Removal of mesh after inguinal hernia repair.

Hello Richard. I live in Australia. I have had the same done as yourself, if you follow my previous posts you will get some idea what I have been through. I am only 5 days post op so too soon to tell of any progress, but so far so good, besides what I still think is nerve pain even though my nerves have been removed. Will just have to wait and see. I think it will just take time. Your story sounds similar to mine. Here's to a good recovery to anyone going through this.

Hi - I wonder if you can let me know where in the UK you are please? I am in London and suffering all sorts of problems after bi-lateral inguinal hernia repairs 3 years ago. I didnt have mesh but i still think scar tissue is effecting the nerves in the area as the pain is increasing as time goes on. I am deperately trying to find a solution as i imagine we all are.

Location: UK

Hi Tom,

I have been following your discussion and those of the others on this thread with  heartfelt sympathy and I am wondering if I’m at the beginning of the same journey. One thing’s for sure Hernia Land is very confusing so knowledge and research are key; in the Land of the Blind the one-eyed man is King!

Before I launch into my story; to answer your question I know of a surgeon in London who does a lot of hernia repairs, he is Mr Sherif Hakky at St Mary’s Paddington. I found out about him through the British Hernia Centre. I hope that helps.

My background: I had a bowel resection at the end of November 2015 due to having a twisted gut - it saved my life! However after a few days in the critical care unit I developed an infection in the wound. They opened up about half the incision and packed it with I think it was Aquacel until the wound healed from the inside out, took about 4 weeks.

However after the wound had healed up nicely and a few weeks/months later, at least by April 2016, I noticed a swelling that has gradually got worse. Obviously I went to my GP and he said I'd got an incisional hernia. He said it was nothing to worry about and that it was unlikely to strangulate.

Presumably the post-op infection adversely affected the healing of muscle wall incision.

Anyway it got worse so I saw the GP again and asked about having a repair. His response was, " ... we don't generally repair incisional hernias, even if we did it would probably re-occur, just don't lift anything heavy ...." I was not best pleased, I can't spend the rest of my life not lifting up anything heavy! What is heavy anyway, I'm not a weightlifter but I don't want to be sedentary for ever either. I was also referred back to the surgeon who did the bowel resection – I have yet to hear from him!

So I consulted a surgeon at the British Hernia Centre, Mr Hakky, at a cost of £150. He told me that he has repaired over a hundred hernias of this type this year alone. He would do an open and laparoscopic procedure under general anaesthesia.

He suggested repair using a laparoscopic technique combined with the open approach to remove the I think it is the peritoneal sac and reduce the size of the defect, they call this the hybrid technique.  He went through the benefits and more importantly the potential complications of recurrence in about 5-10% of cases as well as chronic pain at the site of the mesh. Although I don't have any statistics on the latter.

To go privately it would cost me £12,000.00. I could find the money but it would be hard. So now I need to, 1. convince my GP that I need a repair on the NHS and 2. to refer me to Mr Hakky if he would do it on the NHS.

Now to my present situation: I went back to my GP armed with the clinical report from Mr Hakky and various other bits of research but he steadfastly stuck to the view that it should not be repaired and even if it was repaired it would only reoccur. I pointed out that the rate of recurrence had been quoted at 5% - 10% by Mr Hakky and other published reports but still he said it would “probably” reoccur – I’m not sure what school of statistical analysis he went to though! I also pointed out that the hernia will almost certainly get worse and that surely it will mean a more complex repair with an increased likelihood of recurrence. He remained completely nonplussed.  He told me to wait and see what the surgeon who did the bowel resection had to say.

Now my worry is that if the original surgeon elects to do a repair he will more than likely be less experienced than, say Mr Hakky and would he be au fait with the latest thinking? It has also been suggested to me that the high recurrence rate might be due to the misplaced view that hernia repair is simple and therefore can be delegated to less experienced surgical staff. - how would I know who is doing the procedure I'd be unconscious.

