Dr. Bendavid Answers Hernia Questions

//Dr. Bendavid Answers Hernia Questions

Dr. Bendavid Answers Hernia Questions

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.

 

 

By | 2017-09-10T22:09:18+00:00 September 5th, 2017|Your Turn|32 Comments

About the Author:

I’m National News Editor, Jane Akre and I began Mesh Medical Device News Desk aka Mesh News Desk (MND) in the summer of 2011 just after the Food and Drug Administration issued an explicit warning to the public that complications associated with surgical mesh used for prolapse repair (POP) and incontinence (SUI) are NOT rare! That was the starting point for the litigation you see today and thousands of lawsuits have been filed by women whose lives have been altered, some permanently, by the use of this petroleum-based product.

32 Comments

  1. Denise S May 3, 2017 at 7:01 am - Reply

    I would like a true answer to a question I have asked many drs…. should physiomesh hernia mesh have been used over a aortobifemoral bypass?? on a patient that never had a hernia, didn’t feel or look like I had hernia, over a 8yr old incisional hernia + uncharted umbilical hernia added to make 15×20″ ? Would just like an answer, should it have been done?

  2. Sue t May 3, 2017 at 7:14 am - Reply

    I have had two umbilical hernia repairs. The first one via midline laparotomy with Atrium pro lite then when that failed a larger composite piece of parietex polyester mesh. I have severe right sided pain. I had a nerve block yesterday and the ultrasound showed tight scar tissue. The Dr has now said it’s either nerve of mesh pain. I want the mesh out as I also have translational mesh and I know the harm this is doing to my body. I had no pain pre
    hernia mesh inserted. WHat are the complications to remove apart from the usual surgical possible complications and what can it be fixed with after removal apart from porcine or any other mesh types. thankyou

  3. Jane Akre May 3, 2017 at 8:36 pm - Reply

    Dear Reader,

    Too many details are lacking to analyze what was done or why. What was the surgery for, exactly, when the Physiomesh was used? Was it a ventral, incisional hernia or even perhaps groin hernias? When was the surgery done since Physiomesh® has been recalled since last year?
    R. Bendavid

  4. Martin May 24, 2017 at 12:55 am - Reply

    I had an inguinal hernia repair in 1999 whilst in my third and final year of a degree. I was given the option of a keyhole surgery with mesh. I opted for this over an open surgery due to the reduced recovery time. I lived an uneventful life until 6 years ago when my body started to do strange things. I began to suffer terribly with abdominal pain and my bowels were all over the place. There are days when I cant even put my own underwear on. I also feel as though I’ve been poisoned. All of my glands are up and I get major kidney pain. My mesh ID is missing from my records, as is the surgical report. I want my mesh out! it’s 15 x 12cm of degrading plastic that is reported to hold bacteria… How is it possible to verify whether it is the mesh thats doing this?

  5. Denise H June 10, 2017 at 9:48 am - Reply

    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.
    How long should i wait for the pain to go away before I inquire about taking out the mesh?

    • Jane Akre June 10, 2017 at 10:52 am - Reply

      Dr. Bendavid says:

      Hello Jane

      Re your 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.

  6. george lewis June 12, 2017 at 12:24 pm - Reply

    I need an attorney to represent me on hernia mesh and medical treatment. I had a hernia surgery in 1979 at ft riley Kansas, later I had pain upon running in the army and when I had sex with my wife. I was told by a major to “get out of his office” when I complained of pain or he would “put his boot up my but” my doctors didn’t believe me and later in 1982 they found I had a neuroma and a never was cut because I was told that the first operation had stitched through a nerve. My abdomen around the area is now numb and has been since 1982 and I have never had children. My second wife wants children but I haven’t been able to cause pregnancy in any woman. I need to have this mesh removed and the proper procedure done so that maybe I can have kids. Thanks, George Lewis

    • george lewis June 12, 2017 at 12:25 pm - Reply

      a nerve was cut sorry typo

    • Jane Akre June 12, 2017 at 12:30 pm - Reply

      George- a lot of time has passed since your hernia surgery. You might check with Dr. Kevin Petersen in Las Vegas who deals with complications. No Insurance Surgery

      http://www.noinsurancesurgery.com/about-us.htm

  7. Desiree June 15, 2017 at 10:43 am - Reply

    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.

    • Jane Akre June 15, 2017 at 11:18 am - Reply

      Desiree- I am forward your question to Dr. Bendavid.
      At that young age you are truly looking out for her to ask tough questions. I will return with the answer here…. THANK YOU!

