Good intentions
Forum Replies Created
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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.
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Hello Richard. I pulled much of what you wrote in your other post and tried to summarize it below. It looks like you’ve had quite a bit of surgical activity in the lower abdomen and groins.
I know that even without mesh, scar tissue will form and shrink and get tight after surgery. It’s just how the body heals. I’ve had both of my Bard Soft Mesh devices (“lightweight” flat mesh), removed and even the left side which should have no mesh at all remaining is still tight. I think that the surrounding tissue also responds and thickens in response to the trauma of surgery, so it’s more than just mesh. Flexible elastic tissue turns in to somewhat stiff inelastic tissue due to the cutting and damage alone.
Without more details of the recent surgery I think that even a doctor might have trouble advising on what’s happening. Was the exploratory surgery done at the Vincera Institute? Was it open surgery or laparoscopic? Was any mesh removed, or replaced, or added? Did you get any physical therapy advice? Since you had a more normal muscle repair there should be common PT methods available for healing.
Good luck.
Here’s the summary from your other topic. A lot going on.
74 years old, weigh 160 pounds, good health before this happened.
(Right side???) First surgery failed because a muscle stuck to the mesh and the mesh balled up.
the balled up mesh was removed except for a small residual of the mesh that was stuck to a muscle and that residual was used to reconstruct the canal floor by joining the residual and oblique and transversal muscles to the inguinal ligament. The newly created internal ring was just lateral to the pubic tubercle. Also, the operative report seems to say the newly created ring is between the abdomen and the mesh.(Left side???) Second surgery worked for 2 years and then failed while I was . exercising. I think the weakened muscle may have given way and the repair now pulls from left to right instead from up to down. Puts tremendous pressure on left groin.
for 2 years after the last surgery, I was able to move around pain free. Three months ago while exercising (treading water vigorously with my legs), I pulled my left groin. I felt a tearing of flesh just left of my penis and the ridge on the top of the previous hernia repair scar rapidly released tension. The ridge of the repair scar has moved down and left on my abdomen and now the pulling and hurting sensation is along this ridge and my left pubic area. The last repair replaced the mesh with an Onflex kugel patch from Bard. The repair has always been tight. Both surgeries were open inguinal surgeries.
On the operative report, the doctor said “An Onflex Kugel Patch from Bard was positioned in the preperitoneal space.”Onflex is a technique and material from Bard that attaches a piece of mesh to the pubic bone, via open surgery. The mesh extends up to cover the weak areas of the inguinal canal.
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I would avoid thinking about “robotic” surgery as anything more than adding accuracy and precision to a repair method. The same materials are used and the same thought processes on where to place the mesh. Robotics just makes it easier and safer and allows more precise work to be attempted.
Worry about the materials and methods first. A 6×6″ piece of mesh will affect you in the same way whether it’s placed via robotic methods or typical laparoscopy tools.
In other words, “robotic” has no significant meaning for what you are trying to research. The touting of robotic surgical methods might actually be another attempt to blame mesh failures on the skill of the surgeon rather than inherent flaws in the mesh material.
Good luck.
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You might try contacting Dr. Towfigh’s office directly. She has recently removed a plug and patch, and also showed a neuroma on her Twitter page. She also talked about how the decision to perform a neurectomy depends on the individual situation.
Twitter is hard to pull information from, but it’s the world we live in. Her first tweet shows how to contact her office for consultation.
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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Be careful when studying chronic pain after surgery and its causes, in order to make an informed decision about a repair method. It is often noted in the papers that attempt to study it that the definition of “pain” is poorly defined. Constant discomfort might not be categorized as pain, for example, so would not be counted. In addition to pain or discomfort there might also be other side effects that are barely addressed at all, in normal body functions. The primary focus for many doctors in hernia repair is short-term, fixing the hole. Long-term effects are somebody else’s problem.
Since you have time, use it to find a doctor who actually stays in touch with their patients and knows how their work performs in the long-term. There are surgeons who do that, although it takes much extra effort. Not a few weeks or months, but years if possible. Or find someone who had a similar hernia repair years ago and does the things that you plan to do, and get the same exact repair by the same surgeon. It’s really the best way to be sure. The hernia repair industry is being taken over by the medical device makers, who are selling and pressuring medical institutions to use their products, mesh-based devices, often ignoring the long-term effects of their devices.
Also be aware that many surgeons believe that the FDA is “watching their backs” and monitoring these devices. It’s not true. The FDA generally trusts the big device makers to monitor their own products and only gets involved if there are obvious and extreme failures, like death. The opioid crisis and the transvaginal mesh situation are current examples of the FDA’s failure.
