[Katherine]

Hi Good intentions, thanks for the information on the laproscopic repair using the “eye shaped” lighter weight mesh. I did not know that this was most likely to have folding complications. I would certainly rather have a pure tissue repair – but what I’d like most is to find a fantastic doctor that does a pure tissue repair, but could honestly evaluate me and let me know what is best for me! Finding a needle in a haystack where I am! I guess I could go back to that pure tissue doctor that I had written about earlier (the one with the not so great attitude) and ask more questions about his type of Bassini repair. I keep spending all these copays to see all these doctors and that adds up. I could be using these copays to go see a really good hernia surgeon (thinking about either Yunis or Brown). But again, travel restrictions due to medical issues. Also, given my physical situation, I’m not likely to be lifting heavy things or pumping iron in the gym! So less chance of the tissue repair failing I believe. As always, I appreciate your insight!

[Katherine]

Hi Alephy, thanks for your response. My symptoms are some slight soreness at times (other times I feel nothing). It seems to get larger during the day, when I wake up after sleeping, it’s doesn’t stick out nearly as much. If I bend down to the floor with my knees, I feel it popping in and out. It is more sore towards the pubic bone area than any other area. It also prevents me from doing things like core exercises because then it becomes larger and more sore. But day to day activities, it doesn’t interfere with. So, I would say they are pretty mild. My situation is rather unique. I had a very rare spinal nerve condition that caused me pain, but I wasn’t on any meds for the pain, but I just couldn’t sit! It would cause terrible neuropathic pain and sitting is 1/3 of our lives. So to overcome this disability, I had surgery. Well, the surgery failed. Now not only am I in worse pain, I’m on a ton of meds to control it. So… I guess I am feeling the same way about the hernia surgery. Will I look back and say I should have lived with the relatively minor pain I had before surgery if I end up with chronic pain or a failed repair or potential removal of mesh? I totally have surgery PTSD. I haven’t let anything invasive at all happen to my body since surgery because of it. So a large part of me says just leave it alone although it does bother me some. But I honestly think I’d kill myself if I had to deal with more chronic pain in my body that I already have. Most of the doctors I have seen have said that although they consider my hernia a “medium” size, if it doesn’t bother me, I can leave it alone. The risk of strangulation is very small. My back condition is most likely caused by some type of connective tissue disorder, so it is possible that my tissue is too weak for a tissue repair – but one doctor said he could do a tissue repair after looking at it. But most are just doing the mesh now. None of them would tell me their complication rate; however, after I asked one doctor about “watchful waiting” he said that is fine since “I can always make you worse”. So at least he was honest. I agree with all your comments in your last paragraph. But how do you find such good doctors? I have seen so many. I think if I had seen the one that I really felt comfortable with, I would have already done it. But I haven’t find that doctor yet (note: I haven’t considered out of state in this commentary due to the difficulty of doing so and insurance reasons). I think until we find that true comfort level, we just wait. Of course, it all depends on your personal situation. If you are young, healthy, no other issues but the hernia and you want to exercise, you may want to get it repaired. Because it does interfere with exercising for me. Where do you live? There are a few doctors that I have seen who have hernias as a large majority of their practice (one I saw said he does at least 1-2 per week, he uses mesh). And if not hernias, he practices mostly on abdominal type issues (lap band surgeries for weight reduction, gallbladder, other types of hernias, etc.) It’s so hard!

[Katherine]

Dr. Towfigh – here are the names of the two surgeons I have found in Houston that do non-mesh repair. Do you happen to know either one of them? Both are older and do both mesh and non-mesh repair. Dr. Richard Andrassy is one I saw a few years ago, but at the time my hernia was getting larger, but not symptomatic at all so I decided to just wait. I read some bad reviews about him on the internet, so I decided to look elsewhere this time. However, he did come recommended by some physicians that work with a sports massage therapist that I know. The one I saw last week is Dr. Wade Rosenberg – he is the one I posted about above. He was highly recommended by another physician in the practice who only does mesh repairs. Do you happen to know him? I am at the point where I would like to get it repaired, but just don’t truly know what is the best method for me. I believe I have some form of connective tissue disease, so maybe only a mesh repair would work? Maybe a tissue repair would have to great of a risk of reoccurence?