  8. JOHN ELIAS June 16, 2017 at 9:07 pm - Reply

    Why are Ethicon hernia devices still used when they are dangerous in the human body

    • Jane Akre June 17, 2017 at 1:42 pm - Reply

      That is the $70 billion dollar question. Doesn’t make sense does it?

  9. L.B June 17, 2017 at 7:35 am - Reply

    I had a pelvic mesh implant 9 or so years ago lived with for several years with Doctor after Doctor telling me my implant was fine recommended by my own insurance company’s. After the fifth or sixth telling me it was all in my
    head I got on the Internet and found Dr. Kevin Petersen in Las Vegas,
    Nevada. I truly believe he saved my life I was physically and mentally broken.
    I was lucky enough to have the funds to remove the mesh, I still have some problems from the mesh being implanted but I can function again. He is truly concerned about his patients!
    http://www.noinsurancesurgery.com.
    702-256-7403 Don’t give up! L.B.

    • Jane Akre June 17, 2017 at 1:41 pm - Reply

      LB Im not aware Kevin Petersen removes pelvic mesh, good to know.

      • L.B. June 17, 2017 at 4:22 pm - Reply

        I had an inguinal hernia, prolene hernia mesh was put in it took 17 minutes to implant. The surgery dr. Petersen did to remove took 4 and one half hours.
        He is really a nice man not doing it for the money he really likes helping people. I’ve read this website for a year or two really appreciate what you do too. Thank you! L.B.

  10. Susan June 19, 2017 at 2:30 am - Reply

    My husband has a groin hernia and has been researching whether to have mess or non-mess. He would like more information on non-mess surgery. We live in the US-Midwest area of the country and retired. Do you know of any doctors that he could go to for a consultation?

  11. Lorie June 26, 2017 at 9:49 am - Reply

    The surgeon wants to take out my old mesh I have meshoma. and put in Strattice. What should I do?

    • Jane Akre June 26, 2017 at 1:58 pm - Reply

      Are you reacting to a mesh implant? Is your surgeon skilled enough to do a non mesh repair? I’m assuming you have hernia mesh? That is not always easy to remove. How long has it be implanted? I’d go non mesh if I was a candidate and put it in writing so there is no question if you are under.

      • Lorie June 26, 2017 at 11:06 pm - Reply

        The mesh I have now is all balled up with fluid around it.Manufactured by Tyco, Surgipro #SPM35W Lot #A2T0942X. Implanted 11/2013. they approved my surgery today. They approved “Strattice” Biological matrix, supposed to dissolve within two years. My surgeons is Dr.Winnie Henderson Northwest Surgical Spec. Eugene Or. My surgery to remove is scheduled for Sept 11th. Do you know of any good surgeons in Oregon.

        • Jane Akre June 27, 2017 at 8:48 am - Reply

          I do not but try calling bruce rosenberg 954-701-5094….patient advocate

  12. Matthew Gilliland June 27, 2017 at 7:38 am - Reply

    I am 27 years old. I had an inguinal hernia in 2013 and nerves in my groin have become entangled in the mesh. I have had 2 rhizotomies, and 3 surgical shots, plus physio, accupuncture, etc. My pain management specialist beleives I should have the mesh removed. My quality of life is declining very quickly. Do you remove mesh? We are in PA but origianlly from Canada so I know the quality of care at Shouldice.

    • Jane Akre June 27, 2017 at 8:45 am - Reply

      It’s worth an assessment,,,, might try kevin petersen in las vegas….. no insurance surgery. I can put you in touch with Bruce Rosenberg if you want to supply me with a phone number,,, janeakre@meshnewsdesk.com

  13. Jana Cason July 3, 2017 at 6:44 am - Reply

    The man I live with had mesh placed for double hernia. Has had nothing but pain ever since. Need a recommendation for a doctor to evaluate in Kansas City. His regular docs seem to want to ignore the problem. Would likehim to see someone here who deals with mesh for hernias

    • Jane Akre July 3, 2017 at 8:15 am - Reply

      Welcome to the round robin of treatment. I hope I am wrong, but most doctors are not to the point of recognizing that polypropylene mesh does not do well in some bodies. You will have to go to a specialist. I do not know of one in Kansas City…. you can go to local doctors, spend a lot of money, get denials such as “mesh doesn’t cause problems”. Most will not do anything more. Dr. Kevin Petersen in Las Vegas is the closest to you. Get an expert opinion. Shouldice Clinic in Toronto does non mesh repairs, if he needs more. Likely worth the cost. This is a prime example where medicine has not caught up with the reality of this medical device, in my opinion.