So, now to the questions:

Where do I get unbiased, accurate advice? This forum is great and provides a marvellous resource of personal experience. However I have an inkling that we on this forum are unable to see the bigger picture since most of us are here because we have worries or problems and are seeking support and knowledge (for which it is great!) but what about those that have just sailed through all this and never had any adverse issues or pain? We don't see the success stories.

Do I push for a repair on the NHS and hope that the local surgeon will be good enough?

Can I get referred to a consultant anywhere in the UK? My GP has lead me to believe that I can only be referred to a consultant within a certain geographical area.

How do I find the best hernia repair surgeon?

Do I stump up £12K and go private with Mr Hakky?

Do I avoid “the mesh” at all costs?

Any inputs will be gratefully received.

Thanks for your time.

Regards,

Phil.

Hi Phil

I am new to this site but have read with great interest the posts on

inguinal hernia repair with mesh

I had one 4 years ago which took 3 years to sort of settle

However in the last 2 months the pain and discomfort has returned

I attended the pain management clinic at UC London UK where i live

Have been considering mesh removal but am very hesitant as I read of some awful results.Mind you there are awful results with mesh implants.

Where do you live ?

You are correct about confusion and perhaps downright untruths by some surgeons. Research I feel is the key .

I would welcome a discussion with you and others and perhaps setting up a group to meet to fully investigate the options and possibly publically inform

people of the pros and cons of various types of surgery as experienced by us

Look forward hearing from you and indeed other people in the same situation

Thanks

 

Hiya , I have been following most of the hernia discussions here , my sincere sympathy goes to you all.

I am starting to wonder if I should ever get my inguinal hernia repaired, I really don't know what to expect or do?

Hi Tom

I am new to this forum and have just replied to Phil17356

Interestingly you did not have mesh but still suffer like the rest of us

Would welcome a discussion with you to investigate our options

Look forward to hearing from you

Hi Hern123,

I live in the UK, in the West country.

As you say “… Research … is the key. ….”. The problem is discerning what can be taken as reliable data. I am not medically trained so making sense of the papers available on the internet is hard and at best I can only get a layman’s view.

I feel accessing reliable, meaningful data is a bit hit and miss; at least it is as far as gaining a greater understanding of the topic that is. I put some credence in papers that are published in “medical” looking journals/organisations and where references are provided for data presented from other papers. However I seem to vacillate from “mesh is good” to “mesh should be avoided” as I read paper after paper. I tend to shy away from or at least take with a pinch of salt much of the data published by hernia “clinics” or the like since they have a vested interest even if they are trying to be non-partisan.

Then there is what is considered “best practice” in the rest of the world but which is not necessarily given any credence here in the UK.

My view is that if there was a clear, accepted set of procedures for the various hernia types that can be statistically shown to lead to a successful outcome, i.e. low or no recurrence and no long term chronic pain, then the medical profession would not be so cagey about the subject.

As things stand it seems to me that the NHS consider closure of the abdominal wall and wound after an abdominal open procedure is something that all surgeons who operate on the abdomen have to learn how to do and that this is kind of part of their “tool kit” of skills. I imagine that this stage of a major procedure might be, under supervision, delegated to those surgeons who are still learning their trade, how else are they to gain the skills they need? So maybe repair of the various hernia types is sort of lumped in with learning this skill and is thus considered a simple procedure and so surgeons specialising in hernia repair are few and far between.

Please don’t misunderstand me, I am not denigrating the NHS or doctors or surgeons in the UK. I think that the NHS do an amazing job. They have saved me from certain death three times. I am not exaggerating. However a hernia is not a life threatening condition unless it strangulates, so I think it is given less prominence.

I’m going for a consultation with an NHS colorectal consultant surgeon on the 13th of December. I have already emailed him with a number of questions that I am hoping he will be able to answer and he has replied saying that after the consultation he will send me a written report answering my questions. So that’s encouraging.

