Surgery to Treat Mesh Complications
Most patients who need surgery are experiencing damage to the nerves, shrinkage of the mesh, and scarring of the spermatic cord. All these components of the disaster have to be treated to provide full relief.
The operative notes and photographs from all previous operations are studied. All imaging tests are reviewed. The operation cannot be rushed. Dr. William Brown routinely plans on an operating time of three hours.
Knowing the type of mesh and the location of the mesh is beneficial information. The first step of the operation is to find the spermatic cord. Gentle tugging down on the testicle will often help to find the spermatic cord as it passes over the pubic bone. Once the cord is identified, it is followed to the internal inguinal ring. The spermatic cord will be scarred to the mesh. Separating the cord from the mesh without causing damage to the testicle’s blood supply is complicated and is best done with magnification. (This part of the operation is why Dr. Brown has gray hair.) If not done carefully, the testicle will die. The inferior epigastric vessels will be adhered to the mesh and are very easy to tear. So, these vessels need to be isolated to prevent significant hemorrhage. To avoid damage to the femoral artery and vein, it is sometimes wiser to leave some mesh behind rather than risk damaging those vessels. Bleeding from a tear of the femoral vein is especially difficult to stop. The nerves can be difficult to find, so Dr. Brown uses magnification and special lighting. The ilioinguinal nerve usually runs along the superior anterior aspect of the spermatic cord. The genital nerve usually runs along the posterior aspect of the spermatic cord. The iliohypogastric nerve runs deep to the external oblique aponeurosis about 2 cm above the internal inguinal ring. The nerves have multiple interconnections, so if only one nerve is cut, the pain sensation will still get back to the brain. Therefore it is better to excise the nerve rather than cut the nerves.
If the major component of the patient’s pain is the testicle, then Dr. Brown also advises the skeletonization of the spermatic cord.
Finally, any hernia that is caused by removing the mesh should be repaired without mesh.
Preparing for a Long Recovery
The healing will take nine months. A 100% reduction of pain is rare. An 80% improvement is a good result.
Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.