[Jnomesh]

My guess the majority of surgeons will rx putting more mesh in to at the very least strengthen the area. However, my guess is also that if a person has experienced crippling pain and or systematic allergic reactions there is no way they will want mesh put back in a second time.
If the mesh was put in openly there are a few surgeons out there that remove the mesh and specialize in a pure tissue repair.
if the mesh was put in laparoscopically very often the actual hernia defect is filled in with scar tissue if the mesh was in for a good amount of time at least a year or two. if there is a hernia upon mesh removal you can request the surgeon to do a pure tissue repair-they can do this either openly after removing the mesh laparoscopic ornthey can repair it while in their laparoscopic after removing the mesh.
if their is any weakenesss but no true hernia they can fix the defect laparoscopic with a pure tissue repair.

[Jnomesh]

The people I was referencing were people I communicate with online I do not know them personally.
Again I don’t want to go around in circles but I think the point that most of us are making about mesh isn’t whether it is bad or good or whether it will cause you harm or not (yes I have my personal opinions on many of these matters) but thentake away the big take away is if it does go bad it is a nightmare to deal with on so many levels-you can’t even fathom to imagine it.
on some of your other thoughts-no I don’t think in my opinion many doctors have removed mesh in their careers-maybe if it is infected (easier to remove) and maybe some abdminal meshes but I’d guess most haven’t.
i think dr. Krang’s point is that the mesh is supposed to remain flat and not become hard when it is implanted in you-but when he has gone in the mesh can be and often is folded, squished up, moved or attaching to things it shouldn’t.
Also ask your surgeon to show you the actual size of the mesh he will be using-good ones and ones that do a lot should have some examples handy-I guarantee you will do a double take-average size even for small hernias or about 5″x7″ a huge surface area. It has to be way bigger than necessary mostly Bc it is known without a shadow of a doubt to shrink by 30-50% this is a fact.
anyways when I had my surgery I thought the mesh was probably the size of a bandaid. Nope picture a small plate and hold it over your groin to get a better idea.
anyways I highly rx you get a MRI or a cat scan maybe both if one comes up negative. If they both come up negative I’d send them to the surgeons I already mentioned for review.
if after that they come back negative you can loook into other reasons why you have this pain/ bump
id they come back positive you can decide whether to wait or not
if you decide for surgery you can then decide how you want it repaired and make you own best informed decision.
i brought up the other people I correspond with not as a scare story but to give examples of people who rushed into surgery. It was meant to reinforce your decision not to rush into surgery when you don’t know exactly what is going on.
tou are fortunate that whatever is going on with you isn’t bothering you much so take your time gather as much information as possible (please get something scans) get second and third opinions and then you can make the best informed decision.

[Jnomesh]

Thanks for your reply dr. Kang. I think your real world instincts mirror the article I found. I think they called it herniosis: the three stage formation of a hernia.
Anyways I found it really interesting Bc before having mesh surgery (and eventual removal) I had so much burning and a swelling sensation in my left groin and it felt like it was in two places not one-I even felt a sensation of something pushing through more medially and a swelling- but i cat scan showed nothing, them three months later an MRI showed nothing, then 6 months later a physical by a hernia surgeon showed nothing-but man I was in so much pain.
And 13 months later it was finally diagnosed by the surgeon who would docmy surgery. In the report it said significant weakeness in the Heaschel triangle area with fat in it and fat in the indirect space-2 hernias.
so for 13 months I was dealing with two hernias that couldn’t be diagnosed. So maybe I was one of the few that had a lot of discomfort while the hernia was “forming).
also I wonder why the Marcy repair is no longer used in the US. Of the few dr.’a that do pure tissue repair it is either a Bassinin, or modified bassini, desarda or shouldice.
Again thanks for a your insight and feedback. It is so welcomed.
In America (and I’m guessing a lot of other countries) we need more options to mesh repair. And to piggy back on a point you made earlier about how mesh looks once it has been inside the body for a while-I bet if you opened up people who have mesh and no symptoms you would see that the mesh is messed up inside but for whatever reason it don’t bothering the person and is probably still doing its job of preventing a hernia recurrence.
also how is the Marcy operation performed/Carried out. Is it very different from a bassini approach?

