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pros and cons of each

November 17 2013, 5:45 PM 

Dr Goodyear writes,
"The statement that chronic pain after a non-mesh repair is "almost 0%" is categorically untrue. In fact, the rate is almost the same. Whereas the total number is higher with mesh repairs, this is because of the preponderance of repairs using mesh.

Based on my experience, it remains my firm opinion that PHPS is far more the result of surgical disregard for identifying and preserving the 3 major nerves of the inguinal canal or the "misuse or "misplacement" of mesh by less experienced surgeons, and not due to the mesh itself. In experienced hands, mesh repair is both safe and more effective than tissue-based suture under tension repairs."

I totally agree with Dr Goodyear: in experienced hands, mesh is more effective than suturing under tension.

Here is the problem though: Just about all the companies that manufacture mesh, and just about all the doctors who are promoting the use of mesh, are promoting the use of mesh based on the claim quite a lot EASIER for a relatively inexperienced surgeon to get good results, with mesh, than with a tension repair.

Indeed, for many years recurrence rates were embarasingly high, often at or over 20% in many hospitals and ambulatory surgery centers. This is because hernia operations were handed off to the most inexperienced surgeons, and often still are - as a "bread and butter" operation for young surgeons to build up their experience with, and make a few bucks from. The introduction of mesh caused the recurrence rates to drop precipitously - to under 5%, or even less. But the operations were still being handed off to the most inexperienced surgeons.

The solution to the problem of poor results, was "buy our product" instead of "strive for excellence and develop expertise."

Ira Rutgow (a plug and patch proponent) was notorious for saying that he doesn't think it makes any difference what you do with the nerves; that he didn't even look for them, completely ignored them, and that this saved time and he was able to complete his operation in less than 20 minutes.

Highly skilled surgeons like Dr Goodyear were able to cut their recurrence rate from acceptably low, just a few percent - to almost no recurrences at all. And they saw the incidence of chronic pain, and post op infections, go up only very, very slightly, if at all. The infection rate could be kept down satisfactorily low with the help of prophylactic prescriptions of antibiotics, in addition to normal sterility precautions being taken during surgery (antibiotics are NOT routinely prescribed at the Shouldice Centre). But again - these are the most highly skilled surgeons who are able to get such good results. This doesn't support the "just buy our product" mentality that was bring promoted.

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David S

my No-mesh hernia surgery story

September 24 2013, 11:09 PM 

Hello All, I myself was scheduled for a plastic mesh hernia surgery on 9/5/13. But, after reading stories of surgery gone wrong and of mesh rejections years and years down the road I started looking for a no-mesh option. When I started looking for a "no-mesh" solution to my inguinal hernia I found 3 USA doctors. Dr. Tomas in Florida, Dr Parvez in Fresno Calif (who took 3 weeks to return my 2 calls and 1 email to his office. By the time he returned my call it was the day AFTER my no-mesh surgery was done (your to late doc!)) and, a doctor in Las Vegas who was charging $5000...! I decided to call Dr. Tomas in Florida and he called me back in 30min...! I did some research on him and found no negatives on him or the Desarda no-mesh procedure so I made plans to fly South West Airlines down to Ft. Myers Florida and see Dr. Tomas. The whole trip was AWESOME...! Dr. Thomas and his office staff are all very patient and willing to listen to your health needs. He has a discount arranged with the Fairfield Marriott in Ft. Myers which also provides a shuttle to and from the hotel, the airport and his office (and if you tip a little extra the driver will probably take you to a local grocery store if you need it). Everything was WONDERFUL...! Costco, and Enterprise rental cars are a right nextdoor (the rental car was useful my 1st day so I could take a Ft. Myers beach drive and do some grocery shopping so after surgery all I would have to do is watch TV and rest, which turned out to be a GOOD idea!. Super Target is directly across the street and Super Walmart is a 3min drive south. The hotel rooms are VERY clean, the daily breakfast with eggs & waffle was AWESOME and by shopping for my vegetarian food at Walmart & Target I was able to eat in my lunch & dinner in my room everyday and NOT have to buy any restaurant or to-go food at all...! Microwave & Fridge & coffee/tea maker are in the room...! I was walking upright and normal one day after surgery and flew home to Dallas (7hr trip with delays) on the 3rd day after surgery with no significant problems. I did keep an ice pack (bring your own zip lock bags) on my incision every hour after surgery for 5 days to keep the swelling and pain down (it works too!) Just a little sting and tender but, on the 4th day I didn't need the paid meds only 2 ibuprofen every 4 hrs. Dr. Tomas's office is clean, organized, friendly and helpful. I'm VERY VERY glad that I do not have any petroleum based polymer plastic in my body that could develop unexpected complications years down the road. And, my hernia was fixed in a natural way with my own tissue. I do believe in taking homeopathic healing remedies (those little blue tubes) so I took "Arnica Montana" & "Staphysagria" orally every 4hrs after surgery and now I have NO brusing and very little swelling. That's my story. It's only been 4 days after surgery so maybe I'm still in the honey-moon phase but, it feels good and If I need something else done at least the doctor won't have to deal with something plastic in the way. Just my .02 Comments? Be Well, David

