Good intentions
Forum Replies Created
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There are quite a few references to Dr. Brown on this forum. Use Google to search the site if the search function doesn’t find them. Good luck.
https://www.google.com/search?source=hp&ei=cXfsW8eHDMLB0PEP8a63sA0&q=site%3Aherniatalk.com+dr.+Brown&btnK=Google+Search&oq=site%3Aherniatalk.com+dr.+Brown&gs_l=psy-ab.3…1129.8207..9438…0.0..0.49.1112.29……0….1..gws-wiz…..0..0j0i131j0i10.n1AfEIXY61w
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Was your injury sports-related? Are you athletic? Consider seeing Dr. Meyers at the Vincera Institute. He does labrum repairs and hernia repair. He specializes in sports medicine. My one big mistake in life, so far, was having my hernia repaired by the main-stream methods. I was very athletic and should have put extra effort in to finding a doctor who knows athletes.
I’m not sure that a layperson can really make a good choice based on method-name alone. I would focus on finding a proven surgeon.
Good luck.
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There isn’t really any “normal” for hernia repair results. Especially considering the huge range of materials and methods used.
If you could describe the material used, for example; 3D Max, flat mesh, light weight mesh, self-adhering mesh, two component mesh like Phasix, etc., and the type of hernia, direct or indirect, people who’ve had a similar procedure can give their opinions. But you can’t really lump all of the methods and materials in to one basket of “lap with mesh”.
Also, what have you been doing since the surgery?
Good luck. Provide more details if you can.
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I found this Twitter link that offers a way to get to one of them.
https://twitter.com/HerniaToo/status/1056153655081082881
Also found a fairly recent article, one year ago, about the topic, but in Ireland. Hopefully one of these government organizations will get some traction and make something happen. Notice the vagueness about “most effective”. Effective for who? Medicine as business.
“The Royal College of Surgeons said while “any poor outcomes are regrettable”, mesh implants were the “most effective” way to deal with a hernia.”
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I forgot to say that I had Bard’s lightweight mesh implanted, Bard Soft Mesh, and after just a few months it had stiffened. It felt like a plastic picnic plate in my abdomen. The mesh is only soft when it’s outside the body, and for a short while after implantation. Once it gets “incorporated”, filled with collagen, it shrinks and stiffens. I’m sure it looks like a good idea when the surgeon is holding it in their hands.
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And here are the two studies I mentioned.
http://file.scirp.org/pdf/IJCM_2014072117033945.pdf
Watch Brent Matthews in this video and read the questions on the screen. It’s from 2018.
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Here are the Parietex products. Many different ways to knit a polyester fiber.
https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html
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There are studies that indicate that the “light weight” concept doesn’t actually work and may actually cause more chronic pain. See Dr. Bendavid’s work about nerve damage in small pores. Also Dr. Brent Matthews of the Carolina Group recently presented work that showed that “light weight” mesh seemed to have no benefit over “regular” mesh. He also showed that mosquito netting used in more primitive areas of the world worked as well as the medical device makers’ expensive products. Light weight mesh is an idea that has not really been proven for long-term results. But it sounds promising as a solution for chronic pain so it made it to market.
Parietex is a brand name that covers many different forms of device. I’ll try to post a link to the numerous products that use the name “Parietex”. Search it on the web if I get blocked. Get more details about their plans and how they will make decisions. Don’t be afraid to say no if they can’t give you proof that their patients have actually done well with their method and materials. Don’t let the device makers’ own internal studies be used as proof. Your doctor should know through correspondence with his/her own patients.
As far as being thin, it might be that thin people are generally active people. I am thin and active and it was the activity that caused the pain. Not being thin. From an anatomical perspective I think that the “thin” thing is just a simplistic way to place blame for a failed repair method.
Many many surgeons are on the laparoscopic large mesh implantation train. There is security in numbers, for them, but not us. Get details. It’s the rest of your life. Good luck.
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I might qualify as a fellow runner, but my repair method was different. My impression, overall, about having mesh in the abdomen was that it was the cyclic damage that causes problems. Just the expanding and contracting of the abdomen from breathing, and the flexing and bending of the mesh from running. Quantity more than quality. Each cycle, or step, causes a tiny amount of damage.
But I think that if the mesh is localized to a small area it might not be stressed like it is if it covers all of the lower abdomen, like it did in my case. In my case, if the lower abdomen got stressed the mesh got stressed. If it just covered a small area it might be that the unmolested tissue around it could have taken up the load.
