Dr. Robert Bendavid, Shouldice Hospital, Toronto

Mesh Medical Device News Desk, September 2017 ~  Dr. Robert Bendavid is a leading hernia surgeon with Shouldice Clinic in Toronto, Canada. He also believes in non-mesh repairs for hernia whenever possible and Shouldice does not use mesh in its hernia repairs.  

Shouldice Clinic in Thornhill, Ontario, is the only licensed hospital in the world dedicated to tension-free and natural tissue technique for hernia repair. 

Please ask your question and we will attempt to have them answered here. This should not be construed as medical device and please always consult with a hernia mesh expert.

 

Hi Dr.  Bendavid, 
I developed abdominal pain spreading thru my low back, groin, inner thigh, and genitals. It grew worse and great intensity hours before a bowel movement, after trying to open or close a door, sex, menstrual cycle, basically anything increasing abdominal pressure.
Due to genital and labia pain, a Dr, said I had pudendal neuralgia bilateral. Interestingly, I discovered by accident weeks ago that putting ice all over my mid to lower abs, reduced all my low back pain and groin pain and most genital pain! I did have lumbar fascia hernia 3 yrs ago where during child labor, fascia tore and my inner fat came thru in lumps size of quarters. I am almost positive that if my lumbar abdominal wall herniated, I may have a couple tears and inguinal or femoral and supra pubic hernia. It’s gotten to where I am disabled, can only wear loose dresses, cannot lift even a gallon of milk, and have ice on my abs hours a day to survive it.

I need the BEST abdominal wall hernia specialist as my scopes all came clean. And no major lumps are felt just a ton of tender Ness left of belly button 3 inche’s on left side and 3 inches over on right w 2 inches down.

Who can help diagnose and treat me near Arizona?? Is Dr. Shirin Towefigh in Beverly Hills someone you recomend?
You seem to know soooo much! Im otherwise young healthy, 31 with a 4 yr old. And 120 lbs 5 ft. It’s crazy how intense the pain is.

Anything you can share will be gold. I appreciate it!

 

Hello Jane (reply for patient),
Needless to say that nothing makes any sense and that I do not see the need of a hernia specialist here. This patient needs a good GP and a referral to a good general surgeon who could carry out some basic tests to rule out any common pathology! I don’t know what a “Lumbar fascia hernia” is.  

A bilateral “pudendal neuralgia” from what? A childbirth 4 years ago? 

Since various scopes have been negative, what has been done in a way of ultra sounds, X-Rays, CAT scans, hematology etc. 
I would certainly be most concerned, given the nature and distribution of pain, of ovarian/uterine, retro-peritoneal, spinal cord or spinal canal pathology. I have seen one such which ended up with the diagnosis of a spinal cord tumor!
These are important to rule out. She needs to be investigated thoroughly.
Kind regards. Robert

 

Dear Dr. Bendavid:

 

Hello, I had double and Diep Flap reconstruction in Feb 2017. I’m waiting to have MRI to confirm a hernia. Anytime I bend over, I feel like something is in the way in my lower left abdomen. Very painful. My plastic surgeon has suggested a general surgeon to join him in 2nd phase of reconstruction to repair hernia with mesh. After doing some research I know I don’t want this mesh in my body. Are there any other options to this polypropylene mesh? I read about “tissue-to-tissue” repair, but sounds like it’s only used for certain hernias. And if they can perform this surgery, I’m curious as to what the sutures are made of.
I appreciate any help and direction. Thank you, Michele

Dr. Bendavid replies:

Michelle likely had bilateral mastectomies for breast cancer. In the creation of a TRAM (here called a Diep), muscle is taken from the lower part of the abdomen and swung up to the breast area with its blood supply for the reconstruction of an artificial breast. The donor site invariably develops a hernia because a significant portion of the lower abdominal wall is removed.
 
