[Jnomesh]

Did you research osteitis pubis and what the symptoms are?

[Jnomesh]

I visited brian Jacobs. My consult with him was very positive and I feel he is very thorough and skilled. My visit wasn’t for hernia repair but to see if pain i had from prior hernia repair with mesh was causing the issue. Although I’m sure he prefers to use mesh for repairs I also think he would be amendable if a patient wanted only a tissue repair. However, if I remember he does not take insurance but it is worth double checking. You also aren’t that far away from dr. Belyanski in Annapolis MD who I also highly rx.

[Jnomesh]

No problem. Since you had it put in lapro I would focus on dr. Ramshaw of dr. Belyanski or Towfigh for possible removal. Ramshaw I heard has a long waiting time so I would as I mentioned send your scans to dr. Belyanski. He is doing more and more removals. I have spoken to three people recently who are scheduled to have there mesh removed by him in the winter.
the mesh caused so many issues for me (attached to the bladder, spermatic cord, colon and illiac artery and vein-in addition to being folded up inside. Two things that are gone is that I now urinate normally. I also don’t feel that heaviness in my abdomen and I don’t feel sick like I did anymore. For me I was amazed at how little pain there was in the actual mesh site post removal. I went back to work after 7 weeks.
sitting for me before surgery was the hardest for me and still can be challenging in certain situations. Driving mostly OK couches and deep soft chairs can be bothersome. If I sit to long I can get some burning in the upper lateral thigh. Waking is fine and lying down is fine. Eating and digesting was very tough for me after surgery and although much better is still an issue for me. I eat smaller lighter meals and don’t have as strong of an appetite.
I am grateful to be back at work and getting through the workdays with no issues and back to being out of bed and back with my family doing normal routines.
ive heard from others that healing can take at least 6 months to a year or longer so I hope there will be a day where whatever still ailes me is gone or minimally bothersome.
lastly I have heard mixed things regarding Chen. I would consider ruling him out for removal. I also heard he has a tendency to do nuerectemies as part of the mesh removal whether or not the nerves are cought in the mesh. I know Belyanski does everything possible to preserve these nerves as well as Ramshaw

[Jnomesh]

Hi I am not a doctor but a patient of the same type of mesh you had implanted. This type of mesh has a tendency to fold up inside of you especially if there was no fixation used and it can attached to the groin nerves. Please get your operative report so you can see the details.
I eventusll had to have my mesh removed. It is not an easy process and you have to choose one of the few surgeons out there who do this-warning there are only a handful and you mostl likely have to travel.
here is my advice-you are going to want to do two things simultaneously: 1) rule out that the mesh has folded up inside of you. If it has in my opinion then it absolutely has to be removed especially given the amount of pain you are in. The surgeon who discovered my mesh was folded is dr. Igor Belyanski in MD you can google him. Get a cat scan and send him the scan in a CD and see what he has to say. 2 other top notched surgeons where I live in NYC said all was well when they reviewed my CT scan. They were wrong and truth is 99.9% of surgeons and radiologists just aren’t trained on what to look for.
2) while you are doing this yes get a nerve block make sure the place you are going to uses ultra sound guided nerve blocks. Based on your description to them they rule out one of the 3 groin nerves. If you feel relief from these nerve blocks some people rx doing it a couple more of times and there pain can be lessened or eliminated if not then pulsed radio frequency Albation is the next step and it has been reported to have results that last up to a year and then can be repeated.
make sure the clinic has expertise in these matters.
if it is determined that the mesh has to come out please only go to the best don’t let a local surgeon do it.
also how your mesh was implanted: laparoscopic or open is the way the mesh should come out of it comes to that point.
dr. Belyanski removed mine. He specializes in removing it robotic assisted laparoscopically but can do open removals too. Dr, Bruce Ramshaw in TN is an expert and can do both but usually has a long waiting time
there is dr. Towfigh who runs this forum who has expertise in removing mesh and a dr. Peterson who I believe only removed mesh openly.
also there are drugs like gabapentin that help with this type of nerve pain. There are pros and cons to it but i know how it feels to be laid up in pain and I was willing to do anything and everything I could to get back to work.
best of luck to a very trying and difficult situation you are in.