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my mesh hernia surgery

September 28 2013, 9:27 AM 

My story is similar to RFE. I had a large inguinal hernia for over 3 yrs that grew as time went by. I continued to work out w/ weights eliminating certain exercises from my workouts (squats, leg presses, military presses) over time to compensate for the hernia. Some days I had the hernia descend into my scrotum and would have to lay down to work my intestines back where it belonged.
At first I was hesitant about considering a foreign substance mesh for a hernia repair. I met with several surgeons who collectively among them performed mesh and non-mesh techniques. I was a candidate for all types of these repairs.
After months of research and speaking with many people who actually had hernia surgery (including those who had Desarda, Shouldice, Lichtenstein, and Ultrapro techniques), I decided to use NPHI Dr Goodyear w/ Ultrapro. I felt it was the best choice for my situation and I am very pleased with my results. I agree that choosing a specialist with many yrs of experience is very important.

I had my surgery 5 weeks ago. Not much pain considering the area of the body where the surgery is performed. I took a pain med the evening of surgery, another the next morning for the 4hr drive back home to NY (wife drove). Right after surgery I went out to Whole Foods, bought some fruits & veggies, and then did a little shopping. Early dinner that evening at a local restaurant. The evening of my surgery I continued to go out for 10-15 minute walks every hour. Walking after surgery as much as I could I believe was key to my recovery, along w/ supplements and a healthy diet. 3 days after surgery I was going out for 30-45 walks every couple of hours. 1 week after surgery back to the gym to walk uphill / incline on the treadmill and some light exercise bike. I'm now at 5 weeks post-op and introducing light weights and being careful to monitor my body how I feel. Another couple weeks I will begin training for a local 1/2 marathon. I have 3 friends at work who had the Lichenstein method performed by a local surgeon and they can't believe my recovery. I glad to report I don't have any sharp pains, twinges, etc.
All I can say is do your research, talk to people who have had surgery that are similar to your situation, such type of hernia, size, how long have they had it, what type of active lifestyle do they have, etc.
Then choose what you feel is best. Whatever method you guys decide to choose, I wish you the best and hope your results turn out as well as mine at this stage.

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bruising and swelling

November 17 2013, 6:17 PM 

I had a hernia the size of a large orange or small grapefruit, extending into my scrotum. Yet I also had very little bruising and swelling from my operation - and I didn't take any arnica or any medication at all for bruising. The only medication I took was a dose of opioid pain reliever about an 4 hours after my surgery was finished, and another 5 hours after that. These helped a bit when I first got up and started moving around, starting about 5 hours after the surgery. After that I didn't need any pain reliever. I never took ANY antiflamatories.

I just some very slight swelling in a few spots, that were completely gone by the next day. Similar thing regarding bruising. Just 2 or 3 spots the size of a nickel. They didn't hurt at all. Almost gone the next day. I did not ever develop a "healing ridge."

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It's simple

September 28 2013, 7:33 PM 

Simply to place a foreign polypropylene object inside a complex system based on Immunoglobins, inflammation, rejection, migration, infection, foreign, et al is
against nature. Man cannot create a better environment for natural healing.
The inflammation response will occur to some extent in everyone using mesh or any object inside the human body.

The reason why most use mesh? Because Johnson and Johnson with Ethicon and the founding surgeon in Miami promote mesh through a complex marketing system with unconscious bias studies and money/lobbyist. They attend seminars in SF under the guise of medical science that is based on money.This is how pharmaceuticals and the medical establishment have been operating since greed and corporatism started controlling most every aspect of our lives and our schedules, to include our food.