This is an issue she has to discuss with a general surgeon/plastic surgeon she trusts. I would also recommend she talks to former patients who had the procedure done. I personally feel it is a high price to pay because the defect left behind in the abdominal wall can be large and demand mesh for replacement. Mesh is no longer as benign as we thought it to be originally. 

The patient must also discuss the issue with her partner since that is where the problem may also lie! I hope the patient finds a balance with the choices.

Kind regards,

Robert

 

Dear Dr. Bendavid:

I had open umbilical hernia surgery two weeks ago..A mesh was used…..I am still having pain in the area, especially when laying on it at night..I also have pain in my groin and what appears to be a very painful urinary tract infection. My surgeon said he used the “new’ mesh and that is not whats causing extra pain.

Dr. Bendavid Replies:

Hello Jane,  Re the patient:

Two weeks since surgery … not enough time has elapsed to be totally free from pain. Pain in the groin presently should not have any relationship to the previous surgery. Especially if there is suggestion of an infection?! “New mesh”, just like all polypropylene meshes, may be just as much of a problem. Pain will be considered chronic if it lasts more than 3-6 months.

Some recommendations suggest to wait a year. There is no consensus yet since we know that pain can occur years after insertion of the mesh! You may have to obtain a second opinion re: pain but I suggest a little patience yet. RB.

 

Dr. Bendavid:
My granddaughter, age 16, is scheduled to have an umbilical hernia repair at the end of August 2017. I have been told that they will not be using a mesh (at the family’s request) and the surgeon states she will be coapting the wound with sutures. My questions are: Is that the best procedure for this condition? Is the shouldice procedure indicated for an umbilical hernia and if so, are there any hospitals that can offer this procedure in the New Jersey area? Also, what pertinent questions should I be asking the surgeon regarding the surgical technique? I want to be prepared for this as much as possible to avoid any surgical complications that I heard about on the Ralph Nader Radio Show. Please advise. Thank you.​

 Dr. Bendavid Replies:

 What a luxury to have a grandmother who is so protective of her family! 

The Shouldice repair is an operation which applies to the groin (inguinal hernias). Umbilical hernias can of course also be done with a pure tissue repair (i.e: without the use of mesh). It will depend on the size of the hernia and it would be unusual at 16 to have one that would require mesh. Even if mesh were necessary, it can be done by an open method which must not enter the peritoneal cavity as is often done laparoscopically! No need for such extensive invasion, especially in a primary umbilical hernia. I would consult with a surgeon you trust near you.

If need me, you can contact me and I will provide you with the name of someone in New York who has worked at Shouldice Hospital. Of course there will always be our hospital in Toronto!

Good luck,

R. Bendavid MD.

 

Dr. Bendavid:

How long should I wait for the pain to go away before I inquire about taking out the mesh?​
Dr. Bendavid replies:
Two weeks since surgery … not enough time has elapsed to be totally free from pain. Pain in the groin presently should not have any relationship to the previous surgery. Especially if there is suggestion of an infection?! “New mesh”, just like all polypropylene meshes, may be just as much of a problem. Pain will be considered chronic if it lasts more than 3-6 months. Some recommendations suggest to wait a year.

There is no consensus yet since we know that pain can occur years after insertion of the mesh! You may have to obtain a second opinion re: pain but I suggest a little patience yet. RB.

Hello Mesh News Desk, Thank you for any information.

I had a left unguinal hernia surgery w. mesh 6 months ago. about 3 months after i did incur a sharp “ripping” pain when i did a heavy awkward lift. surgeon days he doesn’t feel any re-herniation. i have pain only sometimes, hard/heavy work related usually. the area of the hernia feels very different than prior to incident, prior to incident, i felt ‘great’. is there any actual test (ct, x-ray, ?? than can actual know for sure, or even if probable damaged ?? or, did i just “temporarily strain myself” ?? thanks… bill


Dr. Bendavid Replies: 

It always helps to  know what was exactly done in a way of mesh repair and whether the previous surgery was done through an open procedure or laparoscopically. Certainly, following mesh or mesh free repairs, after three months, there should be no limitation of activity. The onset of pain can and does occur on occasions, perhaps associated with heavy activity and may also take place whether mesh was used or not. Nothing is more accurate than a physical examination to confirm absence/presence of a recurrence. An ultra-sound may reveal a recurrence but they can be fraught with false positive/negative results.

