[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!

[Katherine]

Dear D. Towfigh, thank you so much for your very thorough response! Have you ever done hernia surgery on a Tarlov cyst patient? I do know this disease is some type of connective tissue disease. I have no idea why the surgeon used a dissolvable plate in my laminectomy not approved for the spine! The result has been adhesive arachnoiditis from the continued inflammation. So any foreign body reaction scares me. I guess I was just lucky with my first hernia surgery (non mesh) back in 1994. Or perhaps age has just exacerbated the weakened collagen. One doctor I went to said I do not have EDS, but since then I’ve learned there are very many types of the disease. I’ve also had a lot of strange autoimmune things pop up since my surgery- RA type pain in the hands, lichen plants in the mouth. Several experts I have seen connect this with the dissolvable plate used in my surgery. They said even though it’s dissolved, I still could be reacting to it. So I guess this is why I really want a non mesh repair. I could not possibly endure any more chronic pain in another area. Surviving the surgery with the back pain is another huge concern. I do hope that in the future there are more brilliant physicians like you and Dr. Brown that have an understanding of this complex situation. You are so right… “it’s not just a hernia” !!!

[Katherine]

Jonsaunt, I’m so sorry about your situation. It makes life kore difficult! Thanks for your input! (If this posts twice for some reason my first comment was unapproved)

[Katherine]

Jonsaunt, I’m so sorry about your medical situation. It really makes life so difficult. I appreciate your input!