Good intentions
Forum Replies Created
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quote ajm222:Forgot to mention my grandfather had an inguinal hernia repaired with mesh in the 70’s. He died around 2007. Never remember him mentioning any issues with the repair. I never asked so I don’t know any of the details and no one else still alive does either, but it seems it worked OK for him for all those years. I never heard him complain about it or heard anyone discuss it.I also have a friend who had a repair done in high school. He’s now 39 and no issues at all. My neighbor across the street has had 3 (!!!) inguinal hernia repairs over the last decade or so (both open and lap) and currently has no issues. He’s a hard core runner, too. Last surgery was at least 5 or 7 years ago. And a friend from college I consulted had two repairs maybe 7 or 8 years ago and he said he’s been perfectly fine ever since. Lastly, another good friend I spoke with (all of these people I discovered had repairs done after posting something on Facebook before my surgery) had two separate surgeries and while he had some big complications after the second surgery (housebound for a month and issues walking because of numbness in the legs), he says he has no remaining issues currently and all is well. His first one was done about 5 years ago (open) and the second was done early last year or the year before (lap). Interestingly they were both on the same side but he didn’t seem to think it was a recurrence.
It is surprising how the mesh problems seem to be getting worse over the years instead of better. One thing that I became aware of as I was searching for a repair method is the increase in the use of laparoscopic methods, and the associated growth in mesh coverage area. Laparoscopy allows a much larger area of the abdominal wall to be covered and the literature seems to supports placing as much as the surgeon can fit, even to the extent of what looks like prophylactic dissection (take a look while we’re in there) and placement (there’s a sign of a potential future hernia). Of course this is just a view from internet stories and research. This type of correlation would be readily evident if a hernia repair registry was in use.
My surgeon actually seemed proud of the size of the pieces of mesh he was able to use. I made a comment about how a 4″ x 5″ piece of mesh was pretty big, and he corrected me to “no it was 6″ x 6” “. Before my surgery he had remarked about how he dissected a space and cut the mesh so that it “couldn’t move”, and that he was doing things differently than he had the year before. I should have asked more questions then but I assumed that he was perfecting a good technique. In retrospect I think that he was adjusting for past problems.
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quote JHue:If V.A. care is the only health care someone has available, there is at least some comfort in knowing that for “many years [as you put it]” this would seemingly suggest consistency in procedure, even if not the best available per individual patient need. However, high V.A. doctor turn-over rates may negate the notion of a doctor having done a sizable number of hernia operations.
Reiterating my major point, the length of time the V.A. has done a procedure one way (based on cost savings) does not indicate anything of rate of complications, which may or may not be better or worse than other procedural options privately developed over the same period the V.A. has been doing hernia surgeries.
That is an excellent point. I oversimplified, and conflated the surgeons with the hospital, which is a big error.
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You’ve probably had your appointment already, but “dog” has done quite a bit of research on the technique. Dr. Kang has also commented generally about many of the suturing techniques.
https://www.herniatalk.com/8427-letter-to-me-directly-from-prof-dr-desarda-m-p
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You might get more details on the procedure used. There might be some useful details there. There are many different ways that individual surgeons do things, on top of the many different ways a hernia can be repaired.
There are members here also that would probably love to know who your surgeon was. Apparently, and unfortunately, your difficulty in finding a surgeon who understood your problem is not uncommon. Can you tell more about your search?
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It depends on the procedure used. Mesh is popular for covering all potential hernia areas, even if the focus is on one small one, when used in laparoscopy. Find images of mesh placement for a laparoscopic repair and you’ll see that they cover lots of extra area.
Dr. Kang has written quite a bit about the difference between a suture, or pure tissue, repair of the two types. You might look for his posts.
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I gained a bulge just below my navel extending a few inches on either side, after my laparoscopic surgery. It doesn’t seem to be fat, just a stiff layer of tissue, almost like some sort of protective measure that the body takes after being injured. Even my physician noticed in when I went in for a physical, he poked at it like it didn’t belong. It doesn’t seem to follow weight gain or loss with the rest of my body either. I assumed it was a side effect of the large area of dissection from my TEP procedure. It’s still there even after mesh removal.