[Jnomesh]

Yes by all means don’t rush into anything-surgery should be a last resort and you should have a definitive reason for the surgery. I know of at least 3 people who had no symptoms and it was debatable whether small hernias showed up on scans. They were encouraged by their surgeons to have them repaired laparoscopically with mesh. All three suffered serious complications from the mesh (2 had allergic reactions that led to not only pain but other severe auto immune symptoms)
all three ended up having mesh removal and although all three are overall better since having the mesh removed they all still have some issues that mesh originally caused. They all say they wish they just waited Bc they all had small hernias ( or maybe not) and they didn’t have any problems.
again my advice is to skip the aberahebfemeral surgeon or even specialist and get and send your scans to someone who can definitely interpret what’s going on. The only two I know of are dr. Towfigh and dr. Belyanski. There was another thread of someone experience pain and dr. Belyanski diagnosed that it was a lipoma and not a hernia (still needed surgery) but that person was in pain.

[Jnomesh]

Dr. Kang,
im curious if you have done any research or are aware of research regarding hernia formation as a process. I read an interesting article where it is suggested that the actual hernia one see as a bulge is actually the final stage of a three step process. And ongoing this interesting for me Bc I never had the classic bulge and the hernias never showed up on MRI or cat scan or during physical examination. But I felt internal heaviness and pressure in the groin. It went undiagnosed for 13 months until I went to a surgeon to rule out a sports hernia and he said I did have a hernia when he did the physical examination. I should not he did the classical examination the finger in the scrotum and cough test but he also did something other before Him hadn’t and that was with me lying down he put his finger at different spots in the surface of the groin and asked me to cough. Anyways when he operated he found a direc and a indirect hernia. Before him at different intervals I had the MRI, the Cst scan and another surgeon spread out months apart all said or showed no hernia-when I actually had two!!!
Anyways the article suggested that the hernia formation is a three stage process and people could feel pain along any three of the stages: weakness in the muscle, fat being hammered into a wedge and then finally entering the inguinal canal. It says this can explain why people may present with groin pain but show no bulge, no confirmation on physical examination and does not show up on scans Bc it has not gone into the canal-which most radiologists are looking for.
just curious as to your thoughts. Thanks

[Jnomesh]

If I can chime in a little bit. The whole topic of recurrence rate is really quite silly when you put it in context. Since mesh is still relatively new in becoming the gold standard there is no way anyone knows the recurrent rate down the line. Are they really following up with people 10, 15 , 20, 30, 40 years down the line? No way.
So as you can see it’s really quite silly to focus on recurrence rates as the main reason to support the use of mesh. Maybe this doesn’t matter as much if you are in your 70’s or 80’s but if you are in your 20’s-50’s it sure does.
However the more important question in my mind is does anyone really know how well mesh holds up in the human body for 30 or 50 years?
so even if you know people who are doing well with mesh and I know them too, how will they be many many years down the line.
the other problem is if you do get a recurrent hernia with mesh, the common paractice is to repair the hernia with more mesh with the opposite way it was inserted. So if you had it placed openly it would be repaired laparoscopically and vice Versa. What you end up having is a what is called a mesh sand which-which is disasterous if you should ever develop pain and want/need mesh removal Bc both meshes can’t be removed Bc your whole inguinal floor will be shredded. So you have to determine and guess which mesh is giving you problems.
And when you think it about it more it is bery disconcerting that failed mesh is left inside of you.
Hmm the mesh failed and was strong enough or good enough to hold the hernia so let’s just leave it inside you. It’s just bizarre and foolish.
There are plenty of people who develop mesh symptoms down the road i.e. 10 years later. It can happen.
so when you look at the totality of the issue with mesh it is just maddening that it is the gold standard with so few alternatives being offered.
i believe from what I’ve researched that even if you just look at recurrence rates-if you look at the best most experienced surgeons doing mesh repairs and the nest most experienced surgeons doing pure tissue repairs recurrence rates would be very similar (shouldice hospital reports recurrence rates below 1%).
but chronic pain? Way higher with mesh.
ill say it again make your best most informed decision and then once you do please find a surgeon who this all they do-hernia repairs whether with mesh or non mesh. And is throw in find a surgeon that is an expert in removing mesh too if that’s what you decide to do. You have NO idea the ringer you will put through if something should go wrong. You will never hear-it’s the mesh!
And good intention has hit on the head-mesh products are continually being introduced to the market. If they are so great why is this? Why are some discontinued or pulled off the market. And others are litigated against.
i came across a post online where a lady was in so much pain from mesh and she finally found a surgeon after years of complaing of pain and every other test being performed instead of looking at the mesh. Anyways this surgeon finally said it’s the mesh and followed with “we don’t use this type of mesh anymore Bc of its bad results”
so she had to go under another operation jus to remove the mesh Bc they have now learned it is no good. So in affect she was a guinea pig-we all are.
do you hear about the numerous new tissue repairs that come out yearly? No.
again if mesh were similar to a walking boot and a walking boot for foot issues turned out to be bad or faulty OK you change the walking boot by simply taking it off and trying a new one.
if a certain type of mesh turns out to be bad you now have to have a prosecutor inside of you meant to be permanent removed surgically.