Sorry to be so negative but you are at a point where the decision you make might be be the most important one of your life. Find a doctor who can actually verify that their method works over many years, with little to no chronic pain or discomfort.
Good luck.
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The variety of outcomes from hernia repair is pretty wide. Are you an active person or more sedentary? Do you know what type of mesh was used? Details are always helpful, the number of possible combinations of mesh and placement is very large.
Most people don’t describe their discomfort as feeling bruised, so that’s hard to compare. Generally though, you’ll be expected to deal with the new problem as well as you can, and decide, eventually, if you need to have more work done. Panic won’t help, I think that dread might be a better word. After three months the mesh will be “incorporated” or buried in to the surrounding tissue. So, there are probably no immediate actions that can be taken. Most hernia repair doctors will suggest pain relieving steps before any further surgery.
Good luck. Post more details, they might offer a path forward.
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Dr. Martindale of OHSU seems to have a reputation for understanding and fixing difficult situations.
It’s not clear if you’re counting the repair as a baby and the umbilical repair as part of the three, or if you’ve really had five surgeries. If you had bilateral repair via laparoscopy less than two years ago then you probably had two large pieces of mesh implanted, and you’re saying that one has failed. There are many different types of mesh available for repair, and many different ways to use them. Those details could be important. The scar tissue problem might have been from the entry point for laparoscopy at the navel, where the umbilical hernia had been repaired.
OHSU has a very long wait time to get in, generally, but seems to be a very good institution. The initial hernia repair and fixing a failed repair are two distinct specialties, I believe. You’ll want somebody that knows how to work around and with the mesh that’s already been implanted.
https://www.ohsu.edu/providers/robert-g-martindale/332DF38FFB324681949B3E75BD3B492B
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quote drtowfigh:[USER=”2686″]tenreasy[/USER]
Also, though I agree with what has been written about national chronic pain rates, those studies were for open repair with mesh. Those risks have been shown to be significantly lower with laparoscopic repair.I hope you won’t be offended Dr. Towfigh, but your comment really affected me when I saw it. So I wrote this…
Hello Dr. Towfigh. I’m sure that you agree, as a doctor and a scientist, that the issue of chronic pain is not one of whether or not laparoscopic techniques are “better” than open techniques, but one of whether pure tissue repairs are better than the new mesh repairs, and/or whether there are certain mesh materials and methods that are the cause of the high levels of chronic pain.
As you know, to do good scientific work, and to make good decisions, good meaningful numbers are needed. Is a 10% chronic pain rate really better than a 15% chronic pain, for example, if a method exists that gives a 2% chronic pain rate? It seems that the commitment and investment in laparoscopic training, and/or open repair with mesh, is dominating the market and the discussion, leading people to compare which of two “bad” methods are best, instead of perfecting these new methods so that true claims of superiority can be made..
Defining things in terms of better or worse is just not going to produce true progress in stopping the growth of the chronic pain problem.
As someone who has been harmed by today’s “best” method of TEP implantation of lightweight mesh by a highly trained, experienced surgeon, and whose problems were found to derive solely from the mesh, no errors in technique, I feel obligated to make this point. No effort has been made by anyone involved in my situation, a perfectly healthy male in excellent shape, a perfect “candidate” for TEP mesh repair, to understand why this optimum method did not work. Chronic pain is, today, accepted as normal, with pain medication used as the solution to the problem.
If prospective patients keep getting assurances that these undefined materials and methods are “better” than others but without knowing the true risk, in usable numbers, then it will be impossible to improve the situation. People need to be aware that there is still significant risk of very debilitating chronic pain. Lucky46 is an example of how bad things can get.
Sorry to be so blunt but comforting words aren’t going to help anybody. They just perpetuate a bad situation.
Good luck tenreasy. I hope that your recovery goes well and that your long-term outcome is one of the good ones. I assume that my words in my previous post, #3, just sounded like the rant of a weak-willed person and you decided to go with what the surgeon told you would work? Can you give more details on the materials used and how it was placed? The possible combinations of materials and methods, using mesh, is really incredible, and adds to the lack of focus and progress. The situation cannot reasonably be described in simple terms of mesh, laparsoscopic or open, I think.
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Which surgeon are you seeing?
What is stopping the ones you’ve seen from removing the mesh?