What type of hernia did you have repaired, and what procedure and material was used?
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Here is a topic with a list of surgeons that Chaunce1234 has collected. Dr. Billing removed my mesh. Dr. Towfigh removes mesh on a regular basis. They both use laparoscopic techniques, Dr. Towfigh uses robotics at times also, apparently. They both will consult over the phone, I believe.
The list starts at Post #4. There are several more surgeons on the west coast.
https://www.herniatalk.com/6259-seeking-an-experienced-hernia-mesh-removal-surgeon
Dr. Towfigh had some advice for your type of situation in a past post, #4 here – https://www.herniatalk.com/47-mesh-removal
Good luck.
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Can you give more information, like your general location, how far you are able to travel, and the type of repair that you had? There is good advice available here but there is no general recommendation that can be made. The more detail the better.
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Hello katie. I don’t think that the “top” removal surgeons have been defined. There really aren’t that many who you could say specialize in it. And they all seem to do it differently. Some use an open technique. Some use TAPP laparoscopy. Some are using robotics. Some do a triple neurectomoy as a matter of course. And the methods used depend on the individual patient’s situation, I believe, for some surgeons. Others do it one way every time, like Dr. Petersen in Las Vegas.
I think that Chaunce1234 has put a list together in past posts. And several of us have made individual recommendations. I think that you’ll find them if you search the forum posts.
I am about nine months out from mine and still feeling the effects of the mesh and the removal. The mesh really made a mess of my abdomen while it was in there and it’s still adjusting. I can’t tell where it’s going to end up.
Good luck. Ask lots of questions.
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quote Jen74:Well my GI doctor said everything came back normal. Well I went to get a copy of the report and the CD today and was reading the report and on the impression it says: “No intra-abnormality to explain etiology of patients symptoms of lower left pelvic/abdominal pain. No evidence of appendicitis or diverticulitis”. Well I started reading over the whole report and in the section where it talks about the Body wall it states that there is a small umbilical hernia!
Your doctor probably just read the summary, like many of us do, and the doctor reading the image was only looking for what he’s been trained to look for specific to how your symptoms were reported to him. Lower left pelvic/abdominal pain. The umbilical hernia was just a side observation.
Good luck.
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To be clear, I do research for a living, but not in the medical field.
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Yes, the design could have made sense, with more care taken to control the other variables. But as it stands, they have overlooked the knit pattern, and, possibly, other factors, like partially absorbable components that seem to be used in several Ultrapro products. Ultrapro is a brand name that Ethicon uses for many different devices. One more way that cause and effect are blurred, making it very difficult to determine which products are good, and which are bad. It’s not even clear which Ultrapro product that they are evaluating. I copied the Ultrapro product page link below.
One interesting fact, is that even though Bard offers a lightweight version of their “gold standard” mesh, they couldn’t find, apparently, enough surgeons that used it, even though they found enough that used the “heavy” mesh. It would have been very obvious that Bard Mesh and Bard Soft Mesh should be the subjects of the study, from the beginning. Makes me think that they compromised to Ultrapro lightweight, or vice versa to Bard heavy, when they couldn’t find the proper devices for a good study.
I do this type of work for a living so these things stand out to me when I see them. The concept is a good idea, poorly planned, but well-executed. Much talent and expertise was wasted to produce a nice paper that doesn’t really show anything, except for the collection of more general data showing that “mesh” causes significant pain and discomfort, even for open surgeries using the Lichtenstein method. That finding has value alone, I think.
https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/ultrapro-hernia-system
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I came across another long-term success story. Open “mesh” repair in 1985, relaying his story in 2005. Twenty years, and an active athlete. Stories like this are probably what have led other surgeons to think that any mesh anywhere is okay.
https://www.hillrunner.com/jim2/id93.html
The surgeon, Dr. William Howard, has, unfortunately, died fairly recently. His story is worth reading.
http://www.baltimoresun.com/news/obituaries/bs-md-ob-william-howard-20160111-story.html
His Sports Medicine Clinic is still there though. Might be a good starting point for people in that area.
https://www.medstarunionmemorial.org/our-services/sports-medicine/
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One week is still early. You could probably do with more walking. I did a lot more walking than 15 minutes at a time after my mesh implantation via TEP laparoscopy. Probably one to three hours a day, easily. The majority of the swelling was gone after about one week, but I was still sore. Walking and staying active gets the fluids moving to where the body can absorb them.