In short though, I think that you just have to go out and try things and see what works. Personally, I don’t think that running itself would cause an immediate recurrence. It would take extreme abdominal pressure to force a failure, which would be unlikely from normal running.
I was mechanically very strong after my mesh implantation. I could lift weight and do repetitive physical work with no recurrence of a hernia. But it felt terrible, a constantly shrinking, constricting feeling, with side effects, and the feeling occupied all of my thoughts. Okay for a farm animal, maybe, but not a human. I was healthy but didn’t feel healthy. I spent all of my free time trying to figure out how to feel good again.
Good luck. Keep a log of your activities and you might find a trend of cause/effect that can guide you.
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Hello Milo. It looks like you had your surgery done back in April by Dr. Martin? Can you give some details on the method and materials used? You should still be well within the time frame for the surgeon who did the repair to respond to you with no charge. Have you tried contacting him?
With the details of your repair people who have had a like repair can respond with their experiences.
Here is a link to your first topic –
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It might come down to the surgeon and how hard they want to fight for you. They are the ones that submit the bills and sit on the panels and justify what they did. Ask your surgeon if what you heard is correct, to be sure. The people that man the phones at the insurance companies are often not really experts, and are just reading from a script.
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I had general persistent soreness and a swollen stiff feeling across all of my lower abdomen, sometimes specific sharp pains in the corners or at the original hernia site. The more exercise I did to try to loosen it up the tighter and stiffer it got. I didn’t have any referred or shooting pains, to other areas. So, apparently, no nerves were being damaged, mine was a generalized damage, everywhere the mesh was in contact.
I had two 6×6″ pieces of Bard Soft Mesh implanted via TEP, bilateral, for a single direct hernia on the right side. Removed three years later, although I knew at two years it would have to come out.
What type of repair did you have the first time, and how did the surgeon go “back in” the second time? And what did he find, or do? You can get your post-operative notes from your surgeon’s office or the facility where the work was done.
Good luck.
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Hello paco. I had mesh removed from both sides, via TAP laparoscopy, and everything functions as it is supposed to afterward. I have full functionality and can run and work, although to a lower level than before my hernia. Full healing is taking some time.
I think that Dr. Billing left as much of the nerves, veins, arteries, etc., intact as he could. He did have to remove part of the epigastric artery because it was entangled and couldn’t be saved. He made a note of that in his post-operative report so I assume that he would have made note of any other important structure that had to be removed or was damaged. That was the only note he made about cutting something that would best be left alone.
So, in short, I don’t think that neurectomies are necessary for successful mesh removal. It probably depends on how entangled they are with the mesh that needs removing. I was probably lucky. It’s the judgment of the surgeon at the time of the surgery, I believe. One reason that robotic surgery seems to be gaining popularity for mesh removal, apparently, because the fine work necessary to save those structures can be accomplished with better success.
Good luck.
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quote drtowfigh:[USER=”2029″]
The most recent study published this past year put mesh and non-mesh repairs head-to-head and showed the risk of chronic pain is similar. It’s important to not that historically, tissue repairs were very painful and patients had to miss work and some were maimed by the repair. That is why a tension-free mesh repair was developed. For the first time, an inguinal hernia repair could be done as an outpatient and didn’t require a 3-day hospital stay. People tend to forget these details.Thank you for the reply Dr. Towfigh. I think that you have conflated the short-term with the long-term, as is often done. Short-term is business, the 3-day hospital stay; long-term is Hippocratic, as in “do no harm”. I think that you are right though, in that people have forgotten what the purpose of the repair is – the quality of the rest of the patient’s life. Many years. Not the hospital stay. No offense intended but it’s right there, in your words.
I would have taken a one month hospital stay if it meant I could have avoided the last four years of dealing with this mesh-caused mess in my abdomen. I would have taken two good years and a recurrence. I would have taken living with the hernia. If somebody had told me the true risk of having mesh implanted I would have avoided it. Instead it was sold as easy, low risk, walk-in-walk-out, you’ll be back to work in a few days, you’ll be back to full performance as an athlete, you’ll be normal again, surgery. I was sold a false story. Lied to, to be blunt.
