saro
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quote linzee.1018:Hi Jonsaunt,
I’m very sorry to hear of your medical problems, and I can understand the position you are in.
I am not a medical person, but I had a hernia tissue repair 12 months ago. Prior to this, I did some research to help me decide the best course of action for myself. I have a biological research background.
Reading your post, I was wondering whether you have an immune response to the pig bladder mesh. If there was, I imagine it would be only part of the obstacles you face.
I mention this because I get an immune response to a certain suture product (made from reconstituted animal tissue), also something I came across in my research. The issue may not be universally recognised, perhaps in part because of alternative explanations for patient reactions from manufacturers defending a particular product, and because strong patient immune reactions are not common. I am not trying to generalise here, good medicos would be well aware of the issue.
All the best with your treatment.
L….I too am sorry to read about problems, anyway congratulations for your studies, I have tried but I have not found any evidence of transmission of a biological prosthesis disease. I have also read that it does not need removal even in the case of infection , because it has a low inflammatory power. only on recidivism there is an unfavorable casuistry, though referred to difficult fields. Recently I read the site who are a little favorable, https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3122-5
…better no mesh but, in case of mesh, better biologic or sintetic is really controverse
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quote Good intentions:Hello andrew1982. I just created a new topic including an article about post-surgery pain, and your topic drew my attention as a result. It is really surprising to see that your surgeon performed neurolysis as a prophylactic measure, in other words, to prevent a future problem, that did not exist at the time of surgery. It has been expressed by the professionals on the site that this is not “standard of care” for a hernia repair.
Since the damage is done, all you can reasonably do, I think, is try to let things heal completely then try to work back to your desired level of fitness and activity.
Beware the pain management programs, they most likely do not have specific regimens for people who have had their nerves cut already. Neurolysis is supposed to be a last resort, not a prophylactic measure. So you are not a typical pain management patient.
Here is a link to the paper I just posted about. It might have something useful in it. Good luck.
very difficult to enter as a layman in such a debate, furthermore, my English with translator has limits in the exposition of the concepts I express … In the intervention suffered by andrew1982 … I believe that our doctors have already diagnosed the damage and also suggested the way to fix it. The question of prophylactic neurolysis, as you well remember, has been debated and discouraged by site doctors here … I confirm that I am aware of excellent surgeons who, perhaps in a different form, they practice it, and pain doctors who claim that neurectomy is to be avoided (perfectly in line with the doctors on this site) while neurolysis can be an option of necessity (when nerve positions require it). Ultimately it would be useful to understand if the diagnosis made by dr Brown is shared by the dr Twight refers to the neurolysis of the ileoinguinale or rather to the neurectomy of the genital branch
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quote DrBrown:[USER=”2908″]Bestoption[/USER]
Also, consider Dr. Muschaweck in Germany.
https://www.fortiusclinic.com/specialists/dr-ulrike-muschaweckregards.
Bill Brown MDThe fortius clinic would result to me with triple costs of the following surgeons who also operate without mesh in Germany: does anyone have experience for dr Wiese in Kelkeim Frankfurt, besides the already known dr Koch in Cottbus (Leipzig) and dr Lorenz in Berlin? They are equivalent for costs, if they are also for results, it could just be a logistical issue. dr towfight provided a list I could not find
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but apart from the risk of recurrence, in permanent sutures there is a risk of granuloma (benign) but also greater complications? in absorbable sutures that of irritation … we are perhaps too picky, the problems of surgery are others
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the guidelines (European, American?) are rather cautious in all controversial aspects. On the sutures I didn’t read anything, maybe I missed it. Here it seems to me that I have read that Dr Brown uses the absorbable and the drtowfigh use the permanents. Both have excellent results. It appears that both recurrences are rare. How can we know any other effects? For example absorbable sutures are more irritating, but they do not seem to cause damage or infection ..permanents can cause granuloma. it will be a reason why dr brown opts for absorbables and dr fight for permanents.
in conclusion, however, it would be interesting to ask both side effects of sutures, for example granuloma -
your information on the intervention is quite detailed and the deductions would seem to give reason to Dr. Brown who claims that it is better not to touch the nerves in any way. In your case the neurolysis does not seem to have worked. I understand that you feel like a guinea pig because many of us expect to know what you will do and with what improvements
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quote allj:I have been living with significant groin pain since having mesh removal after an inguinal hernia repair and a neurectomy. I am considering a triple neurectomy but can’t find anything on long term outcomes. Nor have I found anyone who had this procedure who can attest to the longer term outcome. If anyone can help me out with this it would be much appreciated.
