90. HerniaTalk LIVE Q&A: Pros & Cons of Mesh vs Tissue Repairs

[@SolitudeInE-Minor]

Does having two mesh inserted for bilateral inguinal hernia increase risks of mesh complications? Is open tissue based repair for bilateral hernias too much tissue/nerve damage?

[@herniadoc]

Not necessarily. And Yes

[@buddylove8140]

Very useful information! Bless you for your work. 71 yr. Active male, mesh lap/robitc surgery scheduled for sept.

[@erogel4171]

Hi , thank you for posting these interviews. I was planning on getting tissue repair for inguinal hernia but when i went to Dr.Nguyen , he said i could get either tissue or biologic mesh repair. he said the biologic mesh dissolves after a year. I'm am curious what your opinion is of biologic mesh or if you could refer me to articles for more info on biologic mesh. thanks

[@herniadoc]

Use of absorbable mesh for inguinal hernia repair is not standard and has been shown in multiple trials to result in high recurrence rate

[@erogel4171]

thanks! what do you mean by high recurrence, 15%? any references.? thanks!@@herniadoc

[@fernvelas3753]

What are your thoughts for the bard 3dmax mesh long term. What would cause issues the surgeon or the mesh

[@Life-With-Mikey]

I just had inguinal Laposcopic Surgery to repair the First Open Inguinal Hernia Surgery that didnt work. It came back a year and a half later. So, ive had both types Open and Laposcopic. The laposcopic is definitely more painful than the open one.

[@Richard-e8o]

Apparently I have two more smaller hernias behind my umbilical hernia which is pushing out lately more where I feel it pushing out when I do anything. I went to the Eisenhower emergency where they sent me home to get referred to a specialist. Told me to go back if it gets worse. What should I say in order to get the right kind of care and what should I be aware of?

[@herniadoc]

see a specialist

[@ekatk5185]

Thank you. Small hernias' tissue vs mesh repair question was discussed. What would you classify as a small hernia? Can fermoral hernia be repaired with tissue? Is laparoscopic mesh repair a good solution for young women (before any pregnancies)?

[@herniadoc]

Lots of questions. These have all been answered on various HerniaTalk LIVE Q&A sessions. You can also read or pose a question on HerniaTalk.com

[@OptimumInsuranceMark]

I had laparoscopic inguinal hernia repair (with a mesh) six (6) months [not days/weeks] ago and it has been horrible. My condition is actually worse than before the surgery. The mesh feels like a piece of sandpaper was surgically implanted inside of my body and the area where the hernia was a half year ago is still painful and swollen. My right testicle has been swollen and inflamed and is still approximately 100% larger than my left testicle. My condition is worse because of the pain and aching associated with my testicle being affected as opposed to just the less sensitive abdominal material that would occasionally protrude though my abdominal wall. My condition is affecting my activity level. I cannot walk for extended periods of time before the aching spreads to my lower belly area causing an upset stomach and ultimately headaches. I am dealing with chaffing because of the abnormal size of my right testicle. I can no longer complete a full yoga workout, ride a bike or jog/run and this has caused my physical condition to continually decline since the surgery. I have lost notable muscle mass, flexibility and my energy level is continually lessening. I have found that doctors are more than available to talk about performing surgery, but when it comes to complications secondary to surgery and/or potential medical malpractice necessitating restorative surgery, these same doctors hide in the shadows and are tight lipped about offering aid.

[@herniadoc]

You need to see a specialist

[@zztop8592]

I wonder if anyone has actually tried to use external taping for inguinal hernias? I've heard of a lot of problems with mesh surgeries, we need more research in inguinal hernia repair surgeries!

[@herniadoc]

@@zztop8592 kinesiotape. Doesn’t work.

[@zztop8592]

@@herniadoc I wonder if using the patients own skin or fascia would work, instead of using a foreign material? I've used a hernia belt for years, I don't trust surgery.

[@herniadoc]

@@zztop8592skin stretches. Doesn’t work. Tensor fascia lata has been used. It’s very disfiguring.

[@dutelatte2154]

I watched many of the other videos first and got the idea that non-mesh repair was the best option for me (small inguinal hernia), but now I'm thinking the mesh repair would be fine. I'm 36yr and small indirect inguinal hernia. I already booked a surgery in Korea for a Kang Repair, hope I did the right choice.

[@herniadoc]

Best of luck Follow your surgeon’s guidance

[@TheJcat99]

Beware of the mesh! It rolls, folds, frays, causes more hernias and cannot ever be completely removed.

