way I could fight it. I couldn’t be smarter or tougher or work harder, in order to live with the mesh.
Finally, seriously consider spending the money to travel to the surgeon of your choice. Take out a student loan. You’re only 26 so you have many many more years ahead of you than I do. If you get a bad mesh removal your ability to make money will be severely reduced, as you probably know, because your ability to think and concentrate will be damaged. Any debt you incur now will be an investment in future earning potential. Don’t let money be the decider. Invest in your future.
Good luck.
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Does “ct” stand for Connecticut? The Vincera Institute and Dr. William Meyers, down in Philadelphia, is well known for fixing athletes. I posted a link below. I sent them my images and he took a quick look at them. But he likes to use his own MRI technique.
I see that you mentioned mesh again, to repair torn muscles and athletic pubalgia. I have only followed the problem for a short while but my impression is that the use of mesh for athletic pubalgia started from a basic misunderstanding about what the problem actually was. Or just an attempt to find another market for mesh. And it did not work well, people in the know don’t use it for that anymore. Your surgeon seems behind the times.
Good luck. Marcia at the Institute is very helpful, you could probably just call. She will reply to an email also.
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[USER=”935″]drtowfigh[/USER] is an expert in imaging. I am not but I don’t think they use contrast agents for diagnosing hernias. Your doctor would probably have to ask for that specifically, since the typical insurance company protocol is to approve contrast agents beforehand. Mine was rejected when my surgeon asked for it, to diagnose mesh problems. If they did not ask then it probably will not be used.
Good luck.
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quote mitchtom6:My cousin’s repair was mesh. In fact, I believe he said they did a double layered mesh repair. It was done in Richmond VA about 5 years ago. It freaks me out to see him workout like nothing ever happened. Using the Ab Wheel with full extension, etc. Stressing the area to the max. Appears to have had no complications.
Double-layered typically means the Prolene Hernia System (PHS). But it might mean something else.
Things often get conflated, or mixed up, when talking about “mesh” repairs, Recurrence, versus pain, versus side effects. When I had my bilateral Bard Soft Mesh inside, I could work out just fine. Covering your whole lower abdominal wall with mesh really does make it stronger. I told my surgeon that if I was a farm animal, like a mule or an ox, both gelded, the repair probably would be great. The hernia is gone and extreme physical work is possible. I could go back to the gym and lift heavy weights with no problems. But I could not run or bike or play soccer.
But if you’re a human, who needs to be pain-free, and able to think clearly, and likes their sex organs to work correctly, then there might be a cost.
Thanks for replying but what happens in the gym is just a small part of the situation. I hope he’s one of the lucky ones. You might have to work to get the real details about side effects, for your cousin. Because they’re not good, and not anything a typical man will want people to know. Is he doing everything that he wants to do, or does he avoid certain things. Is everything working correctly.
Anyone considering a repair should get as many details as possible.
Again, sorry to keep jumping in on what seems like good news. There’s always some detail missing though. If he did get the PHS and he is 100% where he wants to be then I can add him to my Good Mesh Stories Topic. Maybe the PHS is a winner for athletes.
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[USER=”935″]drtowfigh[/USER]
The @ symbol didn’t take on my reply, above.
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quote drtowfigh:Most professional athletes have mesh based repairs of their inguinal hernias.
Hello Dr. Towfigh. That is a fascinating answer, you must know more. Which type of “mesh” repair? There are so many. Lichtenstein, TEP with lightweight mesh, TAPP with gold standard mesh. Polypropylene, polyester, or PTFE? I harp on this often, but is all “mesh” really the same? Or is there really so much variation between individual humans that all of these choices are necessary?
A person would think that athletes would have a much smaller variation between individuals, especially in body fat and activity levels, so there should be a smaller set of materials and methods that have successful outcomes. They should all be very healthy people who heal properly.
Can you offer some insight, for athletic people like myself? If I had found information like you’re suggesting exists, with details, I might have been able to avoid my problems.
I hope I don’t seem to be trolling. Your answer doesn’t fit my understanding at all though. It kind of “blew my mind” when I saw it. Dai Greene got the one-size-fits-all standard treatment and it almost ruined his career. We need this kind of real-world insight. Without sharing the knowledge we are all still gambling unless we can make it to California to see you.
I don’t want to be spreading false information, but the things that I write are all that I know at this time. Thank you.
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[USER=”2859″]Informedpatient21[/USER]
I really am interested in your results. You really are a good experiment, just like I was for having bilateral mesh implantation for a direct hernia on one side with fixation,and for a lipoma on the other side with no fixation. Both sides were bad, after mesh implantation, resulting in removal three years later.