[Jnomesh]

Meant to say sewn up

[Jnomesh]

Totally agree on your points. And the fact that the mesh companies don’t have to any clinical trials and can push it through the FDA through a special process is even more disturbing. I’m the perfect model for all the arguments-I have an open placed mesh on my right side that has been pretty good, I have had obviously the mesh removed from my left side which has ruined a part of my life and I had a small umbilical hernia that was seen up during the initial left side laparoscopic repair and I don’t or never feel a thing. Never would of know that pure tissue repair was even done.

[Jnomesh]

Dr. Belyanski is a top hernia surgeon in Annapolis Maryland.
Not to scare you but to inform you about mesh but if something should go wrong with mesh and it needs to come out it is a utter nightmare to remove. And very few surgeons do it. Dr. Belyanski removed my mesh-so if you decide on going with mesh I’d consider getting the surgery with him he is highly skilled and in your area-and even a bigger plus is he does and knows how to remove it-should something gonwromg in the future.
this is my biggest complaint about mesh-it’s not whether something will or won’t go wrong or whether it is good or bad-but if it does go wrong it is a utter disaster and an ordeal to get it removed and even if you do get it removed it’s not a slam dunk that you are better off. This stuff can do a lot of damage.
the D you are talking about is most likely the desarda pure tissue repair. Ask how many he does of these types of repairs.
Do your research and make the best decision you can on which way to go.
there is nothing wrong with waiting however if it is small it is much easier to get a pure tissue repair if it gets bigger over time and you want a pure tissue repair it may be harder.

[Jnomesh]

I would get a cat scan or a MRI-I let dr. Towfigh weigh in which she thinks is best of the two-if the tests come back normal i would then send these to a surgeon who is an expert at finding hidden or occult hernias by reading these scans. However in your case it is even more bizarre since you mentione a bulge pooped out. Dr. Towfigh has mentioned she reads the scans herself and from my own experience dr. Belyanski does too. They may each have there own preference as to the type of test they prefer.

[Jnomesh]

Also in response to your point why do so many surgeons use mesh-I believe it is for a Minnetonka of reasons.
1) I believe mesh was and is promoted to lower recurrence rates. This is debatable but that is what they believe.
2) mesh covers up all the weak spots in the ground where hernias can occur so it protects
you from other hernias-direct indirect and femoral no matter which one you are going in for.
3) most surgeons also use mesh Bc that is what they are trained in how to do.

however the downside to mesh is that it is a foreign body in your system and can cause a boat load of trouble. Chronic pain has gone up with mesh even if recurrences have maybe slightly gone down-again debatable.
if it doesn’t go wrong you are in a big world of hurt with very difficult decision of what to do.
my biggest problem isn’t with mesh itself but the fact that it has become so prevelant that it is very difficult to find alternatives. When I got my repair I wasn’t give a choice-i just trusted what my surgeon told me. At the very least surgeons should receive equal training in mesh and non mesh repairs so the patient can make an informed choice. However the pure tissue repair seems on its way to becoming extinct and that in my opinion is just flat out wrong. There isn’t ever just one way to do something