[Jnomesh]

Hi. I’m a male. I will say from my experience it was more of a burning sun burn kind of pain that I felt in my outer calf and foot. But I do think you just need to try and rule everything out. I can only speak from my experience but since you already have a cat scan I would request a copy of the Cat scan they can put on a CD for you and i would send it to dr. Igor Belyanski in Annapolis MD. You can google him. Speak to his office staff and his assistant. I would type up a detailed letter explaining everything you are experiencing and send that in with your scan. He is an expert at reading cat scans. I would highly trust his opinion. If he doesn’t see a hernia I would then move on to other tests or therapies. Look into Myofascial release therapy and message therapy for the back.
it is also possible that you may have a weakeness in your abdominal wall and no true hernia yet but that weakenesss may be causing you the discomfort. If the cat scan is deemed normal by dr. Belyanski you may wish to use a MRI as that can find muscle tears and other stuff that a cat scan can’t. And of course since you are female there is a higher chance of you do have a hernia it ny be a femoral hernia and as I mentioned there are some different nerves associated with that type of hernia . Best of luck

[Jnomesh]

For almost 13 months my hernias went undiagnosed-had both a MRI and a cat scan and saw two surgeons over that time. I had burning and heavy feeling in two places in the left groin. Sitting at times was unbearable at times. Lying down was the only thing that most of the times would bring relief. Finally after seeing a rx surgeon to rule out a sports hernia (even though i didn’t play sports but I was desperate to find an answer) he diagnosed me as under having a hernia. After surgery he informed me I had both a direct and indirect hernia. No wonder I was I so much discomfort. Imagine that two hernias and no one could diagnose them and I had to live with this pain for more than a year.
What I am learning through my very nightmarish journey with hernias is that there is for whatever reason a subset of people that just don’t present in the normal fashion. And how the medical field as a whole is really quite bad or poorly trained at helping this subset of people. Unfortunately my mesh failed and I had to spend another 6 months in excruciating pain being told by the medical field that everything was A ok. I was told by one hernia specialist that the pain I was going through definitely without a doubt had nothing to do with my mesh or anything to do with the hernia site. Dejected I asked in your expert opinion what should I do? And he said get a deep back massage. Thanks. Anyways I finally found an expert who after looking at the same cat scan this other surgeon looked at that my mesh had folded up. The take away is don’t give up and do your best to do whatever you can to find specialists who can read these scans even if the hernia doesn’t present itself in the typical way. They are out there.
And chaunce 1234 yes pain can absolutely extend below the knee from a hernia or mesh from a hernia. Again this is probably rare in most situations and uncommon but that doesn’t mean it can’t. When I had my mesh folded up I had burning in my thigh all over and in my calf and foot.
if you research the femoral nerve it shows that it can extend to the calf and even the foot.
And everyone just isn’t wired the same way.
when I wanted to rule out the lateral femoral cutsneous nerve as a nerve causing my burning pain the pain management doctor was convinced it wasn’t this nerve Bc I was comparing if not only thigh pain but pain just above the knee and he said this nerve doesn’t go to the front top of the knee-sure enough after they did the nerve block I felt numbness in the area I was complaining about. My case was probably an anomaly but it just goes to show you everything isn’t a textbook answer.

[Jnomesh]

There is brian P Jacobs in NYC. He is a hernia specialist and can help detect or rule out a hidden hernia. A MRI is probably a better test to have. Most surgeons will probably say that a hernia wont refer pain below the knee. I am not a doctor but the pain could he related to back pain which can radiate to the groin, leg and below the knee and a MRI of the back can help. There is a dr. Michael weinberger at Columbia Presbyterian pain management and that paractice specializes in back issues and can help rule out the back.
Hope this helps.