I assume that you are still in the early period of healing from your Ovitex implantation. The most interesting time might be when all of the mesh should have been resorbed (based on the animal studies) and you are back to being fully active. At least as active as the synthetic mesh allows you to be. And the types of activities you engage in. Unfortunately, with the goal of one-size-fits-all, good results from sedentary people are used to justify using mesh in active people, I think. Activity matters.
I hope that you won’t see this as some sort of challenge. But there really is very little real data out there, from humans, who can describe how they feel. You are one of the few.
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I wish you the best of luck with your new hernia repair.
You did not address two of my points though.
The first is chronic pain. Animals do not tell how much pain they are experiencing. They don’t “work” either, especially in captivity. Generally, they just sit in one spot and wait to be fed. So, in my opinion, animal studies are worthless for chronic pain evaluation.
Second is the long-term results. As I said, captive animals don’t have to go to work. They sit, get fed, the mesh is excised and evaluated, or something similar. Or in this case, the site of the procedure is excised and evaluated. I don’t think that an animal study lasts more than few months does it?
Other things to note. The FDA has been asleep at the wheel for many years. The bar to go above and beyond their requirement is on the ground. The 510(k) process. So that has little value.
As far as resorbability, it might be that the tissue is indistinguishable from the patients tissue after a certain amount of time. But is the “new” tissue the good strong fascia type material or some weaker form of tissue? The basic problem of the hernia is weak tissue. So, time will tell. You will be a good experiment, especially since you are experienced in the field. I hope that you will consider yourself that way and report the results back to people that can use them.
Overall, your rationale is the same rationale that gave us the mesh that you have on the other side. In broader terms a better question would be “is Ovitex, the company, a more honorable and honest and capable company than J&J or Bard or Covidien (now Medtronic),or any of the others that supposedly used similar protocols to develop their products?”. Don’t forget companies like Atrium with their crosslinked fish oil coated synthetic mesh. No offense, but working in the medical device field is not really a good reference. That’s where all of these problems were developed.
My fundamental point was that this new material has followed the same basic path as what is out there now. There is no long term phuman data to show that it is better than what is out there. And, I assume, there are no plans to follow up and track results now that it is on the market.
I wish you the best of luck. And I hope that the results are good and that over time it will become apparent that the new product is better than what is out there. But, I’m going to guess, that there will be no way to be sure. Just stories from the internet.
Could you share more about the synthetic mesh that you have and the details of the surgery, and the original hernias (direct or indirect)? That would have some value. Your description is very broad and not very useful, at this point. Please come back, at least once a month and describe your activities and the results. Are you a runner, a weightlifter, a soccer player, etc.? Tell us how Ovitex is doing. If you can make it to two years, that would be a good selling point.
Again, no offense intended. We all want to be part of something good. I chose my screen name for a reason though.
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How long ago was the repair, and how soon after did the recurrence happen? And is it a true recurrence or just another, different type of hernia. The mesh shrinks and pulls on surrounding tissue. You might have had a direct hernia and now have indirect hernias.
I’m not sure that we, the patients, should be deciding which new meshes are good for hernia repair. When the synthetic materials were introduced they had great marketing literature also. I created a Topic a short while ago about an Ovitex mesh device, showing that it was released to market based on a single “trial” of 31 patients, by a single surgeon. No peer review, no official clinical trial, just anecdotes from a surgeon who tried it. It is essentially unproven, long-term. No data. It’s just the way the medical device field is these days, and it’s how most of today’s products ended up on the market.
[USER=”2580″]DrBrown[/USER] has probably seen cases like yours and fixed them via a suture-based repair.
[USER=”2580″]DrBrown[/USER]
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That is a difficult question since most laparoscopic methods start at the navel, as I understand things. It seems like TAPP should be possible but a lap surgeon would know for sure.
Shouldice and Desarda are inguinal hernia repair methods. Umbilical hernias are a different problem. They might be one of the areas where mesh is actually better than sutures.
Are you having specific problems that you can share? Somebody might have a recommendation. Good luck.
[USER=”935″]drtowfigh[/USER]
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Hello Charlotte. Dr. Towfigh will know best, of course, but it seems like you need to see a hernia specialist. Some insurance plans allow you to see certain specialists without a referral, you should check. If yours does not then changing GP’s would be a good idea. Yours seems shockingly ignorant. Post your general location and somebody might recommend a good hernia specialist.
Good luck. You can notify people using the @ symbol. [USER=”935″]drtowfigh[/USER]
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quote mitchtom6:Fascinating question. My NCAA athlete cousin had an inguinal repair, and if I recall correctly, his doctor told him he could expect it to last 10 years.
10 years, and then what? Interesting that a surgeon would offer that information. We can all probably learn a lot from the field of athletics. I wish we could hear more about how they solve their problems.