[Katherine]

Thank you Dr. Towfigh! I wish I could see you, but my insurance plan is not one that you accept. I appreciate your valuable input. I would say that at this point my hernia is mildly symptomatic – but the big choice is are the symptoms better now than they would be if I had chronic pain after surgery since there are no guarantees with surgery. I did see another surgeon who does only laproscopic mesh. I will post another topic in the forum in regards to that visit to get some educated opinions on the matter!

[Katherine]

I guess I’m so worried about mesh because of the continuing inflammation I’ve had from the reabsorbable mesh in my spinal operation back in 2012. It’s weird because I had a bad feeling right when I was on the pre-op table about the surgery and the surgeon. It’s an extremely risky surgery to begin with. I guess I would describe the doctor I saw (hernia doctor) as just so unpersonable. And it is possible that mesh would be the best option for me – but I did have a successful non-mesh repair in my 30’s that’s still going strong (fingers crossed). I wish I had some way to contact the doctor that did my repair back in the 90’s to find out what procedure he used. The doctor I saw last week is probably about 10 years younger than the doctor that did my left sided repair in 1994, so I would bet their procedures are similar – in fact, he did know my doctor from 1994 and said he didn’t know what he used, but their procedure was most likely similar. I also find it somewhat comforting that the doctor I originally saw gave such glowing recommendations to the older one that I saw – said he trained under him and he was great. Of course, time and age effects collagen tissue an I’m not that healthy 34 year old body builder I was back then. You bring up so many good points that I plan to ask when I see the other doctor next week. I wish I had the energy to do more research, but honestly, I’m totally exhausted with medical research after 10 long years of dealing with my other issue. And I also have bilateral tarsal tunnel syndrome (tibial nerve entrapment at the ankles), which is also a very risky surgery and something else I’m dealing with now. Just feel a bit over whelmed. I’m so happy that you did have a good outcome with your second hernia surgery and mesh removal. There doesn’t seem like there are too many with success with this after having a mesh. One thing the initial doctor the other day pointed out to me (the one that only does mesh), is that there are so many different types of mesh, but most of his patients did have an initial inflammatory reaction to the mesh as a foreign body, but gradually the body accepted it and most of his patients did OK with it. However, he did also say that some people do have long term reactions and there is no way to truly predict that I would be one that would not suffer “mesh” consequences. He was a really good guy, very personable. But, yes, I do need to keep researching, thinking, reading. Once you are cut, that is it. And even though my hernia is getting larger and is mildly symptomatic, a failed surgery which left me in chronic pain would be much worse pain than I am in now. I will read over the link to Dr. Kang’s thoughts – appreciate you finding that and sending it to me!

[Katherine]

I have thought about that – maybe scheduling another appointment. After he told me he could do a pure tissue repair, I asked him if I could ask him some questions and he was receptive. Unfortunately, I had questions that were more related to the shouldice repair, not the Bassini. These are the questions I asked and what I remember as the answers.
1. What type of tissue repair do you do? Bassini.
2. Do you cut any of the nerves during surgery? No, I try not to. He sorta “chuckled” at this answer – like cutting nerves was not something he does. I did go to a surgeon last year that routinely cuts the genitofemoral nerve — so I automatically eliminated him from my list.
3. I asked him what type of sutures he uses. I think he said prolene.
4. What type of anesthesia do you use? General.
5. Do you routinely ligate and resect the hernia sac? I believe he said yes, although he got a little more technical that I understood.
6. Do you routinely transect the round ligament? I think he said yes. At this point, he said “you have done your research” and I explained about my failed spinal surgery and why I have so many questions.
7. What type of complications have you had with surgery? He paused, then looked at my questionably. And I said – like chronic pain. I didn’t like his answer here as he kinda looked to the side and said none, really.
8. With my connective tissue disorder, will it make surgery more difficult? He said possibly, but that is probably why you have a hernia to begin with.

So I think I asked some reasonable questions, unfortunately, I didn’t ask specific questions to the Bassini because I just wasn’t prepared. I suppose I could reach out to him and ask either through the patient portal, writing him a letter, or another appointment.

I have an appointment with another doctor next week who supposedly does pure tissue repair. I think I’m a little more prepared this time. I need to do some more research on the Bassini repair in the event he does this repair.

Looking over the forum, it seems the Bassini repair is associated more with chronic pain? Is this true? You seem to be one of the most knowledgeable people on this forum (although there are many – I’m truly impressed with this forum and so blessed I found it). And the doctors that participate are top notch (unfortunately none are in Houston).