My view is it’s a bit like driving in fog at night, when you can’t see where you are going the more experience you have the more likely you will reach your destination unscathed. So I am seeking a surgeon who has done a large number of successful hernia repairs of my type (i.e. abdominal incisional hernia) using techniques that are considered likely to yield a good outcome and with a high success rate. I don’t want much do I?

I’ve not seen data to support this but I am wondering if the occurrence of chronic pain due to nerves trapped by the mesh is greater with inguinal hernias then with ventral hernias, after all the three main nerves do converge in the inguinal area. So maybe inguinal hernias are more challenging than ventral hernias.

As for forming a knowledge rich group to help inform others of our personal experiences, I think that is a laudable aim. I have had a heart valve replaced and when I went for the surgery in Bristol Royal they paired each patient with a “buddy” who had had a similar operation to answer questions and generally be “there” for the patient. It worked very well. I guess this could be a similar kind of thing. However in order to be of any value to others we would need at least one person who is medically trained to guide us.

Regards,

Phil.

Hi Folks,

At long last I had my consultation with the local (Cheltenham) NHS colorectal consultant (Mr Borley) who my GP referred me to for repair of the abdominal incisional hernia that ensued after I suffered a volvulus of my small intestine in late November 2015.

I had done a certain amount of research but as I am sure you know a lot of the available data out there relates to inguinal hernias. I had already been for a private consultation with Mr Hakky at St Mary’s, Paddington as part of the British Hernia Centre and he had advised using a hybrid technique of using an inlaid mesh (part absorbable part, polypropylene) laparoscopically and open to close the wound.

Mr Borley advised me that he would recommend using a technique known as “Component Release” technique and not use a mesh at all. [Actually he said he didn’t think many surgeons were still using mesh – what he meant by that I am not sure since a lot of people on this forum have recently had procedures using mesh. Maybe he meant for abdominal incisional hernias. ] I was mightily relieved to hear this as I was getting somewhat concerned about the prospect of having a mesh inserted.

I have done some small research on this technique and I think it is known under a different name in the states as “Component Separation” technique (CST). This was first described by Ramirez et al in 1990 and is used to repair midline abdominal wall defects such as a large ventral hernia. [Search for “Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias”.] Essentially it involves releasing one of the muscle layers of the abdomen by severing it’s anchor point in the area of the flank. This means that the muscle can then be pulled over the hernia and used to cover the hernia thus forming a tensionless closure. I think it comes under the banner of “abdominal reconstruction” which is probably why it is not appropriate for inguinal hernias. I note that some surgeons still go on to use a mesh as well but Mr Borley is not advocating that in my case. Phew! However this is no “magic bullet” reoccurrence of the hernia is not ruled out.

It was also brought to my attention by my partner that NHS Scotland suspended the use of mesh and tape implants in 2014, albeit for the treatment of pelvic organ prolapse and incontinence in women, conditions that can commonly occur after childbirth – search for “mesh implants NHS Scotland”. Apparently there has been a high incidence of painful and debilitating complications as a result of this procedure.

I am now on Mr Borley’s waiting list which is considerable but I think given, the very competent impression I have formed of him, that I want him to do the procedure despite that fact that he doesn’t do 100’s of them per year (he is really in demand for his colorectal experience)  but he has used this technique for some time.

All this must, I know, be of no solace to you Neil since it is a technique that is not applicable to inguinal hernia repair … as far as I can see … after all the foregoing is just a layman’s view.

Good luck for the future and do let us know how you are getting on.

