[M.G.]

Hello, please find below some suggestions that you could consider implementing to meet your goals if they are not too technically demanding:

1) Tags system where the user sets the tags for a new thread and the ability to use tags while searching the forum.

2) Better handling of posts attachments, including multimedia, I know this would weight a lot due to the additional storage requirements but it could be useful for patients to be able to post pictures and videos and the additional storage requirement could be contained by setting a size limit for attachments..

3) Usefulness score associated to each message and most useful messages displayed first while searching..

4) Two factor authentication before an account is enabled to post messages, this should reduce the number of spam messages.

[M.G.]

With daylight saving time there are 9 UTC time zones between us so 10 AM Pacific Time (UTC -8) would be a good fit for me.
However, please consider I already had most of my questions answered by you so I’d like to suggest you set the time for the next meeting when you know it’s most appropriate to reach the majority of patients who may have undiagnosed or misdiagnosed mesh complications.
These people, who I belonged before your diagnosis, are the ones who will mostly benefit from the rare expertise you are so kindly willing to share.

[M.G.]

Hello Dr Towfigh,
first of all thank you so much, your work is really invaluable for patients in countries like mine where they just implant a mesh and then dismiss or minimize all but the most severe of complications.
You already answered most of the questions I had in your consultation but I would be greatly interested to learn more about the topic from your answers to other people.
Unfortunately meeting’s time is too late in the night where I live.
I’m going to register for the meeting anyway if you plan to make available, after the meeting ends a recorded offline session, to anyone who registered.
If this isn’t possible for any reason a text Q&A extracted from the meeting would still be great.

[M.G.]

Many thanks for your interest.

Since the first laparoscopy after the abdominoplasty and mesh implantation, I asked the surgeon if he found the mesh to be in direct contact with the bowel.

He said that there was no direct contact as the mesh has been implanted in the preperitoneal position, accordingly to the abdominoplasty surgeon report, and he was only able to “catch a glimpse” of the mesh during the surgery.

He never said anything about the integrity of the fascia repair.

Regarding cutting through the mesh, the surgeon who performed all the surgeries after mesh implantation said he was careful not to cut through the mesh because there would be a very high probability that the mesh would become infected otherwise.

Even when the mesenteric hematoma was evacuated, he said that the transverse incision was made to the side stopping at the mesh border.

Personally, after that surgery I can feel a little roughness of the skin on a zone of about 6 cm of diameter on the side where the transverse incision is.

On the same zone the skin is also a little darker, not by much but definitively appreciable.

It is the same zone where a tissue biopsy showing fibro-adipose tissue has been taken during the last surgery when severe adhesions were found but not lysed.

[M.G.]

Many thanks for your advice.

I do not expect, after mesh removal, to return like if I had not had any surgery but at least not much worse that the condition I was before the mesh was implanted.

I expect at least the systemic symptoms to disappear almost completely and to be free from the mind fog.

I am also prepared to accept that due to the severe adhesions, intestinal resection may be needed but I hope not to the point where I would have to depend on TPN first and end up with intestinal transplantation later.

It is great to learn that mesh replacement, even with the absorbable biologic mesh, can be avoided and the abdomen can still be properly closed with autologous tissues.

I was told that in my case the only solution to remove the mesh was removing the abdominal muscles with it, and then using an absorbable intraperitoneal mesh that, given the strong foreign body reaction to polypropylene I had, would only lead to even more severe adhesions.

As you may have found from my English I do not live in the U.S. but in the E.U., though I am willing to travel to the U.S. and pay all I can for mesh removal if my current condition can be improved.

A first problem in having the consultation you suggested is that my surgical reports are not in English but I could always translate them as I mostly did in these posts.

Fortunately, my gastroenterologist, who is a university teacher and director of a gastroenterology unit at a large hospital in my country, is willing to help with the consultations.

[M.G.]

Hello, thanks for your help, I am 49 and had my first laparotomy at 22 for biliary sepsis from bile duct stones. Adhesions surely formed and their management required subsequent multiple adhesiolysis.

However, before the mesh was implanted, adhesions were not so severe to the point of complete impairment of bowel functionality.

Last adhesiolysis was 5 years before mesh implant.

In those years, I had a perfectly normal quality of life save for occasional episodes of pain that were manageable with NSAID use.

The surgeon who performed the mesh implant reported an easy placement of the mesh with only mild adhesions between viscera and abdominal wall.

Never, before mesh implantation, have inflamed peritoneal fluid and peritoneal lesions or intestinal fibrosis been found.

It is like if the foreign body reaction to the mesh implant caused for me not a local but a systemic inflammatory reaction that in turn led to excessive adhesion (re)formation after surgery.

Regarding systemic symptomatology, I never had any before mesh implant.

I remember attributing to a stressing period at work the mind fog, chronic fatigue and joint pain when they started.

I still do not know if it would benefit me but I am told, though by surgeons who never performed one, mesh removal is a high-risk surgery. This leads me to seek, if it exists, any option for mesh removal that can contain risk and does not imply losing the rectus muscles and using another mesh as a bridge to achieve abdominal closure.