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  • Just had open mesh

    I posted in here 3yrs ago following lapro surgery on my left side. Since then that side has been mostly pain free, but starting shortly (few months) after lapro side fix, I began having pain/small bulge on right side. Three different surgeons said no hernia at the time, but CT scan showed small one. I posted here about it. Oddly, pain and bulge went away until last year, then it started coming back. Last couple months the bulge has been present daily and it was confirmed by my PCP that I had a right side inguinal, which was no surprise to me. Rather than go back to the lapro surgeon, I went to boston hernia (Dr. Michael Reinhorn) who specializes in open mesh and shouldice repair. I opted to do open mesh this time around due to his steller reviews and the marginal faster recovery then lapro, despite this being debatable in published literature.

    Had surgery yesterday and am very sore today. Turns out the mesh from the lapro repair extended over to the side of the new repair. The Dr. questioned why my larpro surgeon used such a large (4x6") patch for what was a pretty small hernia. I've since learned this size patch is pretty typically used. Because of this, he had to "do some extra work" to get the new patch not to overlap. I was still somewhat sedated when he told me, but my wife thought he said he had to cut away some of the old patch to make some room, but not sure that's even possible during an open repair. In any case, rather then the ~2wk recovery I was expecting, he said I should extend it to 3wks. I was pretty disappointed since I'm an avid cyclist and this puts my schedule on hold longer than I was hoping for, but what can you do. What's done is done, but I'm wondering if the lapro surgeon put in too big of a patch and never thought about the possibility of needing a future repair on the other side.

    Had I gone back to the lapro surgeon, would he have also been challenged by needing to remove and/or make room for the new patch on the right side?
    Last edited by jzinckgra; 4 weeks ago.

  • #2
    Interesting situation and questions , I would be interested in the replies you receive... nonetheless I wish a speedy and uneventful recovery... please let us continue to know about your progress

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    • #3
      yeah, i thought lapro and open were totally different and the lapro mesh wouldn't be accessible if he entered using the open method. also, is it possible to get lapro mesh repair and then lapro again years later? i had thought you kind of had to do open if you previously had lapro on the other side, otherwise it could be really complicated. interesting situation indeed.

      i also thought 4x6 was standard size

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      • #4
        I agree-it’s weird that he encountered the lapro mesh from the other side when he entered via open method. Since lapro is fork behind the muscle and the open repair is from the front you’d think this wouldn’t be possible.
        id ask him what type of mesh was used. The only thing I can think of there are some types of mesh that are implanted openly but have 2 flaps -one goes behind the muscle and one in front-so maybe this is where he encounter some of the mesh form the lapro repair.

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        • #5
          I think the missing link her is that DOctor does the one step procedure... I don’t know the details of the procedure but the mesh is placed posterior via an open procedure

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          • #6
            Onstep is another new method of mesh placement, introduced to the market with little long-term data. Bard is the device maker behind Onstep. They've branded their mesh as "Onflex".

            https://journals.sagepub.com/doi/ful...57496914529930

            http://ugeskriftet.dk/files/b5467_on...al_hernias.pdf

            https://www.crbard.com/davol/en-US/products/OnFlex-Mesh

            https://www.hindawi.com/journals/srp/2016/6935167/

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            • #7
              It's called Onstep, and Bard makes a device for it called Onflex. You can search those names and find a lot about it.

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              • #8
                Interesting that you had a recurrent hernia repaired in anterior open fashion after laparoscopic surgery (that is standard) BUT they chose a repair technique that involved the same posterior space as the laparoscopic repair (not as standard, but I’ve seen it done).
                #ItsNotJustAHernia
                www.BeverlyHillsHerniaCenter.com

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                • #9
                  Originally posted by drtowfigh View Post
                  Interesting that you had a recurrent hernia repaired in anterior open fashion after laparoscopic surgery (that is standard) BUT they chose a repair technique that involved the same posterior space as the laparoscopic repair (not as standard, but I’ve seen it done).
                  What do you think Dr. Reinhorn did to make space for the Onflex device? And how do you think the mesh from one side got over to the other? That is quite a distance. Did it migrate or was it improperly placed?

                  Or did jzinckgra actually get a prophylactic placement on the right side also and was unaware?

                  @jzinckgra

                  drtowfigh

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                  • #10
                    jzinckgra My notification did not work the first time.

                    jzinck, do you have a copy of your medical records? They would be worth examining. Actually Dr. Reinhorn probably should have examined them also, but I think that some doctors just work with whatever they find once they get in there.

                    All patients should get copies of their medical records so that they can be as informed as possible if problems occur.
                    Last edited by Good intentions; 3 weeks ago.