Thank you
AlanI put other topics and, as Dr. Towfigh has pointed out, they are rather verses from your question, so I apologize. about the pain, besides the excellent dr Brown, there is also another renowned specialist that I quote you, by chance https://www.baltimoreperipheralnervepain.com/bio/baltimore-nerve-pain-specialist-eric-h-williams-md-pain-relief-pain-reduction-burning-paid-n.cfm?utm_source=Email&utm_medium=Email&utm_campaign=Williams%20Bio
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quote dog:Pure tissue repair: A hernia mesh alternative
I think this video must be seen by whole country!
https://www.kvue.com/…/269-b841c4e0-0ca5-42b4-8ace-1035652e…
That is what could happen with me if i would trust our mainstream medical system ! In this video you could see my doctor who extremely honest Dr Brown saved my life ! If you or anyone you know has hernia that is one of very few doctors in the world you can trust to perform fixing it…He think about patients first ,and not about profit that is almost everyone else does …impossible to access from the site … can you repeat the complete link?
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quote Bestoption:Thank you for your response and it does make sense what you’re saying. I am seeing lots of positives for Dr Kang.
Procedure in Germany would be convenient for me
(distance and potential reimbursement). It interests me if how comparable is Dr Koch approach and procedure to the above surgeons. Unfortunately I am not seeing many recent comments about him.It is present on facebook, from which you can speak directly
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quote DrBrown:[USER=”2758″]Dill[/USER]
The major purpose of sutures is to hold the tissues together until the body heals the tissues together.
The final strength is dependent more on the body’s healing than the sutures.
At three weeks a wound has about 70% of the final strength.
At six weeks a wound has about 90% of the final strength.
It is not until about 12 weeks before there is 100% strength.
Thus the ideal suture is one that keeps its strength for at least three months.
I use silk sutures because it maintains excellent strength for six months and then slowly dissolves.
Silk also allows the tension to be set at just the right amount.
And silk has the smallest knots, meaning that less material is left inside.review:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174176/Regards.
Bill Brown MDif still in line I would ask if this suture is ideal only to close the wound of the operation or even to join the band with muscle. because in the latter case, then, in theory, those who write that some absorbables have the same non-absorbable index of recurrence are right
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for what I read the method Desarda and Guarnieri use absorbable sutures, Shouldice uses two rows of non-absorbable sutures in depth and the other absorbable rows.
however from these somewhat dated links (1996 and 2001) the Authors report research with follow-up that compare non-absorbable and absorbable materials in terms of side effects, https://www.ncbi.nlm.nih.gov/pubmed/8908956 e
https://link.springer.com/chapter/10…4419-8574-3_30 -
quote Good intentions:The pain indicates that the material, “fat” or omentum, has already pushed through, or created, an opening. The “fat” in the canal indicates that “breakthrough” has already occurred.
The odds of intestine strangulation are low, especially if there is no intestine in the canals now. The odds of chronic pain from mesh are about one in six. Don’t get in a hurry to get this new problem behind you. Use the numbers and data available to make the right decision for the rest of your life. Mesh problems can not be “fixed”, only modified to less painful problems. Even if you schedule a procedure to get on the books continue to do research, and change your mind if you don’t feel right about it. There is very little accountability for problems with hernia repair. You will have very little recourse if you have problems. Get it right the first time.
Be very careful when listening at your consultations. Don’t get persuaded by confident words if they can’t be verified. Don’t confuse the number of implantations they’ve done with expertise in understanding how to minimize your risk of chronic pain. If your surgeon can only talk about how many operations they’ve performed but not about the long-term success rate of those procedures find a different surgeon. All surgeons should know how their work lasts, over many years. Lack of knowledge does not mean success. Mesh repair is easy and simple for the surgeon but the consequences can be huge and difficult for you. Experience in mesh implantation is not the same as hernia repair expertise.