[Jnomesh]

I’m not a doctor but if you have a small umbilical hernia definitely get it repaired by using a tissue repair. I had both a inguinal hernia and a very small umbilical hernia that were both repaired in the same surgery. Mesh was used for my inguinal hernia which turned into a total nightmare and I had to have it removed. The umbilical hernia was stitched up. I never felt a thing and never have had an issue with it.
no need for mesh for a small hernia.
Also the size of the mesh they use for a small hernia can be quite big.
stay away from mesh if possible and find the best qualified surgeon to do your repair even if it means traveling.
just my two cents

[Jnomesh]

There is a highly regarded sports hernia surgeon in San Francisco named dr. William brown. You can google him-maybe send your MRI to him for review. He has great bedside manner. Lots of people travel to see him and he is an expert in doing non mesh pure tissue repairs if it turns out you have a hernia.

[Jnomesh]

Thanks again!

[Jnomesh]

Gotcha-and this can be done even if say there isn’t a true hernia recurrence? So let’s say indirect hernia recurrs but direct doesn’t- the direct space can still be reinforced separately but in same procedure (even if maybe not recommended)

[Jnomesh]

And my mesh wasn’t fixated at all Bc you don’t have to with the 3D maxx. And mine completely folded into a hard ball. Understand that if you have your mesh fixated with racks or staple or sutures they can hit nerves and cause all sorts of problems. And if they don’t understand that mesh shrinks on average 30%-50% so as the mesh shrinks and is fixated there is a lot of pressure that can ensue. If you don’t use tacks staples or sutures then you avoid all that but a higher risk that the mesh can fold or migrate and do all sorts of undesirable stuff.
i read an interesting research article online that showed it can take a very long time for scar tissue to really solidify the mesh. So if you should get a bad cough or constioation it can actually move and change the shape of the mesh which then over time will solidify into that shape. It’s just a potential mess.
ive also been reading many research papers online that show the recurrence rate to be lower than tissue repairs outside of specialty centers like the shouldice hospital.
so they are actually admitting that if a tissue repair is done by a expert, like the shouldice hospital, the tissue repair is superior. The shouldice hospital reports that there recurrence rates are way less than 1%!!!! And chronic pain well below than 1%.
so to me this is just unbelievable evidence that people need a Chiice here in the states. Where is our shouldice hospital. The focus should be in training surgeons on tissue repairs again without the need for only mesh repairs.
This just smells of big pharma.
People need a choice and then can make there own decision on mesh vs no mesh. The fact that the pure tissue repair has slowly become extinct is just a poor reflection on our health care system.
there is indisputable eveidence that pure tissue repair done by a surgeon whose expertise is in this procedure is way more effective than mesh for most people. Sad.

[Jnomesh]

Hi thanks dr. Kang. In my particular situation I had both a indirect and direct hernia repaired with mesh laparoscopically. The mesh folded up and had to be removed. Upon removal my surgeon noted that the direct space had been filled in with scar tissue. Although there was no indirect hernia upon removing the mesh there was weakness in the indirect space. This was repaired while he was in laparoscopically by bringing the internal oblique muscle down to the illiopubic tract and closing with absorbable sutures. He also noticed some/slight weakeness in the femoral area but it was to vascular to reinforce with sutures.
i know this whole area is still weak, especially with the removal of the mesh so I was just tying to plan ahead should I get a recurrence and need surgery without mesh I’d like to get the both areas reinforced/fixed in one operation given my history even though there only might be one recurrence. I’d hate to get a indirect hernia recurrence have surgery to fix it and then later get a indirect hernia and have to be cut open again (I’ve already had three surgeries)
so I was hoping there was a way to fix/reinforce the area in one surgery without mesh.
i guess this might not be as easy I had hoped.

[Jnomesh]

Very interesting. Any data for people like myself who had both a direct and indirect hernia at the time of repair. If there is a recurrence is it likely to be one or the other or both?

[Jnomesh]

Thanks dr. Kang for your follow up. I have a few more questions regarding the pure tisuue repairs
for indirect and direct hernias.
1) do you know if the shouldice repair for either a direct or a indirect hernia covers both spaces? In other words if you have an indirect hernia will the shouldice repair also reinforce the direct space?