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                    • #11
                      To clarify, I did not have repair of recurrent hernia. The left side was patched three years ago using lapro. I got a new hernia on right side and this one was patched last week using open mesh.

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                      • #12
                        jzinckgra I saw your post of today that contained the records. Apparently it's been removed or unapproved for some reason, since I saw it this morning.

                        But I noticed that the records implied that the new hernia was on the same side, the right, as the old one. It might just have been a typo in your medical procedure notes, my medical notes had significant errors also, with metal tacks mentioned, which were not seen by MRI or found during later mesh removal, and also referring to me as "she" in one instance.

                        Anyway, if you can get the records from your first surgery that would help you understand why the mesh was there, possibly. I still think it's possible that you had bilateral repair, but just did not realize it.

                        Comment


                        • #13
                          Originally posted by Good intentions View Post
                          jzinckgra I saw your post of today that contained the records. Apparently it's been removed or unapproved for some reason, since I saw it this morning.

                          But I noticed that the records implied that the new hernia was on the same side, the right, as the old one. It might just have been a typo in your medical procedure notes, my medical notes had significant errors also, with metal tacks mentioned, which were not seen by MRI or found during later mesh removal, and also referring to me as "she" in one instance.

                          Anyway, if you can get the records from your first surgery that would help you understand why the mesh was there, possibly. I still think it's possible that you had bilateral repair, but just did not realize it.
                          Hi,

                          Here is the report again. I edited the last post too many times and it got flagged for spam. To answer your question about same side repair, I realize the surgery report below doesn't specify, but when he refers to the fact there was mesh on the right side, one would assume this is the side of the previous patch. This is NOT the case. 1st hernia was left side, 2nd and most recent is right. Following the report, I have a few questions.


                          PREOPERATIVE DIAGNOSIS: Right inguinal hernia.
                          POSTOPERATIVE DIAGNOSIS: Right inguinal hemia.
                          PROCEDURE PERFORMED: Right inguinal hernia repair.
                          ANESTHESIA:Total intravenous anesthesia.

                          Us r: LP593 6/25/2019


                          INDICATIONS: . This is a 46-year-old male with symptomatic right inguinal hernia after previous laparoscopic repair. He understands the risks of surgery including bleeding, infection, recurrent hernia, chronic pain and informed consent was obtained.

                          OPERATIVE FINDINGS: There is an indirect right inguinal hernia repaired with a 14x 11mesh. There was mesh from the previous surgery extending to Hesselbach triangle and cue to the anterior abdominal wall. I had to excise some dense peritoneal adhesions
                          to the anterior abdominal wall and repair the peritoneum in order to facilitate the insertion of 14
                          x 11 mesh.

                          PROCEDURE IN DETAIL: After anesthesia was administered, local anesthetic was given after prep and drape. The preperitoneal dissection space was entered in the usual fashion and preperitoneal dissection was carried by first taking down the indirect sac, passed the bifurcation, spermatic vessels and vas deferens. The direct space was socked in from adhesions and I ended up opening the peritoneum and dividing the peritoneum leaving some of the anterior abdominal wall until I could create a pocket for the mesh. I then closed the peritoneum with running 3-0 Vicryl. Hemostasis was obtained with electrocautery and 14 x 11mesh placed in place and sutured to the Cooper ligament in two places, one of which incorporated the previous mesh. I then closed the external oblique and Scarpa with 3-0 Vicryl and 4-0 Vicryl for skin.
                          Steri-Strips and dressings were applied. Sponge, needle, and instruments counts were correct. At the end of the case, the patient tolerated the procedure well and taken to Recovery.

                          Questions:
                          1. I'm am thin (6'1", 155lbs) guy so thinking the left side lapro which used a 6" long patch was placed across abdo, so that explains why it extended over to right side triangle. Agree?

                          2. Is removal of adhesions, presumably from last surgery common?

                          3. Report said he had to repair the peritoneum. Is this above and beyond what's usually done for IH? I believe he had to do it due to adhesions.

                          4. I'm an avid cyclist and go to the gym and was told to not do both for 3 wks as opposed to std 2 wks he usually advises. Could I do stationary bike and/or stair stepper lightly starting next wk? I forgot to ask Dr. I don't want to screw up the surgery and think I overdid 3yrs ago too soon after first hernia, so just asking....

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                          • #14
                            How is your pain level from the procedure

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                            • #15
                              Originally posted by scaredtodeath View Post
                              How is your pain level from the procedure
                              Getting better. Day 6. Pain is mostly from the incision now and less of the deep pain.

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