Non mesh surgery by Bruce Ramshaw will resolve your issues. I have a R Inquinal Hernia and I am fit enough to live with it, but for those of you whom are not, contact Dr. Ramshaw. I have talked with and met surgeons across the nation to include Desarda and Albin and Kravitz and England and on and on...all good guys but once you have been using mesh that is mostly what you know and to change jeopardizes your position and revenue. Desarda has a unique technique and I admire his efforts for natural healing and would give him to nod if Ramshaw is not an option. The energy and knowledge of Ramshaw, whom has been international also, is the best I've seen thus far.

So, why use no mesh? Because how much is your body worth, it's worth letting it does what it does best, heal with as natural a process without a constant foreign object that no one can predict how it will respond acutely or chronically.

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no mesh

September 28 2013, 7:46 PM 

Well the sutures are polypropylene, granted it's not a large piece of mesh but it's still a foreign substance in your body.
GMOs are in our food, but Monsanto lobbies that there are no side affects and spend millions in lobbying to prevent GMO labels from being placed on foods.
We get more vaccines, the doctors say only a few people are affected and it's good for the majority.
I believe 1 in 17 people have some form of mental illness.
My water is fluoridated which is a carcinogen.
More people are exposed to radiation, so they raise the limits of allowed exposure.
Please show me a long term study of the side affects of mesh and there are probably many more people without any issues.
The strong survive, the weak do not - Pavlov.

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September 29 2013, 1:22 AM 

Plypropylene doesn't have to be used for sutures. (Univ. of MO is studying new materials also for hernias.)

Stop voting for politicians whom are in the two parties and end lobbyist. Grow much of your own food and do not buy from companies whom support the non-labeling. We can take the power away if we are aware and work as a group.

Do not get any vaccines. My brother's kids have not had one vaccine. I don't receive them.

Mental illness is relative. Psychiatry and the DSM is now under scrutiny for it's validity and application by the US National Institute of Mental Health and the field is now divided.

Cities are removing fluoride from water basins used for masses.

Don't receive x-rays (use MRIs is need an internal scan) although the EM we receive is everywhere from wireless technology.

What "study" would anyone have about no-mesh, the unconscious bias and money will not allow like many other anomalies caused by medical procedures and pharmacology. Epidemiologist John Ioannidis explains:

The strong survive to a point the immune system and mind is prepared. Beyond that is dis-ease. The mind can change DNA and Mitochondrial Biogenesis is key.

Your over-extension is hyperbolic in justifying placing a foreign object in the body to repair an opening. Why not try natural first then go from there...emergency medicine has it's place yet given a choice nature has most of the answers.

...there is no panacea; yet, awareness and thinking of the betterment of mankind over business models has to be re-visited as the y-gen will probably not live as long as the current one. Placing mesh in humans made of can be better than this.

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no mesh

September 29 2013, 8:16 AM 

Trying the natural approach first should be considered but in my opinion it's not suitable for the majority of people. There are only a few surgeons that practice a natural repair, usually not covered by your insurance. If you can't afford the cost, need to get back to work, are middle aged, etc., and although there are options to work around any obstacle at the end the choice will more likely be mesh.
Politicians work for industries and campaign contributors, not for the common person. The two party system may take several decades to change and that's if we as Americans can begin by supporting other parties for low level government and build support and have them move up the ranks.
It's not the food companies supporting non-labeling, but the providers of genetic seed, special fertilizers, herbicides, etc. that spend millions of dollars and have their former executives hired to infiltrate government positions to further their cause.
Can people do something to stand up and demand a change - Yes in perhaps in other parts of the world where people will stand up and die for their beliefs. Try making a change in America, where the most reviewed topic is probably what are the Kardashians doing?

Yes do not get vaccines. You know how many millions of dollars the vaccine makers have lost in lawsuits yet continue to thrive. Why is this not mentioned in the mass media?

What about the unknown chemicals in our drinking water from fracking?
How many years before the public does something about this but by then it's too late.
Fukushima is still leaking radiation, does anyone care.

I'm not justifying the current use of mesh as the ideal choice but until we find something better I believe mesh should be considered. There are a lot of bigger issues in the world then mesh vs no-mesh.