[@wordsofnonwisdom]

how u do? 36 and dealing with this now, what a nightmare

[@dutelatte2154]

@@wordsofnonwisdom I went to Dr.Kang in Korea, Gibbeum Hospital, it was advised not to do the surgery and wait to see how it develops. I'm doing specific yoga everyday and symptoms are much better

[@user-ci3ji8eg5k]

For tissue repair, the risk of genitofemoral nerve entrapment mentioned at 21:40. Does it get trapped during surgery or is this something that happens in healing and it gets trapped in scar tissue?

[@herniadoc]

all of the above are possible.

[@user-ci3ji8eg5k]

Thank you Dr. Towfigh!! Do you think any specific type of tissue repair has a higher risk of this or are they all probably similar risk?

[@smoothwill]

Good lord you would think with all the medical breakthroughs in medicine and all the other medical stuff including artificial hips knees heart and kidney transplants etc , they can't find something other than mesh to repair a damn hernia hole . It's just dispicable. I think the reason is the same reason they still haven't found a cure for cancer , money , money , Money just like surgery it's Money. Keep the patient coming back and keep the hospitals full . The medical establishment are a bunch of crooks thieves and liars . They can find a solution for these toxic meshes tomorrow but they don't want to because hospitals would bu out of business just like all the cancers and other stuff they could have been found s cure for .

[@bertpainter8385]

I always wonder if people who actually experience Hernia surgery issue understand how it feels to live with the type of pain people who have problems experience. It's very debilitating. So I have this very important question for anyone who is knowledgeable with inguinal hernia repair using mesh. I had open surgery 6 months ago. Recovery took longer than normal that I was told and read about about, ( which was 4 to 6 weeks). Even after the 2 month recovery I occasionally had sharp ripping of tissue type of pain feelings and complete skin surface numbness , but was getting better as time went on. A few weeks ago I woke up with such ripping tissue type pain that dropped me to my knees and kept me in bed for a few days and now the hernia repaired location is very tender and still with some sharp ripping type pain as when I had the initial surgery after a week of recovery. Question is, is this a sign of reinjury to that area or a symptom of chronic mesh issues? I did have a quick ankle turn causing me to fall but I caught myself with hands in front of me and had no pain from that fall whatsoever., except for a very slight sore ankle. I was also doing ongoing core therapy for sciatica back pain on opposite side of hernia for a few weeks prior. Been looking for answers after following up with the surgeon immediately after re-occurrence. The surgeon felt all was still good with the healing process. Which I concur that the area looked fine but was still sore & hurting, which I could tolerate, but not the sharp ripping feeling I've experienced and still do at times. I've always been very active physically. Now all I want is to be able to do repairs around the house and the maintenance that comes with being a home owner and play some golf now and then, now that I'm retired and suppose to enjoy my so called golden years. I still feel I can be that person if this pain goes away. Anyone have thoughts.

[@herniadoc]

most patients continue to improve over time.

[@bertpainter8385]

@@herniadoc Thx for replying. Let's hope so. 3 months or so ago last I felt good enough to play a few rounds of golf before it got cold. Then I had the sciatica issue. Laying around maybe contributed to weaken core muscles I'm hoping that may have caused stretching of muscle scar tissues. I'm obvious going out on a limb and some wishful positive thinking here. But I guess that's as good as any reason I've been able to find about why people still hurt. 🤔

[@larrytaylor693]

I had double inguinal Hernia surgery going on week 7 now I lay around in awful pain I also have RLS and the pain makes RLS worse and it's unbearable to me idk how I'm going to make it one more night as I don't sleep if I do sleep its a few hours here and there and that's usually durring the day. If I can get some decent sleep and stay on the couch for a few days I think I'm feeling better only for the ripping type pains to start and then it gets into my testicles and it's like I've been kicked in the balls.

[@stowfigh]

@@larrytaylor693 that's not normal. ice helps. seek help from your surgeon.

[@krisztianwirsz3612]

In case a Shouldice's scar/suture kind of ruptured 5 years after surgery, resulting in pain but no palpable or visible hernia, would a Lichtenstein repair with neurectomy be a good choice? Ultrasound does reveal a small (10 mm x 17 mm) dehiscence in the Shouldice repair's scar.

[@herniadoc]

The standard repair for recurrence after open repair is laparoscopic

[@krisztianwirsz3612]

@@herniadoc I know but my surgeon changed his stance and said if my pain is nerve related, then laparoscopic mesh placement might do exactly nothing. I am at a loss of what to do. Currently I live a normal life but do no sport apart from a lot of walking and I'm mostly fine. But I know if I went back to a more physically active life the pain would most probably start again.