Any other sage wisdom by you or any one else would be most appreciated! Also would really like to hear comments by our participating doctors if they wish to enlighten me further.

[Katherine]

Thanks Good intentions for your thoughtful comment. Yes, from looking over previous posts that is what I understand about the Bassini. So I guess it all depends on which method the physician uses. From the reviews I’ve read online about him, everyone says he has a bad bedside manner! And this is not just hernia surgeries as he does other general surgeries. However, in the majority of the reviews, most of the people say that he did an excellent job on their repairs (whether hernia or other). There were only a few negative reviews on his surgical skills and those were not hernia repairs. I’m not sure how many tissue repairs he currently performs – I would guess that since he is in a large hospital practice where most of the doctors do mesh, he probably does, too. But at least he has a number of years experience doing it the old fashioned way. I did find some reviews where some people did have hernia surgery by him (don’t know if it was mesh or non-mesh) and they were pleased with the results. Of course, I also don’t know how much you can trust these reviews posted on the internet. He didn’t act like he didn’t want to do mesh – or have empathy for me for not wanting it. He just examined me and then said, we can certainly do a tissue repair on you. I guess he felt that way by the examination. I would hope that he wouldn’t do the repair poorly subconsciously – but you never know. Bottom line – I didn’t like his demeanor and don’t have enough info about his particular Bassini repair, but I’m in a real predicament. I already have a chronic pain issue from a previous failed spinal surgery which makes it extremely hard to travel (I can’t sit without really bad pain so there goes any airplane or car travel for any long periods of time). And I am on a very limited income as I am on disability, so I don’t have the discretionary income to be able to easily fly somewhere and stay for a week. So two strikes against me and thus the desire to find someone locally. Plus, I’m just a little scared of getting a hernia surgery right now with COVID going on. I’m not really scared about the COVID, but I am worried that if I do get it and end up with the severe coughing right after surgery, that would not be a good thing at all.

[Katherine]

Thank you Johnso! Good to know!!!

[Katherine]

Thank you, Dr. Towfigh!!!

[Katherine]

Thank you, Dr. Towfigh. This may be a stupid question – but in your opinion, what defines symptomatic? Exhibiting any symptoms at all, or to the degree that it interferes with daily activities, etc.? I guess I would consider mine mildly symptomatic, but other than the bulge, quite often I don’t even notice it’s there unless I do a lot of squatting down or try to do core exercises (which makes it pop out more and then become more tender). Would a hernia surgeon not know whether to use mesh or not until they are actually doing the surgery or could a good surgeon be able to tell before they actually visualize the tear?

[Katherine]

Thank you, Dr. Towfigh. My physical condition makes it very difficult to travel. Does Dr. Sickle do a tissue based repair? Can you tell me why all the surgeons are using mesh now with all the complications with mesh?

[Katherine]

I had a hernia form in 1996 (small one on the right). It never bothered me until December of 2018 when I did some core exercises recommended by a PT. From 1996 to 2012, I did anything I wanted (2012 was the year of a disastrous back surgery). I lifted in the gym, was a runner, etc. It never, ever bothered me. I think the reason it got worse in 2018 was I was older an my collagen was just much weaker (may also have something to do with an autoimmune issue following surgery). Anyway, no special diet, no special life circumstances, never saw a doctor after 1996 to have it checked until it worsened in 2018.. If I were you, I’d watch and wait until it bothers you.

[Katherine]

I had absorbable mesh in my sacral laminectomy when I had my Tarlov Cyst surgery. I realize this is totally different from hernia surgery, but I developed an autoimmune reaction to it and am still suffering 8 years post surgery. I wouldn’t wish what I experienced on anyone. I think any foreign body can potentially cause a reaction.

[Katherine]

Thank you, Dr. Towfigh – I’ve tried over and over again to write a response back to you, but it keeps getting unapproved.

