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  • Mesh removal after hernia repair

    Hello Dr,

    I had a laparoscopic inguinal hernia repair with Omyra mesh about 18 months ago. The repair failed after 6 months and my small hernia returned. I am having some pain and discomfort coming from the area since the operation and it gets worse with physical activity. I am having other symptoms but not sure if they are related to the mesh...headaches and fatigue. I have been to a couple of doctors but all they offer is to put mesh now by open surgery. I don't like the idea of having two foreign bodies inside of me.

    How can I determine if the mesh needs to be removed? any scans I can have done to make sure?

    Is mesh removal safe? and is it usually removed by open surgery or by laparoscopy?

    What are your views on the Desarda method for inguinal hernia repair?
    http://www.ncbi.nlm.nih.gov/pubmed/22392354

    I will really like to research my options before I go under the knife for the second time,
    Thank you for your response

  • #2
    Mesh removal after hernia repair

    Hello, I'm sorry to hear about your hernia repair not going well. I've looked into different options before seeing any doctors. I came across the proflor. Have you heard of it?

    All i know is that is built differently, even though it's made from polypropylene, which is the most common synthetic material used in hernia repair it has a component that covers under the hernia hole plus a flower-shaped core that sits within the hernia hole. Is like a spring that can compress and spring back. Because the tissues surrounding the hernia hole compress the flower shaped core, the doctor doesn't have to stitch the implant in place. Therefor minimizes potential sources of postoperative pain.

    Maybe this is something you can ask your doctor if you do decide to have an open surgery.

    Good luck and Keep me posted if you can.

    Thanks!

    Comment


    • #3
      Mesh removal after hernia repair

      Thank you for the comment Geraldine,

      I am trying to avoid having surgery with mesh again. I am even investigating if I can safely remove the currently installed mesh that failed.

      Comment


      • #4
        Mesh removal after hernia repair

        Omyra mesh is an ePTFE mesh that is macroporous, ie, there are holes in it that are wide, allowing in-growth of tissue. There is little clinical evidence about this mesh and it is not a mesh with broad usage by surgeons, so I cannot scientifically assess it's risks and benefits.

        Proflor is also newly introduced in the US. There is more experience with this mesh outside the US and it has been positive.

        My bias is that bulky mesh (such as Proflor) and shrinking mesh (such as ePTFE, similar to Omyra) have drawbacks and I prefer simpler mesh products.

        Mesh removal is only indicated if there are mesh-related complications. Headaches and fatigue may be related to mesh reaction (inflammation) or mesh infection. I do not recommend mesh removal due to hernia recurrence. Mesh removal is a complex operation with multiple risks, and it should only be done by specialists. Laparoscopically placed mesh can be removed laparoscopically, by a skilled surgeon with prior experience. There are serious risks associated with this problem.

        The Desarda technique is a non-mesh hernia repair technique promoted by Dr Desarda of India. It's longterm results remain to be seen.
        #ItsNotJustAHernia
        www.BeverlyHillsHerniaCenter.com

        Comment


        • #5
          Mesh removal after hernia repair

          Thank you for the reply,

          How can I make sure I am not having a mesh reaction or infection. Are there any specific medical tests to ask for ?

          Thanks

          Comment


          • #6
            Mesh removal after hernia repair

            At this time, there is no specific test.
            I am working on a research project to determine exactly that problem.
            That said, a true mesh allergic reaction is very very rare. You would know it. There would be a red patch of skin outline of your mesh. However, many have an intolerance of the mesh, with persistent inflammatory reaction and/or chronic pain. That is much more common. There are no tests for it now but hopefully, if my research pans out, there may be one soon.
            #ItsNotJustAHernia
            www.BeverlyHillsHerniaCenter.com

            Comment


            • #7
              Mesh removal after hernia repair

              If there is a chronic inflammatory reaction, how is that determined and what are the possible treatments?

              Comment


              • #8
                Mesh removal after hernia repair

                Great question.

                In pathology, if the mesh is removed, the pathologist can view signs of acute vs chronic inflammation under a microscope.
                In MRI, inflammation can be seen if it is quite a lot.
                We do not have any sensitive laboratory values to show inflammation from mesh. Blood tests such as ESR may or may not be elevated.

                If the inflammation is causing pain, anti-inflammatory medications or steroids, in more extreme cases, may be helpful. For chronic pain due to inflammatory status from the mesh, there is little to help. Some may require mesh removal as a cure, and that is also for extreme cases.
                #ItsNotJustAHernia
                www.BeverlyHillsHerniaCenter.com

                Comment


                • #9
                  Mesh removal after hernia repair

                  Great Answer,Dr.Towfigh,and Great discussion on mesh allergy,infection,removal etc.
                  Dr.R.M.Khattar

                  Comment


                  • #10
                    Mesh removal after hernia repair

                    Hello My question is. After mesh removal.That was in for 15 years.How long does it take for the inflammation response from the mesh to go away? I had pain very soon after the bikini mesh was installed.I had it removed 20 months ago.With little improvement in pain.Also the most effective meds were nsaids (.Celebrex ) Always seemed to help the most.But just a little bit. I still use it.And pain management.Also can the inflammation from mesh effect the hip joints and lower back(lumbar) I have suffered since 1998 with chronic hip butt and leg pain.I was told it was due to mesh??????Removal did not help.Was it in to long? Thank you for this site.I don't want others to suffer the way I have.

                    Comment


                    • #11
                      Mesh removal after hernia repair

                      Hi and thanks for using the site to get insight and help. Your questions are likely those of others as well.

                      The honest answer is we don't really know. Everyone is different. On average, about 80% are no longer symptomatic from the inflammatory reaction caused by surgery and synthetic mesh after 3 months. And so where around 90-95% after 1 year. Most are asymptomatic within weeks to months. It's unpredictable at this time who would fall into which category. Rates differ among different techniques, mesh products, genders, and surgeons.

                      Anti inflammatory medications work the best. That includes ice, naproxen, ibuprofen, Celebrex, and others.

                      Hip and back pain may be related to a hernia recurrence. It would be uncommon to be due to mesh itself.
                      #ItsNotJustAHernia
                      www.BeverlyHillsHerniaCenter.com

                      Comment


                      • #12
                        Mesh removal after hernia repair

                        Hello .My question is about scar tissue. Does mesh create scar tissue? Can nerves be entrapped ? If mesh is removed what happens? Does more scar tissue form? Or does the scar tissue reseed or soften? I have been told different things. I was even told it will dissolve. That one is hard to believe.But could you tell me more on this ? Thank you for the value of this site.

                        Comment


                        • #13
                          Mesh removal after hernia repair

                          All operations cause scar tissue

                          All scar tissue remodels and softens/lessens over the years

                          Some mesh dissolve

                          Nerves can be entrapped by mesh or scar tissue. It's not common.
                          #ItsNotJustAHernia
                          www.BeverlyHillsHerniaCenter.com

                          Comment

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