Good luck.
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Thank you for the correction Dr. Kang. I know very little about the anatomy of the groin. I should have learned more about tissue repairs in general before making that post. Most of my thinking has been about mesh and how it’s used since that’s how my direct hernia was repaired, before I had it removed.
Thank you for staying in touch with the forum and good luck with your efforts. I look forward to your posts.
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I can’t add anything very specific to why “pure” tissue repairs fail, but I have realized that one of the difficulties with hernia repair is that the tissue that fails is not normally injured so does not have a robust healing mechanism. It is very like an ACL tear of the knee, which can only be repaired well by replacing it entirely. That’s why, I think, they call mesh a prosthetic. It’s an aponeurosis replacement. The pure tissue repairs are attempts to tie a “ligament” back together. It doesn’t work well.
The aponeurosis is essentially a wide flat ligament, at the ends of the abdominal muscles. I supplied the Wikipedia link below. Each suture point in the ligament is a new hole that can elongate and tear. That’s why Shouldice uses so many, to spread the load across many holes. There are some basic engineering principles involved. It is a lot like darning a sock or a pair of Levis. More sutures are better. To avoid that, many of the multitude of repair techniques involve moving tissue that heals, over, to take the place of the failed aponeurosis, which will, essentially, never really “heal”. As I understand things.
Just another way to look at things. The more I learn the more complicated things seem. I can understand the attempts to simplify that have led to this huge mesh problem.
https://en.wikipedia.org/wiki/Aponeurosis
UhOh!’s recent topic and link is very relevant to this topic.
https://www.herniatalk.com/8458-guarnieri-technique-and-hernia-center
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Sorry that you’re not getting any responses. The northeast and the southeast seem to have options but the middle is sparse. Chaunce1234 keeps the best list of surgeons with specific skills, if you want to search his past posts. Your situation is not one of the more common ones because you have a recurrence, and it’s very early. It might be that you didn’t actually have a hernia or that the cause of your pain is not the hernia that was repaired.
I’ve copied your original post here for reference, below. I think that a hernia specialist would know more than the “common” (no offense intended) surgeon because of the unusual nature of your recurrence, so soon. While you’re searching, make sure to get a copy of your medical records. Having them yourself can save a lot of waiting, for the “system” to get records transferred. Especially if you are working outside of your local network. Since you have images, or even without, Dr. Towfigh might be able to do a remote consultation. She has specific expertise in women’s issues, which others might not have, and she is a hernia specialist. Sometimes you have to contact the imaging facility to get your images, outside of the office that requested them.
https://www.herniatalk.com/8431-early-recurrent-inguinal-hernia
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I haven’t got to the technique description yet but that “Online Book” under the Doctor heading is an excellent overall review of all of the repair techniques. Thanks for sharing that. It’s very high level and full of references and illustrations.
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I am pasting the link to your other topic here, for reference. The Vincera Institute seems more focused on athletic pubalgia, or sports hernia. Certainly worth talking to but your situation doesn’t seem like their normal type of problem.
Good luck.
https://www.herniatalk.com/7977-need-help-2nd-hernia-repair-gone-bad
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quote EHF97:How does this happen so soon after original repair? I was advised to proceed with surgery on the original hernia as it was irreducible. The “new” hernia is five times the size of the original and is also irreducible. The CT showed a 5mm wall defect. Should I request to be referred to a hernia specialist? What is the timeframe I should expect to undergo surgery again? Will the second operation be more complex?
A hernia specialist seems like the way to go at this point. Your situation is not simple.
I would try to step outside of your insurance/medical system to see what your options are. By this I mean choose your next surgeon yourself. If you stay in the system you might or might not get a good surgeon. Many times referrals are chosen by somebody in the office just getting on to their computer and picking the first name they find, or somebody they know, or somebody within driving distance.
Post your general location and somebody can suggest someone. Many practices do not require referrals.