[Katherine]

Hi Dr. Towfigh, I’ve tried posting several times but for some reason the posts are unapproved. I hope this one goes through. Thank you for your thorough response!!! I do know now that TC’s are a form of connective tissue disease – I should not have had the surgery. Back in 2012, less was know about the disease than now. It is my biggest regret and I do not want to make another mistake with hernia surgery and have chronic pain in another area. I could not take it. I also know now that Ehlers Danlos takes many forms and I think the doctor I went to just looked at how far back my fingers/elbows/knees bent and came to the conclusion that I do not have it – so I still do not know. However, I do know that my connective tissue has worsened since I’ve gotten older. My unrepaired right hernia was fine since 1996 and now all of the sudden a simple core exercise made it worse. That tells me something is just not right with my body anymore. Perhaps its also the decline of hormones from old age. I had mentioned I had a reabsorbable plate used in my spinal surgery for the sacral laminectomy. I believe it is why I am still in pain and developed adhesive arachnoiditis. So, I would be very, very cautious with any type of mesh at all. But, I would not want a tissue based repair to fail, either. Sometimes I think it’s best left alone – it does bother me some, but I know the risk of strangulation is small. Since I have seen many physicians in Houston, none of them take all of these things into consideration. So, I know if I am to receive good care, I will have to travel to see the very best like you or Dr. Brown or others that are mentioned on this forum. I so appreciate your valuable input. This forum is amazing. Now, I hope that this posts and doesn’t get unapproved!!!!

[Katherine]

Hi Dr. Towfigh, I’ve tried posting several times but for some reason the posts are unapproved. I hope this one goes through. Thank you for your thorough response!!! I do know now that TC’s are a form of connective tissue disease – I should not have had the surgery. Back in 2012, less was know about the disease than now. It is my biggest regret and I do not want to make another mistake with hernia surgery and have chronic pain in another area. I could not take it. I also know now that Ehlers Danlos takes many forms and I think the doctor I went to just looked at how far back my fingers/elbows/knees bent and came to the conclusion that I do not have it – so I still do not know. However, I do know that my connective tissue has worsened since I’ve gotten older. My unrepaired right hernia was fine since 1996 and now all of the sudden a simple core exercise made it worse. That tells me something is just not right with my body anymore. Perhaps its also the decline of hormones from old age. I had mentioned I had a reabsorbable plate used in my spinal surgery for the sacral laminectomy. I believe it is why I am still in pain and developed adhesive arachnoiditis. So, I would be very, very cautious with any type of mesh at all. But, I would not want a tissue based repair to fail, either. Sometimes I think it’s best left alone – it does bother me some, but I know the risk of strangulation is small. Since I have seen many physicians in Houston, none of them take all of these things into consideration. So, I know if I am to receive good care, I will have to travel to see the very best like you or Dr. Brown or others that are mentioned on this forum. I so appreciate your valuable input. This forum is amazing. Now, I hope that this posts and doesn’t get unapproved!!!!

[Katherine]

Hi Dr. Towfigh, I’ve tried posting several times but for some reason the posts are unapproved. I hope this one goes through. Thank you for your thorough response!!! I do know now that TC’s are a form of connective tissue disease – I should not have had the surgery. Back in 2012, less was know about the disease than now. It is my biggest regret and I do not want to make another mistake with hernia surgery and have chronic pain in another area. I could not take it. I also know now that Ehlers Danlos takes many forms and I think the doctor I went to just looked at how far back my fingers/elbows/knees bent and came to the conclusion that I do not have it – so I still do not know. However, I do know that my connective tissue has worsened since I’ve gotten older. My unrepaired right hernia was fine since 1996 and now all of the sudden a simple core exercise made it worse. That tells me something is just not right with my body anymore. Perhaps its also the decline of hormones from old age. I had mentioned I had a reabsorbable plate used in my spinal surgery for the sacral laminectomy. I believe it is why I am still in pain and developed adhesive arachnoiditis. So, I would be very, very cautious with any type of mesh at all. But, I would not want a tissue based repair to fail, either. Sometimes I think it’s best left alone – it does bother me some, but I know the risk of strangulation is small. Since I have seen many physicians in Houston, none of them take all of these things into consideration. So, I know if I am to receive good care, I will have to travel to see the very best like you or Dr. Brown or others that are mentioned on this forum. I so appreciate your valuable input. This forum is amazing. Now, I hope that this posts and doesn’t get unapproved!!!!

[Katherine]

So three responses not approved. Why!!!!

[Katherine]

Why are all my responses to Dr. Towfigh not being approved???????

[Katherine]

Dear Dr. Towfigh, I tried writing a response to you and it was not approved! Hoping the moderator can approve it!