I am almost certain that Dr. Petersen or Dr. Brown will remove the mesh, since they are very aware of the problems that mesh creates, and definitely anti-mesh. Dr. Petersen works outside of the insurance companies and has a basic flat-rate that he charges. Have you called them? They will explain everything and help you get out there. He has been around a long time so there are some bad stories but overall, he seems to have a good reputation.
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quote Liz52408:Ok thanks did you have your mesh removed? It’s hard to determine what’s causing pain if its inflammation, scar tissue, tacks or the mesh…..
yes his surgeon kept telling us that he did the least invasive surgery and best technique for surgery, and basically surgery was a success…he didnt have any of this pain before surgery.Yes, I had the mesh removed by Dr. Peter Billing of Shoreline WA. In my case it was just the constant inflammation from the mesh. Depending on what activities I had been doing recently the location of the soreness/discomfort/swelling would move. Sometimes it was my complete lower abdomen, both groins, the centerline under the navel where the two pieces overlapped, and the pubic symphysis. Everywhere the mesh had been implanted. At times I could feel the unnatural periodic nature of the mesh sliding against the pubic bone. I could feel the corners of the mesh poking in to my groin when I crouched to work on something low. Eventually, about a year in, my penis started being affected in ways that were worse than just erectile dysfunction, especially after simple exercise like biking or running. I spent about year accepting the fact that I had been badly screwed up by the mesh and trying to develop a way to stay healthy yet still have full function of all of my parts. It was absurd to think about planning ahead for certain activities but that’s what life was like then.
Since having the mesh removed, most of those symptoms have resolved. I still get some soreness at the what seems to be the internal ring area of the canal, after more intensive running or work actions, but the soreness resolves in a normal way over a day or two. It’s been about nine months and I’m still healing.
That description of my situation is more for you to hang on to and consider as time goes by. Since your husband is only four months in there will be attempts to save the mesh and fix the problem via other means. In the meantime, one thing I found that seemed to reduce the swollen spongy feeling was lifting weights. I had got to the point where I realized that my surgeon was out of ideas so had to improvise based on what I was feeling. Creating abdominal pressure seemed to help compress whatever swollen tissue was there and stretch things out to where I was comfortable for a while. But I could still not run or bike without causing soreness and pain, and the other problem, again.
Here is a recent paper showing the typical pathway for chronic pain resolution. Hopefully it helps you to form a plan.
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quote jmehan:The real question is who are the best doctors to do inguinal hernia mesh/plug removal?
It’s difficult to say who is “best”. Dr. Towfigh just removed a plug/mesh system and posted a tweet about it. Dr. Brian Jacobs is in your general area, NY City, and has a good reputation. Dr. Peter Billing removed my mesh and has been removing mesh for about nine years, he is in Shoreline WA, by Seattle. Dr. Petersen in Las Vegas specializes in mesh removal and hernia repair and has developed a fly-in/fly-out type of program, focused on making the whole process easy for the patient. Dr. Muschaweck in Germany removes mesh and works on professional athletes often. Apparently she also has a program developed to get the patients in with a place to stay before and after the operation. Dr. William Brown in California also works on athletes and removes mesh.
These are just some details to add to a few of the names you will find in other topics. You’ll find that some surgeons do triple neurectomies as a matter of course when removing mesh. Others seems to consider the specific pain or discomfort symptoms more specifically and act accordingly.
You’ll have to research each surgeon carefully I think, to decide what’s best for you. Expertise, ideas about mesh removal, travel, cost, etc. all have to be considered.
Here is Dr. Towfigh’s recent tweet showing what will be removed, with contact informaton. And Dr. Jacob’s info, since he is fairly close to you.
https://twitter.com/Herniadoc/status/1021561699290116097
http://www.laparoscopicsurgeons.com/our-surgeons/brian-jacob.html
Here also is a recent paper about chronic pain that attempts to summarize current methods in to a type of flow chart for action.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896652/
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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You might consider seeing a surgeon who repairs hernias but also removes mesh. Dr. Igor Belyansky, in Maryland, is a possibility. He would be more likely to objectively assess the issue, and recognize the symptoms of a mesh sensitivity. Many many surgeons will waste precious time, the patient’s time, avoiding the realization of a mesh problem.
Dr. Belyansky removed Jnomesh’s 3D Max mesh. You can search for Jnomesh’s posts on the forum to get more details. I’m surprised that he did not reply to your recent post, since he just replied to two topics, but he might have missed it.
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Can you travel to the states or do you need to use the health care system in Canada? What region of Canada are you in?
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Do you need to stay in Canada for health care cost reasons? There are surgeons in the states that are close to Canada if you can travel. Which part of Canada are you in?