It would be wise to simply treat conservatively with heat, massage, anti-inflammatory medication for two-three weeks and avoid the activities which you know give pain. Often, the pain is due to adductor pain or lower rectus insertion strain. More and more, pain is being reported following mesh repairs and may contribute to a “chronic post-herniorrahphy pain syndrome”.

Proper assessment should be made by a hernia specialist. RB.


Hello Dr. Bendavid,

Do you remove mesh from women? I have had a total of 3 inguinal hernia repairs, two on my left side (one laparoscopic and one open). I’m in chronic pain and the Dr’s really don’t care, and the ones that do can’t help you. I also had purple plastic found during my second left surgery. The Dr claimed that material could not have been from her. I had Dr Shirin Towfigh review my records (I live in Seattle) and she said that material has to be from the secure straps (or tacs?) used in my first left sided inguinal hernia repair. I believe that and the mesh are causing wierd problems. About a month after each surgery I had weird things happen. For example, I stared having panniculites in my inner thighs. I want to have the mesh removed, but I’m scared to make things even worse. Most Dr’s say mesh causes no problems.


Hi Jane (for your patient):

Mesh definitely causes problems. Not in everyone, granted, but when it does it can be quite the challenge. Since you live in Seattle, if you do not know anyone near you who has removed meshes (make sure they do not insert a new one after removing the old one… which often happens and doctors may convince you that the new meshes are lighter and cause no problem. They will if you have had issues with polypropylene) you could consult Dr Kevin Petersen in Las Vegas who removes quite a few and in fact has supplied me with many explants to study. 

It is difficult in Canada to do surgery on US patients as the system (State medicine) will not protect surgeons against any suits brought on by US patients. Also, in some states, patients can sue Canadian surgeons and hospitals from their hometowns! It is a conundrum. Your US insurers generally will not cover you for surgery outside the US unless that type of surgery is not done in the US! It would also have to be approved beforehand.

Good luck, R. Bendavid MD.

 

Dr. Bendavid,

I am a 36 year old woman and was told yesterday in the ER that I have a small inguinal hernia. I was referred to a surgeon because the hernia gives me pain when I carry anything over 5 lbs. I was wondering which type of repair you think someone in my situation should receive?

I am worried because I have a three-year-old who needs her mother and also I very delicate skin. I react with rashes to many creams, wools, and some non gold jewelry. I was told this type of hernia is rare in women, mostly men set it. So, I would like to find an experienced surgeon who has repaired these on Women.

Do you recommend anyone in the Chicago area or in Illinois? I would prefer to just get sutured with no mesh, but I am worried it will. It hold. It so close to my uterus that I am really worried because I had always hoped for one more child. of coarse, I am more worried about my long term health and trying to avoid the horror stories related to mesh.

Please help. Thank you and God Bless you.

 

Dear Reader,

It is possible that you have a femoral hernia and that is present in 16% of women. The majority of female patients however have an indirect inguinal hernia (70%) which do not need mesh or a direct hernia as in 14% of women. If a femoral or a direct hernia is/are present, they may require mesh but there are safe ways to do it. Laparoscopic surgery does not represent a safe way to do it as it lays indiscriminately mesh against femoral vessels and bladder. An open technique would directly and accurately cover the defect only.

I do not know anyone in the Chicago area in particular. I do in New York. Many US patients consider that surgery in Toronto, when all is said and done, turns out to be cheaper than in the US. You may contact Ms Nancy Law at at nlaw@shouldice.com.

If you decide on New York, you may contact Dr Samer Sbayi at samersbayi@gmail.com. He did train with us and can be recommended.

Good luck. R. Bendavid MD, FACS.