[@herniadoc]

@@krisztianwirsz3612 see a specialist or get a second opinion

[@krisztianwirsz3612]

@@herniadoc thanks. Does it mean even if my pain is nerve related you think laparoscopy could be the solution?

[@SpeechesBeyond]

Can having any type of Hernia cause you emotional and mental stress ? Especially if caused by work ? Also I found it took me 3 months to full recover . Could the long term recovery be because I've also been diagnosed with vitamin D and B-12 Deficiency ?

[@andrewcameron6611]

Reparing my inguinal hernia caused inflammation and vitamin D and B-12 Deficiency and impotence for 12 years now.

[@krisztianwirsz3612]

@@andrewcameron6611 Jesus christ, what kind of repair was it?

[@andrewcameron6611]

inguinal hernia. i forgot to mention that i suffer from waek pelvic floor that was caused by the hernia mesh stress. i still havent recovered. @@krisztianwirsz3612

[@Dontworrybehappy-mt8yz]

Saw Dr Heniford two times got to lose more weight to have a successful surgery and having a very difficult time losing weight due to so much pain when active! Any suggestions please

[@Dontworrybehappy-mt8yz]

My real name is Teresa Hicks

[@herniadoc]

Find a weight loss specialist physician who can prescribe medications that can assist with your weight loss. Also, consider weight loss surgery if you have a lot of weight to lose. It’s nearly impossible to lose a lot of weight in a short period of time otherwise.

[@stevewinter9315]

Follow the advice of Dr. Jason Fung - you can look him up

[@janiecox284]

I have been inquiring about a specialist in hernia repair. This mesh have me scary ish about even having surgery. I was a perfectly healthy individual up until my hernia have actually but a halt in my social & work life. I suffer with pain, due to the weight of this hernia. Back pain, knee pain, foot pain is a daily for me. I need surgery but not going to let anyone use me as a genie pig. I need someone who actually care & is extremely knowledgeable about hernias

[@usvadi]

Do you do Non mesh same as shouldice. ? Cut and fix For men ?

[@herniadoc]

Yes 👍🏻

[@topgopnik]

It seems to me like stretching is important. Also working out. I am losing weight and the mesh starts moving. It kind of shrunk I feel like and I am stretching gently. Ever since I became more active and started moving around most of my symtoms disappeared. I still feel my nerves sometimes cause me a minor tinkle down my leg. Is it dangerous? Tickles. Sometimes a funny pain, but nothing serious. I wonder doc if the mesh is not so flexible for me to function, should I remove it? I would rate it 2/10 in terms of needs. I had a 1 cm hole in my belly button. Is it worth the risk to remove? I am worried about nerve damage...

[@mrtnclaudiuable]

hello Bless you dr ❤ I am 37 ,male , 175 h, 82 kg, right ing hernia it did grow a little in 8 years. I am in 5 day after open (10 cm) surgery and my surgeon chose retrofunicular Postempsky The funiculus is made to run through the subcutaneous tissue. In 10 day i will check in for suture removal and i will ask him if my tissue whas ok/healthy to sustain such repair on long therm. I did not want mesh (unfortunatly i saw situation in my family mesh rejection..seromas and infections and cronic pain). I am dentist, some medical information i am aware. My surgeon is not young and he is a professor of an university and he is a specialist in laparoscopy and robotics, bariatrics... If you have an honest opinion i would be grateful💐 You are beautiful, inteligent and wise! My respect ❤

[@miJesus007]

What makes a good candidate for absorbable synthetic mesh?

[@herniadoc]

We’ve reviewed this in other podcasts. Also go to HerniaTalk.com

[@rigaleb]

Maybe, when you have time, in the future you can include in your questions for your specialist guests about how athletes or people that are generally physically active and that is their way of life, they work out medium to intense and they practice mobility and weight training on a rrgular basis and they are constantly conscious of their body health. Usually doctors, in my country, at least, tell people to give that all up, completely disregarding the value of strength training in longevity and healthspan. Is this a discussion, are there ”special” surgeons or ”good” surgeons dar really understand this issue and research the newest and improved technologies and techniques or am I just dreaming a fantasy from an utopic medically advanced futuristic civilization? Sometimes I think pacients need to have been to medical school themselves so that they know what to research and ask their doctors.

[@callingoz7466]

Oo😊o😊m I’m

[@VijayKumar-eh8bd]

Hi doctor i have bilateral inguinal hernia small size. Which surgery i can choose? Laparoscopic or open. Which is best.?