Regards,

Phil

You said a while back you don't hear the success stories. To date, I am one. I developed a lump and had it checked out and was told possible Inguinal hernia.I had ultrasound scan and was told maybe inguinal hernia but not sure, non-committal. I had appointment with surgeon, who didn't appear at the meeting, and no-one really knew anything. Perhaps I got a bit awkward asking questions, so junior doc went for surgeon, who I suspected hadn't read the notes, and he said open surgery (to my surprise, expected keyhole), and no mesh because I am female, males all done with mesh. I said good, better than a foreign object Inside. Surgeon gave some terse good advice about recovery - just get on with it, and I had the pre-op to get on NH waiting list, in case I wanted to go through with it. I researched through this web-site, and realised the op could led to more trouble than I already had, and could not make up my mind whether to have the op or not. Eventually after several delays the date came through, and I was really still unsure. Might even have pulled out at the last minute. However had the op at 9.00am and walked out at 11.00. Took it very easy for a few days, but kept moving around to keep the muscles working. No real pain, so no medication necessary for that, just tool a stool softener to make like easy, and could have gone back to a sedentary job 3 to 4 days later. There was no aftercare at all. It took 3 months really to heal, and after 4 was just about back to normal. It's now 8 months post op, and although I am still not sure whether I needed it, I am glad it was done because I had started having some discomfort when sitting for long periods in certain chairs. I don't have that discomfort now, but I still have the lump I went with first, which maybe was not related to the hernia at all. Skilled surgeon I believe who did a good job, with a good outcome. Communication just lacking.

Hi Anne,

Good to hear from you and that thus far you are having no negative effects from your surgery, long may it continue.

Regards,

Phil.

Hello Phil, just wondering how you are going?

I am still getting pain 4 months post op since last surgery. Trying to keep positive it will heal in time as I do get the odd good days.

A lot of trauma in a 12 month period, six ops.  My body will take time to heal and nerves take a long time to settle down. Would have been great to have been told this before I was cut open.

 

richard would you be willing to share the name of the doctor who removed the mesh in the UK...thx audrey

Hello, it is way to soon for me to tell if there is any improvemnt as I am only one week post op from my third surgery in the same area. I can't tell yet as I still have surgical pain. I cannot feel any numbness as yet, I wish I did and it was instant relief, but unfortunately that is not the case. The first couple of days after the op I had my hopes up thinking it was better than before, but the pain increased again daily. I am still in pain, especially at the end of the day if walking a lot. I will let you know as the weeks progress. It has been a long haul. Are you considering surgery to remove mesh?

Hey Adele I am in so much pain 11 months post hernia surgery. I've done all sorts of doctors appts. I've basically complained so many times to the surgeons that they are interested in doing mesh removal. I am timid to do it but I am not improving. What a challenge this has been in my relationship and life in general. I'm on tramadol and lyrica. I don't know what else to do. I consult with Bruce Rosenberg down in Florida who is apart of the American Hernia Society and is apart of the Meshoma Foundation. He seems to think I describe the symptoms of a meshoma. (Balled up, folded, malfunctioning mesh, as I'm sure you are aware) it gets to a point where you're damn near desperate and what makes it terrible is I look fine on the outside and am not on the inside. Hence being perceived as a liar or hypochondriac. Absolutely insane. Anyways hopefully you get better. A surgery for me would be mesh removal and that would be in October or early November. Bruce and I are going to compile a list of questions prior to this surgery in terms or what they will do while inside of me if anything is seen with the nerves. Any further surgery, neurectomy/ denervation. Just posting to vent mainly and I am following the board. Any insight would be helpful. Hope you feel better for real. I know this has been very hard. I am 31 years old and the majority of the work I do and activity is labor, moderately strenuous. Ughh.

Hi Adele, thank you for your reply. Yes I'm considering this but not sure if it would make it better o worse...

I really hope you get better soon and please keep us posted about the progress.

Hi Adele,

I've been following the discussion and hope you get better really soon. Sounds like you have been through hell and back. I live just south of Sydney and had a bilateral inguinal hernia operation performed 1.5 years ago. My pains started about 8months after the op when i lost about 10 kgs through dieting and are constant now.I need the mesh out i havent felt the same since the operation and wish i had done more research before the op. My question is..was it difficult to find a surgeon who would remove the mesh and what did they tell you the outcome would be??

My thoughts are with you and i hope you have a speedy recovery without any further pain.

