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  • jzinckgra
    started a topic Just had open mesh

    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; 06-20-2019, 09:55 AM.

  • Jnomesh
    replied
    Never heard that before. Maybe a misunderstanding.

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  • jzinckgra
    replied
    Had my 3 week post-op visit yesterday. All went well. Still a bit of pain, but starting to cycle again this week. One question: Surgeon told me that even with mesh, hernia's continue to grow in size. I may have misunderstood what he said, but is this true? Why wouldn't everyone do Shouldice and use tissue to close the hole if the mesh wasn't supposed to stop the hole from growing?

    Leave a comment:


  • Good intentions
    replied
    Originally posted by jzinckgra View Post
    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.

    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?
    Since the Onstep procedure does extend down to the pubic symphysis I guess it does make sense. Both procedures go deep and toward the midline.

    What is kind of surprising is that Dr. Reinhorn was not aware of the trend toward implanting the biggest piece of mesh that will fit, for laparoscopic mesh implantation. He should have seen "laparoscopic mesh" and thought "there's going to be mesh in my way". He should not have been surprised because that's been "state-of-the-art" for many years.

    The surgeon who implanted the mesh that I later had removed actually overlapped the two pieces at the midline by about a 1/4 inch. I don't know if it's in the "Guidelines" to do that but I guess that he was planning for shrinkage. If you had gone back to your same surgeon he probably would have just laid it down as close as possible, maybe even overlapping it. That's how the lap procedure works, just lay it down, close things up, and let whatever happens happen.

    He does not report any fixation, so it's still possible that it moved.

    "The mesh extended lateral to the internal ring,deep to the Coope/s ligament and to the midline. CO2 was then evacuated under direct visualization as the trocars were removed. The mesh maintained good position and trocar sites were hemostaiic." "

    Whatever the reason, good luck.




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  • jzinckgra
    replied
    Originally posted by Good intentions View Post
    Yes, there is something off with the overall description. Either the original mesh was placed incorrectly or moved immediately, or it moved quite a distance before it was "incorporated", or it migrated over a longer time, or jzinckgra actually had a bilateral mesh placement. The notes from the first surgery would tell something. Without those it's a mystery.
    Here is a snippet from my left side lapro surgery:

    "The mesh was then inserted via the umbilical trocar and positioned in the left inguinofemoral region to completely cover the direct,indirect and fenrcral spaces widely. The mesh extended lateral to the internal ring,deep to the Coope/s ligament and to the midline. CO2 was then evacuated under direct visualization as the trocars were removed. The mesh maintained good position and trocar sites were hemostaiic."

    Based on the position over to the midline, I am not surprised it got in the way of the right side mesh.

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  • jzinckgra
    replied
    Originally posted by kaspa View Post
    I'm trying to understand this and hope I won't say something too ignorant.

    As I understand, JZ had a laparoscopic repair of left inguinal hernia and now had an open one for right hernia. When suturing at 2 points in Cooper ligament, one point included previous left mesh.

    So the question here is, wouldn't previous doctor wish to have a bilateral repair, something not too difficult by laparoscopy, perhaps as prophylaxis for right side?
    A month or so after lapro on left side was done I started getting right side pain with bulge. I assumed another hernia. Doc said no. I went to two other docs, including Dr. Goodyear who also said no hernia felt. CT scan did show fat hernia but since docs couldn't feel it they wouldn't do surgery. Fast forward three years and I had hernia on right side which was just patched.
    i dont think patch from lapro moved. I read surgery report and can post here, but ultimately that patch which was 5.5" in length was placed lengthwise across abdomen and extending to the midline. Whether this was oriented incorrectly I don't know, but it's not hard to understand why recent right side open surgery ran into the other patch. I have follow up appt with Dr for recent surgery and I will ask more about what he encountered during surgery

    Leave a comment:


  • Good intentions
    replied
    Yes, there is something off with the overall description. Either the original mesh was placed incorrectly or moved immediately, or it moved quite a distance before it was "incorporated", or it migrated over a longer time, or jzinckgra actually had a bilateral mesh placement. The notes from the first surgery would tell something. Without those it's a mystery.

    Leave a comment:


  • kaspa
    replied
    I'm trying to understand this and hope I won't say something too ignorant.

    As I understand, JZ had a laparoscopic repair of left inguinal hernia and now had an open one for right hernia. When suturing at 2 points in Cooper ligament, one point included previous left mesh.

    So the question here is, wouldn't previous doctor wish to have a bilateral repair, something not too difficult by laparoscopy, perhaps as prophylaxis for right side?

    Leave a comment:


  • jzinckgra
    replied
    In my report, Dr says he used two sutures to hold mesh in place. It states "...and 14 x 11mesh placed in place and sutured to the Cooper ligament in two places, one of which incorporated the previous mesh." Am I to infer one of the sutures was actually placed between the new and old mesh? Or that both sutures are in the Copper's ligament?
    Last edited by jzinckgra; 06-28-2019, 11:31 AM.

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  • jzinckgra
    replied
    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.

    Leave a comment:


  • scaredtodeath
    replied
    How is your pain level from the procedure

    Leave a comment:


  • jzinckgra
    replied
    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....

    Leave a comment:


  • Good intentions
    replied
    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.

    Leave a comment:


  • jzinckgra
    replied
    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.

    Leave a comment:


  • Good intentions
    replied
    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; 06-22-2019, 11:54 AM.

    Leave a comment:

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