I know that there has been a great deal of discussion among surgeons as to how to best treat inguinal hernias (with mesh, without mesh, type of mesh, open, laproscopic, etc.). As I have had one hernia repaired with mesh and one hernia repaired without mesh, I thought it would be useful to provide to you a detailed description of my experiences.
What follows below is written for somebody who is not familiar with my medical history. As such, some of what is written will not be new to you. But, some of it will be new.
My experience with mesh
I had surgery on August 20, 2019 to repair a small inguinal hernia on my right side. The procedure was performed laparoscopically under general anesthesia and the hernia was repaired by placing a Progrip self-fixing polyester mesh over the defect. As far as I am aware, the surgery went exactly as planned with no complications. After the operation, however, I experienced a number of problems, detailed below.
First, I could not urinate upon coming out of anesthesia. As such, before I was sent home, my bladder had to be emptied with a catheter. The evening of the operation, I still could not urinate. So, I had to go to the emergency room to have my bladder emptied with another catheter. The next morning, when I woke up, I noticed that I had pain located at my right hip bone. Given that my hernia was nowhere near my hip bone, I was quite surprised by this. The pain at my hip bone did not resolve with time.
About three weeks after surgery, in addition to the above-mentioned pain in my hip, I began to notice a brush-like feeling at my pubic bone and also a very deep ache in the area where the mesh had been placed. The only way to get relief from the ache was to begin a regular regimen of Advil –600mg 3x/day. The pain at my hip bone, the ache in my abdomen and the brush-like feeling at my pubic bone made my life absolutely miserable. The unending pain caused serious depression. Between September and December, I spent nearly every evening crying myself to sleep, and I called the national suicide hotline at least 10 times.
In addition to being severely depressed and having a great deal of pain, I spent a lot of time visiting doctors and getting tests/exams. Here is partial list of the medical appointments I had
- at least five follow-up appointments with my surgeon
- two trips to a sports-medicine doctor to have a hydro-dissection injection
- an MRI to get an image of the mesh
- a visit to a pain clinic (where it was suggested that I begin taking narcotic pain medicine and/or the antidepressant Gabapentin)
- a visit to a 2nd surgeon to discuss the possibility of mesh-removal
- a visit to a chiropractor to try to loosen up scar tissue
- a visit to a acupuncturist
- multiple phone calls and e-mails with doctors out of the state and out of country to discuss mesh removal
Additionally, I spent countless hours on internet forums talking with other patients who were also dealing with serious mesh-related complications.
After six months of suffering with very little improvement, I finally chose to have the mesh removed. The mesh was removed (again, as a laparoscopic procedure under general anesthesia) on February 18, 2020. As with the first operation, I could not urinate upon waking up. So, before I was sent home, my bladder was emptied with a catheter. In the days following the procedure, I developed a urinary tract infection. Clearing this infection up required two trips to the doctor and two rounds of antibiotics. Keep in mind, going to the doctor is not at all easy when one if just a few days removed from a major operation. I also experienced nausea for a few days after the operation and have additionally experienced some short-term memory loss. Specifically, it has happened numerous times that I think “I should do the following thing” only to immediately forget what that thing is. I do not know if this is a permanent or short-term effect of the anesthesia.
Despite the post-operative complications, removing the mesh was a fantastic decision. Of course I had pain immediately after surgery. But, the brush-like feeling at my pubic bone was gone immediate after the operation. And the deep ache also disappeared within a week or so. I am now a few months removed from the operation. I still do not feel “normal” and I still have some pain at my hip bone. But, I can say that I am much better than before I had the mesh removed. And, I am hopeful that, in a few more months, I might feel normal again. Overall, my experience with mesh was a six-month-long nightmare. I came very close to committing suicide during this time. And I suspect I will suffer some level of PTSD for some time.
My experience without mesh
A month or so after my first operation, I began to feel pain on my left side. I suspected that I had another hernia and a physical exam by my surgeon, as well as imaging from an MRI, confirmed this. As the pain from the mesh was far worse than the pain from the hernia, I decided to not do anything with the hernia on my left until after I had removed the mesh on my right side. Once I felt sufficiently recovered from the mesh-removal operation to have another operation, I schedule a non-mesh hernia repair with an out-of-state surgeon.
On March 25, 2020 I had the operation to repair the hernia on my left side. This was an open repair performed with local anesthesia. I had no nausea or difficulty urinating after the operation. And, in fact, I felt well enough to fly home the same day as the operation. I was in quite a bit of pain the days immediately following the operation. But, I would much rather deal with two to three days of pain than have to deal with the numerous complications that I experienced from my two previous surgeries (nausea, inability to urinate, etc.). I am now three weeks removed from my operation and I already feel pretty close to normal. I can sprint up stairs, do push-ups, pull-ups and dips without any pain on my left side.
Most importantly, I am not experiencing the deep ache or brush-like feeling that I experienced when I had a mesh inside of me. Overall, my experience having a hernia repaired without mesh has been pleasantly uneventful.
Recommendations
For people like me (healthy, normal-weight, active males), who have small uncomplicated hernias, there is no reason to perform a mesh-based hernia repair. The risk of recurrence (both with and without mesh) is low and the risk of chronic pain (with mesh) is high. Chronic pain is a serious condition which doctors and patients should seek to avoid as much as possible. A recurrent hernia is simply an unpleasant event, which can still be dealt with, should the need arise.
If I were a surgeon, knowing what I know now, I believe it would be immoral of me to perform a mesh-based repair on a patient as a first resort. Even if a mesh-based repair is performed perfectly (as I believe was the case with my operation), the patient may still have chronic pain. The conservative and responsible approach should be to perform a non-mesh repair first and deal with any complications that may arise in the future.