Kind Regards Rod

Hello Rod. Too early for me to tell if any improvement as I am only one week post op. Mesh removal alone did not cure my groin pain so I have had a triple neurectomy. I am still having pain now, but as I said probably too soon to tell. The only surgeon in Sydney who will confidently remove the mesh is Dr John Garvey of the Sydney Goin Pain Clinic. Look at his website or call for an appointment. I am sorry to hear you are suffering also. I wish I had done my research before my original hernia repair with mesh. If I did I would have gone to Dr Garvey first up, he does not use mesh for hernia repairs. I will keep you informed if I improve.

So sorry to hear you are in the same boat as a lot of people on this forum. It is too soon to tell if I am improving as it is only one week since my surgery. I will keep you informed of my progress. I really hope I will get better soon as this has been a nightmare. I have had a couple of half days not too bad, but the more activity/walking I do it starts to hurt. Fingers crossed for a miracle.

Hi Adele,

sorry for the late reply.

Thank you for the information i will be calling him soon for an appointment.

Hope your recovery is going well.. all the best. Keep me posted.

Regards Rod

Good luck, I will keep you posted. Dr Garvey is familiar With Dr Kevin Peterson, he knows him through their interest in this area.

Best of luck.

Hello Rod just wondering how you are going? I am 5 weeks post op and have been having some good days this past week where pain is subsiding. Still bothers me at night at times, but otherwise I think I may be slowly improving. I have also started physio.

Hi Adele,

Good to hear your improving...since we last spoke i went to see your surgeon and had a UT scan and MRI done...didnt find anything drastic...apart from a little anomoly on the right side of the groin.

Aparently the mesh is in tact - I started to think the worst because i had lower and upper abdominal pain and swelling.... I still have pains everyday but the pain has decreased to a 4-5/10. I do get some days where i have very little pain on the rare occasion. Im due to see the surgeon when he gets back from holidays.

If you dont mind me asking - what did they find on your scans? To be honest im a little bummed out that that didnt find anything much on the scans...i wish that it was more clear cut.

Regards,

Rod

Hello Rod, my scans were not that clear cut either, but on my last scan Dr James Black found found an area of scar tissue in the superficial inguinal ring which did seem to correspond to the area of tenderness along the genitofemoral nerve. Earlier scans suggested illioinguinal nerve entrapment in the mesh. I think it is very difficult to see the nerves on the scans. Surgery for inguinal hernia is not just routine and simple as it is made out to be, from the pain I had it was obvious the illioinguinal, genito femoral and or the illiohypogastric nerves had been damaged because the pain was so bad at times I felt suicidal. Could not get out of bed some days. I believe I am now improving very slowly after my last op, still having nerve type pain at times, but the last week it has really settled down. Even though I had a triple neurectomy I still have had nerve type pain, which could be phantom pains I have been told. Some good days some not so good, but all in all I am a lot better than I was. I just think I need to be patient. Let me know how you get on.

Just an update John. Unfortunately I am still having awful pain. If it is going to settle down it will be at least a year. I am now going to try and get an appointment with a pain management psychologist and have been put on a new drug to try for the pain. Even though I had a triple neurectomy I am still suffering, but trying to stay positive it will pass. My brain still getting pain messages even though nerves cut. I seriously should have done more research before ever letting anyone touch me. How are you going?

Hi Adele

I am wondering it's been 3 months since I had my mesh and Neurectomy I still have some sharp zaps and I cannot sit for too long without getting sore. Activity lime red to walks and gentle bikes. How is your experience going?

Hi John

Have been following this forum for a short while only.

I too suffer pain from inguinal hernia surgery which I had 4 years ago

Although I live in the UK  I have been researching mesh removal  in the USA and Dr Rosenberg seems to be heavily involved in this area.

There is a reluctance by Drs in the UK for mesh removal but I did discuss with one one last year in London who  was prepared to do it.

