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  • Choices and Decisions

    Hello everyone,

    I am a very active 55-year old male and have been diagnosed with a left-sided inguinal hernia. I am at the point where I feel that surgical repair is my only option as the discomfort has become too distracting too often and my quality of life is being negatively affected. I love to work out every day but have had to reduce what I do by some measure (for example, whereas previously I would regularly walk 3 miles on the treadmill at the gym, now I cannot go further than a mile without hernia pain).

    I recently met with a surgeon specializing in open mesh repair and have an appointment scheduled next week with another surgeon whose specialty is laparoscopic repair. I have myriad health issues and am put off mesh repair by some of the things I have read, especially related to issues of chronic pain resulting from the mesh itself.

    During my research, I have read about the Shouldice method using natural tissue repair. From what I have read, this would be my choice. The problem is that it doesn't appear that there are many surgeons in the United States qualified to perform this procedure -- certainly not anywhere close to where I live in Minneapolis. And I doubt whether my insurance would cover it, anyway.

    I'd like to get back to being very active and wonder whether anyone can comment on working out a few months after mesh surgery. I would also be keen to hear from anyone who has had a hernia repaired by the Shouldice method and whether anyone has specific doctor recommendations. Or whether a hernia belt or truss is an effective short-term solution to wear for activities such as walking.

    Thank you very much.

  • #2
    If you choose the Shouldice method you should go to the Shouldice hospital itself. Depending on your insurance plan you might find that it will actually cost less. You might also find that your insurance will not cover a non-mesh repair. When you're calculating costs be aware that some of the cost estimates you receive might not cover "incidentals" like anesthesia. All of the procedures I've had since I got involved with the medical system due to my hernia have cost more than the original estimate.

    Finally, calculate the long-term cost, mentally, emotionally, physically and financially, of a low quality repair, even if it is a non-mesh repair. Minneapolis is not far from the Shoulidice hospital. If I had could start over with my direct hernia repair I would go to Shouldice, Dr. Brown, Dr. Kang, or Dr. Muschawek.

    As far as getting back to working out soon after surgery, I would not even think that way. Plan for years of good life after the surgery, don't make a choice just to save a few months of down-time after surgery. A poor decision will affect the rest of your life. At 55 that could easily be 30 - 40 years.

    Comment


    • #3
      https://www.shouldice.com/

      Launcelyn

      Comment


      • #4
        Launcelyn
        Your best chance to find a local surgeon who can do a non mesh repair is to consult with a surgeon who is at least 60 years old. He/she would have been trained before mesh was widely available.
        The weather is pretty nice in California if you wish to make the trip.
        Regards.
        Bill Brown MD

        Comment


        • #5
          Did you find a surgeon in Minnesota? Also, who did you consult with?

          Comment


          • #6
            I am a 56 year old male who has been training Brazilian Jiu Jitsu (BJJ) for the past 2.5 years. I first developed a left inguinal hernia which was subsequently repaired in May 2018. It was repaired by Dr. Brian Pellini at Doylestown Hospital in Pennsylvania. He used a laparoscopic TEP repair and polypropylene mesh with no fixation. I have gathered from my research that TEP repairs are more technically difficult than TAPP or open. I prefer TEP because the peritoneum is not breached. Since the initial surgery, I have put the repair though its paces as BJJ is a demanding sport that is hard on your core. Due to the physician's skill and maybe some luck, I have endured no complications whatsoever and was mobile and virtually pain free immediately after the operation.
            I had the right side repaired by the same surgeon on 11/7/19 and so far, it has been an uneventful recovery and I'm feeling great. Some takeaways from my personal experience and research:

            1. Whatever type of surgery you choose, it is important to find a surgeon who has developed competence in that procedure (typically accomplished by doing hundreds of that procedure. I cannot under emphasize the importance of this factor in determining outcomes.
            2. Since "new and improved" meshes are brought to market via the laughable 510(k) process, only use mesh that has been around and with proven safety profiles.
            3. I was healthy and in excellent shape prior to the surgery. your baseline health does play a role in outcomes.
            4. I am a firm believer in active recovery and practice a progressive method of physical activity post surgery.
            5. it is my personal opinion that you can minimize mesh contraction and subsequent "stiffness" through consistent vigorous exercise once cleared to do so. My theory is that the subsequent tissue in growth will occur not only in static and contracted states, but also in stretched and expanded body positions..