[Jnomesh]

Hey i totally hear where you are coming from. That’s one of the reasons i rx if you do go the mesh route do it with a hernia specialist. They have not only a better understanding of the anatomical area but an understanding of what the best type of mesh to be used for the specific patient. For example not only was the mesh used in me having a lot of issues with other people (bard 3D maxx-please avoid this at all costs as it has a tendency to fold over Bc of its design). The surgeon who removed my mesh felt not only was that type of mesh not the best for thin people like myself he also felt that he surgeon tried to fit to big of a mesh into to little of a space.
some thoughts I have about open repair vs laparoscopic pros and cons.
open repair is not as close to vital organs so doesn’t pose as much risk if something should happen to the mesh. However, if something should go wrong with the mesh and it needs to be removed I feel it is a more invasive procedure and a higher chance one or all of the inguinal nerves have to be cut or aggrebated. It is will also take a little longer to heal.
laprascooic there will be less recover time and less pain in the groin area but there will be three incisions in your stomach for the instruments and the camera and you will be filled up with gas to inflate the stomach and of course general anesthesia. And that can be an uncomfortable process during recovery. Lapro als puts the mesh closer to vital organs such as the bladder etc.
however i also feel from my experience and from corresponding with others that it may well be easier to remove the mesh should it need to be.
my biggest discomfort from my removal was the incisions and gas used for the surgery. I had very little “traditional pain” pain from the removal which I thought was remarkable especially since it had to be peeled off my bladder amongst other things
Don’t get me wrong recovery hasn’t been a cakewalk and their is discomfort that I am going through but people I talk to who have mesh removed openly seem to be in a lot of pain in the early months of the removal.
some more thoughts. Shouldice repair isn’t the only type of pure tissue repair. There is the desarda and bassini repair. But you will have to travel-these seem like less invasive repairs these the shouldice and many don’t use permanent sutures but absorbable ones. There is dr. Tomas in Florida that does the desarda repair, dr. Peterson that does some version of a pure tissue repair and dr. William brown that does a modified bassini approach. Worth looking into if you haven’t already. Of course you will most likely have to travel and pay out of pocket.
I think it also depends on how big your hernia is. If it is small, I really think you should consider anoute tissue repair and may not have to go with the shouldice if it looks a little to invasive etc.
there is a dr. Kang from South Korea on another thread I’ve been on-no mesh repairs and he only does pure tissue relairs and again supports is results are very good. Maybe you can ask him his views on the different tissue repairs pros and cons. He has been great in responding to me
ans finally dr. Towfigh has mentioned that she is now doing a laparoscopic pure tissue repair for select patients. Man this seems promising and with looking into.
i totally understand your hesitancy and I think you are wise in researching this and weighing the pros and cons of each type of surgery. But on the other hand you don’t want your hernia to get larger as your options may dwindle.
whateber decision you make the best thing you can do is select the best and qualified surgeon
for the type of repair you go with. This will dramatically increase a successful repair.
hope this helps

[Jnomesh]

Thank you dr. Kang for your input and offering a different and welcome point of view!!!

[Jnomesh]

Hi. Is the doctor who does the shouldice repair located at Stoney brook? Ultimately you will have to make a decision on what you feel is the right way to go on this one. I can tell you I had laparoscopic hernia repair with mesh 6 years ago and it ruined my life and I eventually had to have the mesh removed in a long and tough surgery. My mesh had folded upon itself and folded over and become rock hard. It had to be peeled off the bladder and a few patches had to be left on the spermatic cord and other structures. It seems the majority of people do well with mesh but if it goes wrong you really are screwed and are left alone to figure it out. Ultimately I had to travel out of state and pay out of pocket for s lot of this procedure.
if you decide on getting a mesh repair then I rx going to see a specialist-I’d even rx making the journey to another state if I have to. I’d pick a surgeon who is not only an expert at this procedure but has experience removing it if something should go wrong. Unfortunately there are very few of these surgeons.
i never experienced the shouldice repair but I can definitely tell you if I could do it all over again I would have gotten a pure tissue repair and avoided mesh. Just my two cents