I have not had it done yet as with all surgical procedres ther are risks which some Drs are reluctant to discuss. as we all to bitterly now know Indeed my

surgeon was adament that his patients did not suffer from post operative

chronic pain

One of the things I do detect  like all of us you are desperate OK on the outside but distressed and traumatised psychologigally inside.

At the end of the day I am physically and mentally  drained

I would be very interested in what Dr Rosenberg has to say both +s and

-s on mesh removal and  success rate on eliminating pain and whether you went ahead with surgery to remove the mesh

How does he fix the hernia after removal, with more mesh ?

As you can well imagine though for me to travel for surgery in Florida

would be pretty costly but with odds in my favour I would seiously consider it

Please let me know how you are getting on

Regards

Hi hern

Just wondering what have you done so far in a way of diagnosing the problems ? As in finding out if it's the mesh or the nerves that are the cause of the problem ?

Regards

Adam

Hi Adam

Good hearing from someone

I do not know where you live but I live in the UK so have consulted with

Drs in London after my operation by a local surgeon just outside London where I live

After 4 months of agony the original surgeon said there were no problems with the hernia and to do a little excercise !!! .I had consulted privately and was funding myself

Having taken a 2nd opinion in Oxford Hernia  I was advised that pain management would be the next step with an anaesthetist.

This I then realised was because there was a problem and surgeons in UK are reluctant to re-operate especially if they did not do the initial operation

Having been somewhat naive and trusting in the medical profession

i decided to do my own research and came up with the Pain Management

Centre at a major London Neuro Hospital and managed to get my GP to refer me there

I attended for approx 1.5 years on and off

I have to say for the first time people actually listened to my concerns

After a very thorough examination the anaesthetist said in his opinion there was no nerve damage and that it would get better .I asked whether better was better than now or completely better.There was a reluctance to give a prognosis

However this was pain management not pain elimination

As time went on (3 years) the pain did reduce consierably (early days could be up to 8 on the pain scale)

I had the odd flare ups

However 2 months ago I stated with severe pain in the right groin

and have been taking co-codamol ever since

Now to answer your question nerve or mesh . I my opinion it is a combination of mesh and scar tissue which leaves me with the dilema of whether to have the mesh removed

What I have learnt thru all this is that a Drs opinion is only an opinion and with little medical experience in this area a Dr can make the wrong judgement

Certainly in my opinion most GPs have little understaning of targeted pain control

Look forward to hearing from you

Best regards

 

Hi I am also in the U.K. But based in West Yorkshire.

Like yourself I struggled to get answers and was continually passed into pain management specialist. I had my hernia repair done in 2014 and the original surgeon passed the book on me in February 2015 after doing a ct scan and a laptop investigation which apparently turned up nothing so I ended up going privately to help and speed things up, I visited 2 other specialists who wouldn't touch me at all and then went to a specialist at the Huddersfield bmi who has an interest in hernia repair who sent me for a Mri with a contrast dye which is very rare for this type of problem, but low and behold it showed up significant scar tissue, trapped illio inguinal nerve, bladder adhesion and damage to spermatic cord, I was going to use this surgeon to operate but he had only done the procedure once so as you can imagine didn't fill me with confidence. I stumbled across the Manchester hernia clinic and a guy called Aali sheen and after a consultation he booked me straight in and weeks later mesh was removed well 90% as small part was and is stuck around cords and to dangerous to remove, he cut 3 nerves to stop any pain in the area. It is major surgery and not to be taken lightly as recover is upto a year

Hello Hern-

I have the same issues and have commented here before since my groin hernia op in 2014. Have you heard of Dr. Bruce Ramshaw in TN? He is a specialist in mesh removal. I am reluctant to have second surgery though nerve blocks were no help. Wondering if others have used Methadone or Buprenorphine as a functional pain med where nothing else works. These meds are much more effective on nerve pain than other opiates. I have found Tianeptine in combo with Tramadol is helpful. Tianeptine is also called "Stablon" in Europe, not rx'd in US, is a anti-depressant and pain med.