Good luck.
hello Good intentions. I have your ideas about the mesh, but I’m not as ‘expert’ lyke you. I am instinctively averse to any foreign body. I don’t know what scares me the most, having to choose between an operation without a mesh with a permanent suture or a collagen and suture absorbable in a year. Good question
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quote Good intentions:Hello saro. I just clicked on the link and it opened. It opens to a page where you need to check two boxes (“I am not a robot” is one) to get to the next page.
If you use Google and search for “ACS NSQIP Surgical Risk Calculator” it should be the first result. Maybe that will work.
hello Good intentions, thank you it worked. I have your ideas about the mesh, but I’m not as ‘expert’ either. in another post you mention the case of a semi-absorbable prosthesis, of which the permanent half will then be a problem. . But in the case of a completely absorbable, biological collagen, how does it behave in a year from absorption?
the idea scares me, but it is recommended to me because I have waited too long and my hernia can only be contained with a mesh or with non-absorbable sutures
the latter are never absorbed, while the biological one takes a year
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quote Good intentions:
the mesh in question was semi absorbable. but absorbable shirts? what references do we have? as far as I know, the absorbable meshes must keep exceeding a time of eight months / a year to allow time for the tissues to collagen, or in any case close the wall. It is a relatively short time in our lives, but a very long time for the organism,I also read the question on another post
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since it is reabsorbable, in order to last a limited time to carry out its function, so the question you ask seems pertinent … if in the long time it will not produce effects because it is reabsorbed, what can happen in the time of reabsorption? except for personal experiences, it’s a question for doctors
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quote Ddot14:First attempt to post this was flagged as spam after attempt to edit, so will try again…
No, I still haven’t been able to get my inguinal hernia dealt with – family medical issues have gotten in the way. The good thing about that is that I’ve had additional time to research and ponder options. The bad thing about that is that I’ve had additional time to research and ponder options. 🙂
Definitely still wanting a no-mesh repair. Shouldice seems overly invasive and I’ve read multiple patient reports of lack of understanding and support by Shouldice Hospital with post-surgery complications. I’ve been seriously considering Desarda repair with Dr. Tomas in Florida or Dr. Parvez in New Mexico and have been In contact with both offices. Have talked on the phone with Dr. Parvez directly, but Dr. Tomas charges $ to talk directly to him on the phone so I’ve only talked with his staff at this point. I’m now also looking into Dr. Grischkan’s 2-layer Shouldice repair, but haven’t found any data or studies about it regarding practicality, reliability, long term results, chronic pain, etc. His website says that he’s done over 25,000 hernia repairs, but it doesn’t say how many were his 2-layer Shouldice (no mesh) and how many were his modified Shouldice (using gore-tex mesh) repair, or if the chronic pain or recurrence percentages are different between the two methods.
His website describes his 2-layer Shouldice this way:
“With the appropriate layers opened as prescribed in the Shouldice Method and hernia tissue reduced, the Transverses Abdominis Arch and lateral edge of the Transversals Fascia are approximated in a continuous manner to reduce tension. No wire suture is used as is called for in the pure Shouldice Method, but instead a flexible polybutester suture is inserted to accommodate athletic movements. A second layer incorporating the Inguinal Ligament and Transverses Abdomens Arch is then placed to reinforce the first layer in a similar manner.”
I have no idea if the above method is sound or not, but it definitely trims some steps from the original Shouldice technique. The website also says:
“The modified Shouldice hernia repair takes less than 20 minutes and patients can be discharged within one to two hours following the shouldice surgery. Most patients return to full activities and employment within two to three days following the repair.”
Sounds too good to be true, so I’m very interested in input of any kind.
I’m also interested in the practicality and durability of the 2-layer Shouldice vs. the Desarda repair – which (if either) makes more sense from a structural/mechanical/physiological/reliability perspective. I’m not a doctor so I really have no idea which structures of the inguinal area are most likely to provide the strongest, most reliable, most comfortable repair. Does anyone that knows more about this than I do (which is probably everyone reading this post) have any thoughts?