[Jnomesh]

Thank you again for your reply and offering a different perspective. It is very refreshing.
So im guessing that where you described the nerves going isn’t where I’m feeling the issues. It seems like maybe it is the lateral femoral cutaneous nerve location. Maybe when the mesh folded it aggrebatedbthis nerve and then she the mesh was removed it is still aggravated. The area is like 3 inches below the ASIS and slightly to the left. A slight rigging issue when walking and burning when sitting. I guess time will tell.
on another note Mesh for hernia repair in the US has become so prevelent that there aren’t other options offered.
when I went for my hernia repairs never ever was a pure tissue option offered so I can make an informed decision. Never ever were the risks-however small-of mesh explained to me. Never ever did the surgeon say if something went wrong with the mesh they didn’t know how or couldn’t remove it. It really is troubling. I know of after searching relentlessly of three surgeons in the US-that’s right 3! Who specialize in non mesh repairs-out of probably 100,000 surgeons who perform this procedure. It’s just wrong.
The shoukdice hospital in Canada reports that there recurrence rate is less than 1%!!!
and even less then that for chronic pain.
so why do surgeons in the US keep quoting high recurrence rates??!!! One doctor on this site said he believes recurrence rates with tissue repairs are 100% if you were to follow the patient throughout there lives. What a nonsensical statement.
bottom line is patients need more options when it comes to hernia repairs. The bias towards mesh is so out of whack that if someone doesn’t want this procedure they either have to travel or travel out of the United States to get this procedure or to roll the dice that a surgeon who doesn’t routinely do tissue repairs will do a good one.
i recently found a surgeon in LI NY who is from the shouldice clinic and has performed over 650 surgeries using this method. But I had to search like crazy to even know he existed. We need an operation similar to the shouldice clinic here in the states. A place where only pure tissues are done by highly skilled and trained surgeons. A pure tissue repair with less than a 1% recurrence and pain VS the gold standard of mesh with a 3% recurrence rate and possible debilitating pain due to a plastic foreign material that can reek havoc in the groin. With chronic pain rates that are reported as high as 20-30%. Dr. Towfigh what’s going on here? Something isn’t right. There needs to be at the very least a balance.
Again patients need alternatives and options.

[Jnomesh]

Hi. As I mentioned earlier Dr. Igor Belyanski (Annapolis Maryland) and Shirin Towfigh (LA)
are the only two I know of. Maybe dr. Bruce Ramshaw in Tennessee. If you google them all them tjere contsct info will pop up.

[Jnomesh]

Yeah I think that is a start. I know that I was able to send my docs to Belyanski and he reviewed them with no charge. Not sure if there is a fee for the other surgeons. You’ll have to assess the pros and cons of who you send them to.

[Jnomesh]

I had mine in for 6 years and had it removed 6 weeks ago. Your best bet is to have an MRI and a cat scan and send it off to a surgeon who knows how to read these scan as they relate to mesh and see if there are any issues with the mesh. Dr. Igor Belyanski was able to see in my cat scan that the mesh was defective. Two local surgeons in Ny said everything was fine when they read the cat scans and MRI’s.
dr. Towfigh also has mentioned that she is able to read these scans as they pertain to mesh.
so in my opinion step one get these tests read by experts to rule out that something is wrong with the actual mesh-them you can go from there. It will also be helpful to now if your mesh was implanted laparoscopically or open.

[Jnomesh]

Understood. Thank you

[Jnomesh]

Wow! Seems awful early-i definitely wouldn’t of even been able to think about do any gym activities at two weeks out from my mesh removal.
would this advice be any different if absorbable sutures were used? (I know you use permanent) since the sutures are losing strength or would you still feel if one is feeling up to it to be more active.