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Best method for fixing recurrent inguinal hernia?

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  • Best method for fixing recurrent inguinal hernia?

    I had a left side inguinal hernia repaired in May 2016. The procedure used was laparoscopic with Bard mesh placed between perineum and muscle layer. The mesh was sutured on both ends with dissolvable sutures.
    In late April of this year, I started getting symptoms again and was diagnosed with a hernia on the same side as the original. I met with original surgeon and two other surgeons and all three surgeons recommended the same basic treatment: Open surgery with mesh. None recommended doing any imaging work to determine actual cause of failure.
    Questions:
    • Should imaging work be done to determine the actual cause of the failure?
    • What is the best method for fixing a recurrent inguinal hernia? With mesh or without?
    • Should the original mesh be removed if it is not functioning anyway? It doesn’t seem to be causing any other issues.
    • Assuming I would get this repaired open with more mesh, would it be safe to have mesh on both sides of the repair or would it cause more chances for pain? I plan on getting back to the gym after I am healed up, so I don’t want that area to be too stiff or cause other problems.
      • What other complications will come due to having all this mesh in my body? Potential complications for future surgeries for prostate or something?

  • #2
    How have things been before the symptoms in April? Looks like you got about two years out of the first repair. Were they a good two years?

    I've mentioned that some surgeons seem to just lay more mesh on top of old mesh when fixing a recurrence but Dr. Towfigh replied that that was not how it's supposed to be done. You should get more details on what, exactly, these surgeons are planning. If the original mesh failed, some or all of it will need to be moved or removed.

    As far as having the other side done, prophylactic mesh placement, to prevent a hernia that has not occurred, is not medically advised, as I understand things. But, reality suggests that many surgeons do so. Surgery can always have complications so that seems like an unnecessary risk.

    Also, it's unclear if there are differences between the types of mesh. Your "new" mesh might be more problematic than the old mesh, as far as chronic pain. And, open surgery could mean the use of a "plug" which seems to cause many problems. If they don't plan to remove any of the old mesh, they'll probably use a plug to fill the new failure point. Some surgeons feel that plugs are "evil". See the Tweet below.

    Besides all of that, it doesn't seem that anyone has even guessed at the cause for the failure. They're just going to perform a different procedure without understanding why the first procedure failed. If you're inherently at risk of failure because of weak tissue, you'll probably have another.

    Personally, I would avoid all three of those surgeons. You're on the beginning of what could be a long trail of failures and problems. Find a real expert, with verified successes, not someone who has just performed a large number of procedures. Good luck.

    https://twitter.com/Herniadoc/status...61699290116097

    Comment


    • #3
      [QUOTE=Good intentions;n8909]How have things been before the symptoms in April? Looks like you got about two years out of the first repair. Were they a good two years?

      I've mentioned that some surgeons seem to just lay more mesh on top of old mesh when fixing a recurrence but Dr. Towfigh replied that that was not how it's supposed to be done. You should get more details on what, exactly, these surgeons are planning. If the original mesh failed, some or all of it will need to be moved or removed.

      As far as having the other side done, prophylactic mesh placement, to prevent a hernia that has not occurred, is not medically advised, as I understand things. But, reality suggests that many surgeons do so. Surgery can always have complications so that seems like an unnecessary risk.

      Also, it's unclear if there are differences between the types of mesh. Your "new" mesh might be more problematic than the old mesh, as far as chronic pain. And, open surgery could mean the use of a "plug" which seems to cause many problems. If they don't plan to remove any of the old mesh, they'll probably use a plug to fill the new failure point. Some surgeons feel that plugs are "evil". See the Tweet below.

      Besides all of that, it doesn't seem that anyone has even guessed at the cause for the failure. They're just going to perform a different procedure without understanding why the first procedure failed. If you're inherently at risk of failure because of weak tissue, you'll probably have another.