2) the reason I ask is Bc I have had my laparoscopic mesh removed by the Same method.
when mesh was originally put in it was noted that I had both a direct and indirect hernia. However, when the mesh was removed there were no hernias noted by the removal surgeon. The direct hernia was completely filled in by scar tissue and there was weakeness in the indirect space that the surgeon repaired by bringing the internal oblique muscle down to the illiopubic tract and sutured with absorbable sutures. I’m curious if only one hernia should reoccur in the future is there a pure tissue repair that can reinforce both areas even if only one hernia reoccurs. I guess my question is since I had Both types of hernias (and don’t want mesh again) if i should have say a indirect hernia that reoccurs I’d hate to Just have a pure tissue repair of the indirect space knowing I’m susceptible to having a direct hernia and might need a second repair down the line-I’d definitely prefer if possible a pure tissue repair that can not only repair one hernia but in essence also reinforce the other space as well.
just curios if that is possible. How would you handle a patient like me?
thanks in advance -looking forward to your input.

[Jnomesh]

Totally agree-and love the Seinfeld reference. Unfortunately these days the patient has to be their Own advocate and really do their due diligence and research before going ahead with all a lot of things-surgery, prescription drugs etc.

[Jnomesh]

I’m glad you have made the decision to wait and also came to a decision on how to proceed if/when you need surgery.
my last 2 cents will be when you take any advice from anybody make sure they are apples to apples. WasinTn was very nice to offer his experience and knowledge concerning his hernia repair journey-although I don’t understand the genetic statement-yes if family members have had hernias there is a greater chance you may have one too but that doesn’t in my opinion have anything to do with recurrences-a hernia by definition is due to weakness. But i degrees.
WasinTn had an open procedure I know this Bc this is what doctor Goodyear does-open procedures. Yours if/when you have it done will be robotic assisted laparoscopic surgery. They are very different and recovery is very different.
i have had both procedures my first was open placed mesh on the right side and my second was laparoscopic on the left side and my mesh removal on the left was performed by robotic assisted laparoscopic.
recovery from open repair is longer and more painful in the area of operation-you are being directly cut open with muscle dissected in the area laparoscoic repair the recover and pain is easier at the site of the repair but three small incisions are made in the abdomen and your stomach is inflated with Co2. With robotic asssisted repair these incisions are bigger. The biggest issue with recovery is recovering from the bloating from the gas-it is not fun. It can also mess with you appetite, indigestion etc. in 2-4 weeks if all goes well you will be fine with either type of repair. Laparoscopic repair has to be done under general anesthesia which carries more risk although minimal. Open can use local anesthesia.
so why do I bring this up? Bc it is important to know that these are two very different surgeries albeit with the same goal in mind.
laparoscopic places the mesh at its deepest level and almost always uses a bigger piece of mesh than open. When your stomach is inflated the repair is done from behind the abdominal wall and incision is made in the perotineim. With the mesh being placed this way it is very close to many other structures, the bladder and your intestines to name a few. This can be a disadvantage if something should go wrong-as I mentioned my mesh had to be peeled of my bladder, spermatic cord and the colon was pressed up against it causing bowel problems and urinary problems.
When I was having my mesh removed I met another man who also was having his removed Bc the mesh had attached to his appendix. The only thing separating your intestines from the mesh is your peritneum.
Again I bring this up Bc WasinTN had his done openly and your surgery will be a different surgery. Statistically you should do fine with either but I bring this up Bc this is another detail you should research and look into-the pros and cons of open vs laparoscopic hernia repair.
finally robotic assisted laparoscopic repair has a lot of advantages including as you mentioned a 3D camera-but again your surgery will only be as good as your surgeons experience-as how many robotic surgeries he has done and decide which procedure you think will be best for you based on your research. There are pros and cons to both.
i just think too often hernia surgery is passed off to the consumer as no big deal and we jist usually go with whatever the surgeon says and does.
WasinTN did his research and has had a good outcome-he went with a expert who only does one thing and does it well and traveled to accomplish this.
So I encourage you since you have the time to continue to do your research and ask as many questions as you can. I know that the north penn institute where dr. Goodyear is from they do mesh removal (only open removal Bc that’s what they specialize in)
so as you can see this isn’t just about mesh or no mesh but method-open vs laparoscopic vs robotic assisted laparoscopic