            I've read some articles related to the possibility of degradation of the PP mesh over time due to oxidation as it is apparently not completely inert in vivo and am unclear as to the very long term performance of this type of repair. at this point i have no regrets.

            If you want to avoid all possibilities of mesh complication, both short and long term, go with a tissue based repair in the hands of an experienced surgeon like Dr. Towfigh. This assumes that you are willing to travel to the state where your physician of choice practices (as there are only a few I would use for this nationwide) and you can pay cash as most do not accept insurance.

            Otherwise, I stand as an example that mesh repair, in the hands of a qualified surgeon can work well.

            Hope this helps.

            Comment


            • #7
              Originally posted by Sicily63 View Post

              Otherwise, I stand as an example that mesh repair, in the hands of a qualified surgeon can work well.
              It's good that you are one of the lucky ones. Thanks for sharing your story.

              The hard part for people to understand in this mesh implantation problem, is "probability". The odds, the luck involved. The bulk of the studies show that there is a 1 in 6 chance that a person will have chronic pain or discomfort from a mesh implantation.

              One of the ironies of this is that it seems to take the blame off of the surgeon. The responsibility. They are doing everything perfectly, what they were trained to do, but the odds determine who wins and who loses. In other words, somebody else has loaded the gun, they are just pulling the trigger.

              So your last comment was most correct. If a person wants to improve their odds of avoiding chronic pain and discomfort they should choose a tissue/suture repair. If it fails then they can choose a higher risk procedure, a mesh implantation.

              It's just the way the math has come out over time. One of six people will have problems. Your one of the five that, so far, apparently, will not. Congratulations, and good luck in the future. It's still early, you're young, in terms of the rest of your life.

              Comment


              • #8
                Originally posted by Sicily63 View Post
                It was repaired by Dr. Brian Pellini at Doylestown Hospital in Pennsylvania. He used a laparoscopic TEP repair and polypropylene mesh with no fixation.
                And, the actual brand of mesh would help, if type of mesh is actually a factor. Polypropylene is just a polymer that is used in many different knit patterns. the word does not really help make a decision, there are many device makers that use it. The brand and model of mesh might be important.

                Comment


                • #9
                  Good intentions:

                  Thanks for your comments. I have a follow up with the surgeon on 11/19 and will find out what mesh brand was used. As for the rest, I agree that mesh repair is somewhat of a crap shoot as I believe the frequency of chronic pain, for example, is grossly under reported in the literature.

                  I will say that many of mesh related issues dealt with:
                  1. Trans vaginal mesh placement, POP or SUI related repairs.
                  2. Defective mesh products.
                  3. Surgeon error.

                  Do not mistake my comments for me being a die hard promesh exponent. I'm simply saying that one can have a successful inguinal hernia repair, both in the short and long term.

                  Comment


                  • #10
                    The only differences if something would go wrong with mesh even theoretical 1 % { we all know that the real numbers probably about 25% in long term } People will be no way out ..you will be left alone with your problem .Your doctor most likely will drop you off ...but actually nothing he can do ..once it is there.. it is there. . No loving Dr.Brown on your side like it was in my case . You can loose everything ! So think and think again ..Read this forum ..listened to Good intentions and other senior members. Don't make the mistake that you will regret for life!

                    In my humble opinion of mesh cannot be safely remove it cant be used at all ..Not Worth it... Golden students in plastic surgery.. implant can be put in,if you can't safely remove it......

                    Comment


                    • #11
                      Dog:

                      Agreed. if mesh goes bad, it goes really bad. The problem is a availability. We can all agree that there are only a few (less than 25?) across the country that are significantly experienced with tissue based repairs and many of them don't take insurance. A lot of people cannot take off work and incur the travel and surgery costs to do it this way. They must go to a more local in network provider. I know you are gonna say that spending the money is worth avoiding many years or a lifetime of issues, but its not that simple.