I do have concerns with Dr. Grischkan’s reported lack of interest in dealing with follow-up problems/complications from his surgery – I’ve only seen a small handful of these reports but I find them very concerning. I want a surgeon that will be there for me if I have problems after surgery, not just before.
The reason I’m looking into Grischkan’s repair is that he’s much closer to me than either Tomas or Parvez. However, I don’t want to end up cutting corners to stay closer to home and end up with an inferior repair and/or a surgeon that won’t take care of me if I have problems after surgery. So I guess I’m trying to rule Grischkan and his 2-layer no-mesh Shouldice repair either in or out as a possibility – thus the reason for this much too lengthy post.
I have also found another less-distant surgeon that has offered to do Shouldice or Desarda for me – whichever I want. But as I understand it don’t think she’s done that many of either, so I feel unsure of the quality of the repair I might be receiving. May be fine, or maybe not. Unsure how to proceed there.
I realize that no single method of hernia repair is guaranteed to give perfect results to every patient. Therefore, I’m trying to do what I can to maximize my chances of a good outcome by doing due diligence on surgeons and methodology before surgery. Any thoughts or information anyone may be able to share is appreciated!
hello
fortunately this site offers unrepeatable experiences, and I, when I read stories like yours, I finally recognize myself, because out of here my own relatives consider me a madman, who wants a tailored intervention.
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quote drtowfigh:Biologic mesh has a role, but not typically for recurrent hernias. I used to use them for some patients at risk for mesh-rated allergy or chronic pain who couldn’t be closed with just non-mesh repair. I’ve moved to the hybrid meshes.
good day. A recent text by Campanelli and other Italian Authors on biological prostheses, among other things, maintains that, although it offers advantages compared to other prostheses, it would have a considerable recurrence index.
My question to the forum doctors is typically from patient to doctor: in a patient, as drtowfigh cites, that cannot be repaired without a mesh, does the organic prosthesis give less recurrences than prosthetic repair?
The reasoning is as follows: having to risk recurrence anyway, the patient could opt for an intervention without mesh rather than introduce a biological mesh, where the risk margin is superimposable in both interventions -
quote DrBrown:Dear Saro.
Preventive neurectomy only started after mesh was introduced. Sometimes after hernia repair the nerve can become scarred to the mesh resulting in pain.
There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides sensation along the inguinal ligament, on the inside of the upper thigh, and on the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and sensation to the testicle or labia majora.Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the nerve tries to grow back and a neroma forms, then that can be a source of cause chronic pain. It is best to carefully identify the nerves during the operation. And then take care not to damage the nerves while the hernia is being repaired.
The iliohypogastric nerve can usually be identified running parallel to the inguinal ligament about a centimeter above the level of internal ring and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin.
The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect the spermatic cord (or round ligament).
The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring and then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.
Regards.
Bill Brown MDexcellent dr Brown
sorry if I return to your post which I think is unexceptionable, confirmed by a distinguished colleague who is expert in nerves, who has had the kindness to write to me about it, so I have no reason to doubt. Moreover it is intuitive that the nerves should be preserved, they are there for vital functions. however, many patients are perhaps at the same crossroads as the following. I knew that in Europe there are many good surgeons that the doctor Towfight has also recommended in another post, but not all of them are reachable from any location, even Europe is large. In particular, assuming that the mesh can be avoided, if possible, patients may find themselves at a crossroads: operating from a surgeon who preserves the cremaster muscle or from a surgeon who preserves the nerves. In this case the surgeon declare that the rescued nerves would grow back. The other surgeon that the cut of cremaster muscle is necessary to access the bag and the cord. Don’t you think so, but do you think that this possibility exists that the nerves, if you cut properly, can grow back? and what do you think of disorders after cremastere cutting , are they so unbearable? Thanks for the further reply you will want to give us. I know it doesn’t comfort her, but also me I’ve also had white hair after i had hernia -
I’m also very worried about nerves, but I talked to some patients at the follow-up visit after a month of surgery: I thought I knew about complaints, but after neurectomy they didn’t complain about particular problems, and the pain lasted a few days and the hypoesthesia seems to be lasted a week.
Only one still had
non-annoying hypoesthesia after a month I haven’t met anyone
with a biological prosthesis (animal dermis) so far, but I know it spreads but
I can’t find any reports