      Personally, I would avoid all three of those surgeons. You're on the beginning of what could be a long trail of failures and problems. Find a real expert, with verified successes, not someone who has just performed a large number of procedures. Good luck.


      I would totally agree
      Dr. Shirin Towfigh would be a great choice along with few others we mention here all the time....Personally i was lucky to find this forum and trusting doctor ..and was smart enough to cancel my mesh surgery after reading these horror stories....i made my choice of doctors for no mesh surgery ..you can find it here..https://www.herniatalk.com/8654-dog-...-doctor-choice As active member of this forum i see that unfortunately so many people getting themselves in all kind of problems and just after that starting to do a research:{
      Remember ! Every revision surgery will not be as good as it could original one .People please be careful i read this forum... Smart people learning by others mistakes ...When it comes to your health... don't learn by your own mistake. From the bottom of my heart !

      Comment


      • #4
        Let me clarify one point, as I see that I have not explained it very well. The first surgery was done laparoscopically so the mesh is on the inside. The surgeons I have met with are recommending repair with an open procedure, so they would be coming in from the outside and place the mesh on the outside of the hernia. That way there would be two layers of mesh that would be sandwiching the abdominal wall. It just doesn't seem like this is a good idea for many reasons. Hopefully this clears that up. I think I gave the impression that they are recommending putting mesh on the right side when the left side is the side that is broken.

        As far as pain goes, I had two decent years. I could certainly tell there was mesh in there but nothing that would stop me from doing anything. About a year after the original surgery, I joined a crossfit gym. It was march and April of this year when we were doing a lot of squats and deadlifts and increasing weight that my hernia got bad again. Since then, I have stopped exercising so the pain is minimal, but I have also gained about ten pounds. I have held off surgery to preserve what I could of my summer and so I could spend more time figuring this out.

        In regard to research the first time, I waited too long to get diagnosed. By the time I went in, the pain was so bad I had to get surgery as soon as possible. I was diagnosed on a Friday and was in surgery on Monday morning at 5am. I trusted the surgeon who came recommended by one of the hospital's top nurses, who is a friend of mine.

        Comment


        • #5
          Sorry for the confusion. Points of reference can get turned around when trying to discuss all of the possible ways to repair a hernia. The word for what they're suggesting is "onlay", I think.

          Whatever the method used they will still have to push the hernia sac and its contents back in past the existing mesh, I believe. They can't leave it between your abdominal wall and the existing mesh, it's supposed to be behind the mesh. Usually when they perform an onlay method they are pushing the hernia sac back to "virgin" territory, a short distance. They will have to go much further and might cause more problems while doing so. I'm no expert though, just trying to visualize what they would be doing.

          My main point is that you are now well outside the common repair methods. Your surgeons are probably improvising. You might be their first patient with a recurrence. You're at higher risk. Ask them how many recurrences they've fixed using their methods.

          Besides that, why would you go back to the surgeon who didn't fix it the first time? The method he/she used is supposed to be almost infallible, for recurrence. Yet yours failed.

          Was the Bard mesh used originally 3D Max? The suturing method seems to fit what they do with that device.

          Comment


          • #6
            Thanks for the comments on getting everything put back into place during the surgery. That is one aspect of the procedure that I hadn't considered. How much damage could be done when that happens? Probably a lot if not done correctly.

            One of the surgeons I met with theorized that the mesh might be working ok but there might be some fatty tissue that was on the other side of mesh. He thought maybe that was working it's way out and causing the pain. But again, that's just speculation because he didn't recommend doing any imaging work or any other type of diagnostics to determine what was actually wrong.

            I have absolutely no intention of going back to my original surgeon. I only met with him to get a better understanding what was done and get his notes. I think it was Bard 3D max, but I would have to look back at the notes. The weird thing was that the actual mesh brand and type was not documented and I had to specifically ask that question.

            I am still left left with the same questions. What is the right way to repair this at this point? Remove the old mesh or not? Repair with more mesh or do tissue only repair? Thanks again.

            Comment

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