Do you have a reference for that most recent head-to-head comparison paper? I have not seen a well-done long-term study. Most use short-term results, and many seem biased toward showing that mesh is “okay”, or that it’s no different than a tissue repair. Many are funded by the device makers, indirectly. The medical field, and society in general, needs some good honest hard-working researchers, unbiased by device maker support, to do real research, exposing the truth. In the long term, everyone will benefit. In the meantime, lack of knowledge and business reasons will be used to keep the mesh industry growing.
Sorry to be so blunt. I have worked for several very large organizations and have seen how these situations develop. Once the commitment is made and the money and effort is spent to build the program it’s very difficult to get people to see the truth, if the program was built on faulty reasoning. Lives and careers are built around the sales and implantation of surgical mesh, right or wrong.
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Here is a web page describing the mechanism, or working action, of the inguinal canal. Easy to see how placing a piece of mesh over all of its complexity is an easier choice than working with the fine details and repairing it to resume normal function.
This is just one, I’ve seen others.
http://inguinalhernias.weebly.com/31-mechanisms-of-the-inguinal-canal.html
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Without insurance? Call Dr. Petersen’s practice in Las Vegas and they can give you a baseline number to work from. The insurance companies have distorted the cost of many common procedures. It’s all funny money when you’re in the system.
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quote seeker:But ultimately, I trusted my surgeon.
So did I, and it was a mistake. Then I trusted another one three years later to remove the mesh the first one I trusted implanted. My trust in the first surgeon was flawed.
Good luck I had Bard Soft Mesh implanted via the TEP method and it was never comfortable, often painful, ultimately removed. Do you have the details of your so-far-successful repair? Without the details it just gets lost in the “mesh” pile. Even the surgeons don’t really know which method or material works best. Nobody is tracking results, beyond just a few months.
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Sorry for the confusion. Points of reference can get turned around when trying to discuss all of the possible ways to repair a hernia. The word for what they’re suggesting is “onlay”, I think.
Whatever the method used they will still have to push the hernia sac and its contents back in past the existing mesh, I believe. They can’t leave it between your abdominal wall and the existing mesh, it’s supposed to be behind the mesh. Usually when they perform an onlay method they are pushing the hernia sac back to “virgin” territory, a short distance. They will have to go much further and might cause more problems while doing so. I’m no expert though, just trying to visualize what they would be doing.
My main point is that you are now well outside the common repair methods. Your surgeons are probably improvising. You might be their first patient with a recurrence. You’re at higher risk. Ask them how many recurrences they’ve fixed using their methods.
Besides that, why would you go back to the surgeon who didn’t fix it the first time? The method he/she used is supposed to be almost infallible, for recurrence. Yet yours failed.
Was the Bard mesh used originally 3D Max? The suturing method seems to fit what they do with that device.
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How have things been before the symptoms in April? Looks like you got about two years out of the first repair. Were they a good two years?
I’ve mentioned that some surgeons seem to just lay more mesh on top of old mesh when fixing a recurrence but Dr. Towfigh replied that that was not how it’s supposed to be done. You should get more details on what, exactly, these surgeons are planning. If the original mesh failed, some or all of it will need to be moved or removed.
As far as having the other side done, prophylactic mesh placement, to prevent a hernia that has not occurred, is not medically advised, as I understand things. But, reality suggests that many surgeons do so. Surgery can always have complications so that seems like an unnecessary risk.
Also, it’s unclear if there are differences between the types of mesh. Your “new” mesh might be more problematic than the old mesh, as far as chronic pain. And, open surgery could mean the use of a “plug” which seems to cause many problems. If they don’t plan to remove any of the old mesh, they’ll probably use a plug to fill the new failure point. Some surgeons feel that plugs are “evil”. See the Tweet below.
Besides all of that, it doesn’t seem that anyone has even guessed at the cause for the failure. They’re just going to perform a different procedure without understanding why the first procedure failed. If you’re inherently at risk of failure because of weak tissue, you’ll probably have another.
Personally, I would avoid all three of those surgeons. You’re on the beginning of what could be a long trail of failures and problems. Find a real expert, with verified successes, not someone who has just performed a large number of procedures. Good luck.
https://twitter.com/Herniadoc/status/1021561699290116097
What do you see?
This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR
— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018
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I mis-wrote above. The Onlfex mesh is placed under the pubic bone, but, apparently, not directly attached. Typically, as I understand things though, the mesh will “bond” to the pubic bone during “healing”, if it is in the vicinity. My mesh had to be peeled from the pubic bone during mesh removal. It was placed via TEP.