                      Also, the statistics are misleading in both directions. When one looks at the estimated overall rate of hernia mesh related complications across the U.S. in any given time period, we are including ALL cases done by any surgeon. This means patients with prior pain issues, poor surgery candidates, complex cases, good doctors and bad doctors with sub par surgical skills, hospitals that cater to medicaid populations, etc. Plus the sample size (n) is huge. My point is,that if we factored out the unfortunate transvaginal cases, cases where the mesh was defective, only operated on good candidates (like Shouldice Hospital) and sent these patients to ONLY the top surgeons in the county, the outcomes would be greatly improved and the adverse consequences would fall within the limits of any other type of invasive surgery.

                      Another issue is that people who have positive outcomes in the immediate, short and long term with a mesh based repair, rarely post on a forum like this or any other. Why would they? They just move on with their lives. At most, they thank their surgeon and post a positive Google review for that provider. There are many people who fall in this category.

                      I'm trying to say that in the hands of a very skilled surgeon, using mesh with a good track record, one can achieve a safe and lasting repair. Particularly if you are into contact sports, power lifting, etc, where the repair is expected to withstand continued and repeated stress.

                      Yes, if my mesh goes bad, it was inserted via TEP method and will be even harder to remove. I just think one can drive themselves bonkers playing the "what if" game.

                      Comment


                      • #12
                        Got blocked -

                        You are parroting the talking points of the mesh repair industry. By insinuation, blaming chronic pain/discomfort on the lack of skill of the surgeon. That plays directly in toe pockets of the mesh makers.

                        Here's a question for you - who are you trying to convince, and why? You pulled the trigger and hit an empty chamber. Why hand the weapon to the next guy, assuming that they will hit an empty one also? The odds don't change. There's still a chronic pain bullet in the weapon.

                        You should really just be happy that you are one of the lucky 5 of 6. There is no way, yet, to predict who will be lucky and who won't.

                        Read ajm222's post, from his first to his last, recently. He went through the identical process you describe. But he, apparently, is not one of the lucky ones. Same situation, different result. https://www.herniatalk.com/member/2051-ajm222

                        You put some good research, but, in the end, it's still luck. I hope you stay lucky, but I don't think that you should be trying to convince people that they can control the outcome of their decision. The evidence says it's not possible, where mesh is involved.

                        Comment


                        • #13
                          Just trying to give people who are considering their options a balanced perspective, particularly the ones who cannot afford to self-pay a tissue based repair. You should be really happy that you were one of the lucky ones who found a caring and qualified surgeon who listened to your concerns (and not dismiss them) and then skillfully remove your mesh. I wish you continued luck in the future as well.

                          Comment


                          • #14
                            Sicily63
                            insurance companies routinely pay for pure tissue hernia repairs. So the cost is not the major issue. The major issue is whether or not you can find a local surgeon who still familiar with the classic techniques.
                            Regards.
                            Bill Brown MD

                            Comment


                            • #15
                              Sicily63
                              As someone who has had there mesh removed and had the awful experience for 6 months of having the top NYC surgeons, doctors and medical facilities and scans say all was well with me only to learn at removal that my mesh was completely balled up and rock hard and on all sorts of structures it shouldnít be on your statement if I understand it is very inaccurate that if transvaginal cases were factored out mesh issues would be say in the normal range of all surgeries
                              As someone who stays active in the mesh forums trying to help people who have had issues post hernia mesh procedures there is one common theme that prevails-they arenít helped by the medical community, their surgeon etc. there complaints fall on deaf ears. They are told it is something else and passed on to other doctors in a endless merry go round. So there is no way to tell the true number of mesh related complaints bc they arenít getting reported-they are being denied and passed off.
                              There is no registry! No way to tell the true numbers!
                              Again I was someone told everything was fine with my mesh, scans showed this, physicals showed this-but my life was ruined. No one believe me and my mesh was found to be completely defunct.
                              if I didnít travel out of state-pay my own way-had a supportive family and finances unlike so many- I would of never known. I Woolf if Laid In bed suffering-believing want the medical community told me.
                              if no one thinks itís the mesh causing the issues then the stats will reflect this

                              Comment

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