[@herniadoc]

no best answer. seek consultatioon with a hernia specialist to provide you options.

[@Jackjack1978.]

If I'm in fort Worth Texas area, what is the top recommended doctor for hernia repair? Are there any in the area that actually specialize in hernias?

[@herniadoc]

go to HerniaTalk.com to search for Texas

[@TheJcat99]

@herniadoc I went to the site but didn’t see a search tool…?

[@Jackjack1978.]

@@TheJcat99 already had mine taken care of by a doctor I researched.. Dr Paul Gray in fort Worth.. He specializes in hernia repairs. He did an Open surgical repair on two small epigastric hernias for me using no mesh. I couldn't believe how painless and easy the whole procedure was. Everybody was saying how much pain they were involved in for the first three or four days, But I experienced almost none And use just three Advil and two Tylenol for maybe 3 days. Most of the people were talking about alot of pain and discomfort were ingrual hernias though. So I'm guessing there would be a lot more pain involved in that lower region where it seems like it might be more sensitive.

[@Jackjack1978.]

@@TheJcat99 I literally went online on chat GPT and just started asking questions about top doctors that specialized in the exact type of hernia repair that I was needing. And then just started looking those individual doctors up and narrowing down my circle. Asked Chat GPT about experience, accreditation, medical awards, doctors that other Doctors looked to for correct protocol..etc. Took about 3 hours to really narrow it down to about 5 surgeons in my local area who are all some of the best of the best. In any field, there's always good, better, and best. When someone's cutting you open, you want the best:)

[@darlaballard5654]

I am literally dying from patch plug mesh! Im in bed every day, and there is no help for me. I had an inguinal hernia and now my surgeon retired. No help! Trying to see someone in dallas or Houston soon!

[@herniadoc]

Good luck! Be your own strongest advocate.

[@darlaballard5654]

@@herniadoc I'm trying and getting nowhere quickly.

[@semsemeini7905]

Can allergies to the mesh lead to itching and night sweats as well as minor stomach upsets?

[@herniadoc]

It’s Possible.

[@TheJcat99]

Also maybe just immune response

[@fernvelas3753]

Is it common to have erectile disfunction?

[@pauldarrigo4395]

polypropylene is bad. The gases has been shown to be negative on humans. What about immune response or dysfunction of the immune system from toxicity? Auto immune issues? So to show data how successful mesh surgeries are is incomplete because your data set is not looking at vertical issues. Have you looked for the issues? I doubt it. Was immunologist involved in these studies? ePTFE's... I can't believe you would put that in a body. I wonder if RFK had any lawsuits with that. That fact that you are mentioning there are reactions should cause pause and reconsideration of Shouldice. A million repairs. Love to see an immune analyses of inflammatory markers. Good convo- though it created pause and may be worth it.

[@herniadoc]

Watch our episode discussing ASIA autoimmune reaction to mesh episode 23

[@pauldarrigo4395]

@@herniadoc Thanks. Who is the Shouldice who uses steel sutures here in LA?

[@herniadoc]

@@pauldarrigo4395 no one that I know of uses steel in LA

[@pauldarrigo4395]

@@herniadoc are you avail to talk a minute

[@herniadoc]

if you would like to schedule a consultation, please contact my office directly [e-mail]

[@SolidNate99]

Why can the body not heal this area by itself?

[@herniadoc]

It’s a hole. And the area has abnormal tissue.

[@dougbabbit2681]

I've had other ' holes ' heal on my body over my lifetime...why not hernia holes?

[@herniadoc]

@@dougbabbit2681 what other “holes”?

[@ArtOfHealth]

​@@herniadocI think he means cuts and gouges on the skin and or flesh. I have had this as well. If I stay in bed 9-10 hours with a light meal the day before, I have a tinier protrusion. But, once I am up and moving around, I get an orange size bulge. I thought about fasting for several days and emptying the gut so it relaxes. I hurt my lower spine and back 8 weeks ago. I took it easy. Pain was incredible. Acetaminophen and Naproxen got me through. I finally feel great. I am 69. 5'8" and 125 lean lbs. Thanks for sharing your life's work with the people! You are a gem😊.

[@lesact]

I think they mean that if you get a big cut on your body, its like a hole. First it bleeds, then a scab, then scar tissue, the finally it goes back to how it was before. Thus the 'hole' heals itself! Obviously, for a hernia, there is no bleeding from the gap ... the body is nkt even perceiving this hole as damaged tissue. More generally tho, is it not possible to push a small hernia back, then carefully do exercises to build up the supporting fascia?