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Re: no mesh

October 23 2013, 1:03 PM 

Hey Kravitz,

You spew irrelevant nonsense about vaccines (with no evidence), claim that fracking is poisoning drinking water (with no evidence), but say that non-mesh repairs are not suitable for most people? Based on what???

In fact of all the things you mentioned in you post, successful non mesh repairs are the most realistic. Thousands of non mesh repairs are done each year. There have been many debates here about their pros and cons, which are fair game and worthy of discussion.

And another thing - You say that mesh vs non mesh hernia repair is not the most important issue in the world.

Did you happen to notice that this IS A HERNIA MESSAGE BOARD??

Take your opinions on irrelevant topics somewhere else.

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Re: Cons of NON MESH Repair!

October 23 2013, 11:26 AM 

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Re: Cons of NON MESH Repair!

October 23 2013, 12:32 PM 

I had two years ago double hernia repair open inguinal surgery with mesh with long term pain. I have been through suggested remedies that is, trying a hernia brief for support, pain pills, two consultations with original surgeon, and pain specialist. A second surgeon did exploratory laproscopic surgery removed scar tissue coagulated nerves. Mesh gives sensation of pulling or stretching with daily activities and normal exercise is impossible. This is pain for life unless another operation helps.

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Dr. Grischkan patient

Re: Cons of NON MESH Repair!

October 25 2013, 7:20 PM 

If you had mesh put in and you believe it is causing you pain, there are doctors out there who will/can remove the offending mesh and will/can do a shouldice method on you. About 6-8 months ago, I went to Dr Grischkan (Cleveland,OH) after having very noticeable pain from a previous mesh surgery. I had him rip out the old mesh and he used a non-mesh method on me and I've had no negative side effects since. I had another surgery with him yesterday, but this was just a non-mesh repair this time around. There was no pre-existing mesh in there this time around for him to rip out. I'm not saying this would 100% alleviate your pain, but ever since my first bout with mesh, I am against that stuff in my body if at all possible.

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I need options - Lt Inguinal Hernia

November 4 2013, 5:42 PM 

I was injured in April 2012 and have had burning, stabbing, swelling, knife slashing sensations as well as the feeling that I was perforated (bowel or bladder). I started to have Light Bladder leakage. UTI's and a bladder infection along with the pain in the Iliac crest, low back, buttocks, pelvic, groin. pubic bone area and upper thigh areas. Here it is 18 months and 10 physicians later (9 being specialists) and I had no diagnosis that is until I went to see and Orthopedic Surgeon a few weeks ago who aggravated my symptoms and I went home and got on the internet and found the referred pain section on hernia's at North Penn (but at no other hernia site). I fit them all, so I asked my PC to test me for an Inguinal Hernia, and that is what they found on my ultrasound. Due to past failed surgeries for other problem, I know my body does not accept foreign metals, so no staples, wires, mesh or pins etc. All the research I have done on the mesh and all the side affects, I do nto want mesh, but found there is a biograde mesh made from pig. I went out of town to see a hernia surgeon and she claims that shouldn't be in this much pain becuase of an 1 3/4" hernia, but if that was true how could I have found this site bymy symptomsd and diagnosed myself correctly. How do you find a surgeon who specifically handles female hernia's and a patient like me who has all the referred pain symptoms. I haven't had a life all this time, all I am doing is surviving and I don't want to live this way anymore. But I certainly do no want mesh when it can migrate and attach to your bowels and cause infections or migrate elsewhere in the body. Everyone here who has had surgery says how hard it is at first, when the surgeons make recovery sound like a piece of cake.

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Re: I need options - Lt Inguinal Hernia

November 5 2013, 2:25 PM 

I wish you the best of luck, but you can still end up with complications with a non mesh repair. it comes down more to the skill of the surgeon than mesh or non mesh repair. The list of non mesh surgeons are very few, and those that still practice it are skilled in what they do. Mesh has become the standard, so that non skilled surgeons now just mess you up using mesh instead of non mesh surgery. Skilled mesh surgeons do not have a history of patients with complications.
Dr, Goodyear has posted on this forum multiple times, that mesh migration is very unlikely, due to the healing properties of he human body. It is locked into place almost immediately. Its more likely that the surgeon misplaced the mesh. Very rarely is an infection caused by the mesh itself, it is more likely that a foreign contaminate was introduced at the same time as the mesh was placed, like it may not have been handled properly to keep it sterilized.

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