[Jnomesh]

And one last thing-it is almost inevitable that you will end up with mesh put in if you have the other side explored. Most surgeons will do this Bc A) there is a good chance they will find some weakeness however great or small on the other side and just decide to repair it. You will now have mesh on both sides and some will just implant a huge piece of continuous mesh that basically wraps around you lower groin/abdomen.
another reason there is a good chance mesh will be implanted on the other side is that when he explores the other side he has to take down a wall (as my original surgeon explained it) to gain access to the area and that intself might need some reinforcement.
My two cents would be to hold off surgery with mesh as long as you can unless you plan on getting it repaired without mesh and then there is an argument for getting it repaired while it is small.
There seems to be no conclusive consensus whether you truly even have a hernia.
if you aren’t in pain I would just wait and line the earlier poster mentioned just be very conscious of the things you do.
you need to stay away from things that cause a lot of intra abdominal pressure-like
jumping
chronic coughs
excercises like squats
constipation and straining to pass bowels
and lay off Strenous activities like lifting etc.
surgery should be the last resort-take a wait and see approach and slightly modify your lifestyle it may be well worth it

[Jnomesh]

Hi. Was debating whether to respond or not Bc I feel you’ve done so much more than most people do when looking into hernia surgery and you have listened to both the good and bad arguments and have come to a decision and that’s really all you can do. My experience as I’ve mentioned was a nightmare and the mesh had to be removed and this was a very very painful, psychologically and emotionally and financially draining ordeal.
so I will leave you with two thoughts that you can think k about and follow up with your surgeon:
1) please ask what would happen if down the line the mesh causes you major pain and issues?
Does he remove mesh? Can he read MEI’s and Cat scans to see if there are issues with the mesh? Please ask if he says yes how many mesh removals he has done and don’t let him get away with oh about one or two a month-ask for a ball park figure. Ask him if he gets all the mesh out and if the groin nerves routinely have to be cut (called neurectomies ). Ask how long he will make you wait to see if symptoms disappear before considering mesh removal. 3 months 6 months a year? Remember you mentioned that it was mentioned that mesh is supposed to permanent-and it is and that is why removing it is so hard.
2) one point that I would definitely run away from is the use of the Bard 3D maxx hernia mesh. It is a disaster. Please don’t let him put that in you (whenever you are ready for surgery). Don’t take my word for it-but please just google it! There are numerous lawsuits in this brand. It folded up inside of me and in the process attached to things it shouldn’t have. It had to be peeled off my bladder, removed as much as possible from the spermatic cord and some pieces of mesh had to be left on the illiac vein and illiac artery Bc I could of bled to death if something went wrong when removing it. There is a huge design flaw-it is concave which is supposed to help with the 3D aspect of the inguinal canal region but this makes it highly susceptible to folding over.
The surgeon who removed my mesh said it is also a heavier mesh and does not do well in thinner people. This is why I implore you to please find a hernia specialist and not someone who says they are just Bc they do a lot of hernia surgeries. The surgeon who did my original surgery also told me he does many many hernia surgeries but yet he used this crap piece of mesh in me and I was a thin guy.
find a surgeon who only does hernia surgeries-they are out there but harder to find. They will know which mesh is best for YOU! Not just use a mesh that he soley uses for everyone.
You are moving in the right direction and seem determined to use mesh-if so please make sure you give yourself the best odds of s successful long term outcome. There are a good number of people I’ve come across who had mesh removed and had the Bard 3D maxx mesh.
best of luck!

[Jnomesh]

They (mesh repairs) are better meant to be permanent-because the mesh sure is. But the fact you are hearing if recurremcess down the line (10 years) should again make you weary of using mesh for hernia repair Bc the mesh itself is meant to be permanent in your body whether or not it does its job of preventing a recurrence or not.