  14. Ann August 21, 2017 at 11:00 pm - Reply

    I have inginual hernia mesh for 20 years what should I do?

  15. Candace August 22, 2017 at 2:21 am - Reply

    Hi!! 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 abdomin all 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!

  16. Leronda June 7, 2018 at 11:21 am - Reply

    Dr. Bendavid, I listened to your talk yesterday and I have several questions regarding mesh products. Is there any difference in the construction of polypropylene mesh (vaginal versus sheets)? Specifically, my husband had an incisional hernia repair and the mesh used was Bard flat sheet mesh 10″ X 14″ mesh. The product number is 0112660. I saw a 60 Minutes documentary on mesh and learned that my husband’s complaints are very similar to the ones in the stories shared. His surgery was in 2016 and he has suffered from pain which continues to increase since that time. In the 60 Minutes special, they talked about Marlex polypropylene mesh (vaginal); however, when I looked up the information, it appeared that Bard made the Marlex mesh. Is this accurate? Does Johnson and Johnson own C. R. Bard? There are so many stories that it is hard to decipher the facts. If there are two different companies making the mesh, can you please let me know the difference between Marlex polypropylene and Bard polypropylene mesh products? Would the Bard mesh be safer and what are the contraindications of using the mesh as a long-term implant?

    I have been asking that worker’s compensation order an ultrasound for my husband because I read that this is the best possibility of viewing hernia mesh issues. He is unable to have an MRI due to medical issues or a CT scan with contrast as he is allergic to iodine. Can you please confirm that this is the best diagnostic tool to find out if the mesh has shrunk, rolled up on edges, degraded, etc.?

    He has had injections to decrease nerve sensitivity and the pain has not decreased. In fact, after the last injection, the pain increased so much that I had to take him to the OR. I am trying very hard to find out what is wrong and the best way to “fix” it.

    Thank you very much for your assistance in answering these questions.

    • Jane Akre June 7, 2018 at 4:26 pm - Reply

      From Dr. Bendavid:

      As to the question from your listener:

      Polypropylene is a polymer and is the same for all devices. Physically, variations are seen in its thickness, its weave, its weight, its colour. Chemically, each manufacturer includes additives such as antioxidants, stabilizers, antiozonants, copper, zinc etc … which will prevent the degradations of the polymer but also to give it the properties required for the intended use … softness, memory, directional elasticity, shape etc… It is impossible to obtain the list of additives from anyone company!

      The lot numbers mean nothing other than the ability to go back and look at a lot (if there is such a lot) and to declare that the mesh in that lot is quite normal and any complications are due to the surgeon … his lack of experience, his lack of familiarity with the product, its recommended use when in fact the mesh was designed because it makes surgery easier and supposedly more reliable in terms of results.

      Yes Bard made the Marlex® mesh which was introduced in hernia surgery in the late 1950s by Francis Usher. It is one of the original designs as there were many of different thicknesses and weaves. The one used by Usher became the standard for some years.

      Ethicon (a subsidiary of Johnson and Johnson) and BARD are two entirely and competing companies.

      Imaging such as X-Rays, CAT and MRI, as well as ultrasound are notoriously poor and controversial at identifying mesh accurately or their complications once in place. They can become secondarily delineated with collections of fluids (seromas, cysts, hematomas). I do not think anyone could state that one mesh is “safer” than the other , whether Bard or J & J or other.

      You describe your husband as having had an “incisional hernia”. The behaviour of these hernias differs from groin hernias mainly due to the degree of tension, the lesser extent of nerve supplies to the area, and basically the anatomy where there is much more muscular bulk which affect the physiology and pathophysiology of the clinical problem.

      Many of your questions need to be addressed by an experienced hernia surgeon who will have all the necessary facts of the case since each case will have its own particular characteristics and criteria.

      I hope that some of your questions have been answered.

      R. Bendavid MD.

  17. Joe Keller July 16, 2018 at 1:12 pm - Reply

    Dear Dr. Bendavid,

    I have been diagnosed with a bilateral inguinal hernia. I met with a few hernia surgeons in the Boston area and they all recommend a mesh repair. I read a transcript of your debate with Dr. Voeller where you raise excellent points about the chronic pain resulting from mesh implants. Boston is known for its excellent hospitals, but I have been unable to find hernia surgeons who perform the Shouldice repair. Do you know of hernia surgeons in New England that you would recommend for a Shouldice hernia repair?

    Thank you very much for any advice you can offer.

    • Jane Akre July 16, 2018 at 1:29 pm - Reply

      I will pose the question to him but honestly, you will probably spend less by going to shouldice in Toronto,,,and have A better outcome than in the states.

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