This is laparoscopically placed mesh which which had been causing the patient severe groin pain for 15 years. Notice the four screws on your left and one screw on the bottom edge of the large piece of mesh. Sometimes it is necessary to take the mesh out in two or more pieces. This mesh was wrapped around the vas deferens, testicular artery and testicular vein causing severe testicular pain. One of the screws was in No Man's Land. This patient woke up in recovery with his groin pain gone.
This is a inguinal hernia mesh patch that was placed using an open technique. The arrow points to the ilio-inguinal nerve that was entrapped by the mesh. The nerve is grossly thickened and neuromatos where it hits the mesh.
Mesh hernia repair is the most popular means for repairing hernias. There are surgeons and institutions who do non-mesh hernia repair but there is a lot of pressure on individual surgeons to use mesh. Expert pure tissue hernia repair surgeons can achieve low recurrence rates that rival mesh repairs without the same high risk of chronic pain and other mesh related complications. It is my opinion that if a surgeon cannot do a good non-mesh hernia repair then they should not be doing hernia repair. Resorting to a crutch like mesh to keep their recurrence rates down is not really doing the patient a favor considering the complications of mesh. It is my prediction that in ten years using mesh for routine hernia repairs will be a thing of the past.
This investment in mesh has lead to resistance to acknowledging mesh problems and treatment of these problems:
Patients who come to us with mesh pain typically have suffered all of the above. Some have been made to believe that it is all in their heads and that nothing can be done.
If you have pain where your mesh was placed lasting for more than 3 months and not getting better we can assure you that:
Our experience with hernia mesh removal for pain has been that roughly 80% of patients are cured or significantly improved. April 2015 Dr. Petersen presented his hernia mesh removal for pain results to the 1st World Conference on Abdominal Wall Hernia Surgery in Milan, Italy. The presentation was well received and Dr. Petersen had an opportunity to discuss his results and exchange ideas with several internationally prominent hernia surgeons.
The average pain score of our patients before mesh removal is 8.4/10. After mesh removal it is 2.6/10.
Patients are confused by their doctor's resistance to acknowledging their pain and the fact that it is coming from their mesh. Patients have an innate awareness that their pain is coming from their mesh and thus are disappointed by their doctors. Patients need to know why no one understands their problem and why no one will help them by removing the mesh. I have tried to explain this to hundreds of patients but my explanation is a harsh criticism of a profession that is generally held in high esteem.
There are only a few surgeons in the world who will remove hernia mesh for pain. We know of fewer than a dozen and most of them are outside of the United States. Most any surgeon will remove mesh for infection.
The problem is that medicine has become bureaucratized and standardized. Doctors are no longer managing their own profession. Doctors are told how to practice medicine by the government, insurance companies and hospitals. Device manufactures and pharmaceutical companies are spending billions of dollars on advertising successfully defining standards of care and controlling patient expectations.
I remove hernia mesh because it relieves pain in properly selected patients. If it did not I would not be doing it. I do not have industry support for obvious reasons. But I have the support of many grateful patients and that is all that I need to keep doing this kind of work.
A recent publication in a very well respected surgery medical journal says "The value of open inguinal herniorrhaphy without mesh is being lost. Mesh herniorrhaphy is being inappropriately used as the standard of care. The complication of inguinodynia is occurring at inappropriately high rates. Ilioinguinal neurectomy is not a simple solution."Am J Surg. 2012 Apr;203(4):550. Epub 2008 Sep 11. Inguinodynia and ilioinguinal neurectomy. Danto LA
"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News
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