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Dr. Robert Bendavid: Women May Not Always be Candidates for Surgical Mesh for Hernias

Dr. Robert Bendavid

Dr. Robert Bendavid

April 9, 2013 ~ Dr. Robert Bendavid  is a well-known hernia surgeon who in this editorial for the Africa Middle East  Hernia Society discusses surgical mesh.

Past president and a founding father of the American Hernia SocietyDr. Bendavid has performed thousands of procedures and is presently associated with the Shouldice Hospital in Toronto where the natural tissue, mesh-free, tension-free procedure was developed by Dr. Edward Earle Shouldice.

The same polypropylene mesh used in men and women for hernias is also used in women to treat pelvic organ prolapse and incontinence.  Dr. Bendavid tells MDND he was one of the early collaborators with C.R. Bard on the use of polypropylene mesh for the “Umbrella” and “Fletching”, the first devices ever designed for treating difficult femoral and inguinofemoral hernias. Such devices, as the hundreds of subsequent ones, were never meant to be used on every patient.

Today he believes surgical mesh should only rarely be needed to be used on women for inguinal hernia repair, though it may be needed for femoral hernias.  He is about to publish his latest work on the connection between polypropylene and pain that would apply to all aspects of its use.  That information will be released  later this year. 

Here is his editorial from the April newsletter:

Afro Africa Middle East Hernia Society

 

27 Comments

  1. Kathy says:

    Great article ! Dr. Bendavid, Do you have an opinion on mesh used for SI ?

    • Dr R.Bendavid says:

      Sorry! I do not see patients with stress incontinence. It is not a procedure which is carried out at the Shouldice Hospital.

  2. Nonie Wideman says:

    I eagerly awaiting his latest work! I am so glad that he is familiar with and advocating against the use of PP mesh……..he needs to be interviewed by CTV national news……..to shake up the medical apathy towards women and men with adverse reactions to PP mesh……..I would so love to talk to him ! validation of my objection to the indiscriminate use of PP mesh….hooray for Dr. Bendavid !!!!!

    • Dr R.Bendavid says:

      Thank you! As we began to use various meshes at the Shouldice Hospital in the early 80s, we quickly realized the potential for complications, especially when mesh was left in the preperitoneal space. Mesh was reserved for unusually difficult cases where pure tissues were evidently inadequate (2-3% of cases). In the last 30 years, despite the ubiquitous use of mesh in most institutions, recurrences have not lessened on average. However, chronic pain has become the new major complication. Within 3-4 months we shall be publishing some interesting new work which touches upon some of the complications of polypropylene. RB.

  3. Stephanie says:

    I am a fit and active 50 year old woman who regularly rock climbs and a little over a year ago I tore my hamstring and concurrently created a femoral hernia on my right side, while making a particularly strenuous climbing move. (Lesson learned; I won’t be doing that again :).

    The hernia has been confirmed as almost certainly a femoral hernia both through palpation and from an MRI. It is fully reducible and I make a point of gently reducing it every evening. It causes me no pain and only occasionally do I feel some pressure in the femoral canal from the hernia. It presents as a bulge about one inch in diameter and when reduced the hole in the femoral canal feels about the size of the tip if my finger. Though it is not an urgent situation, the hernia does seem to be progressing toward getting somewhat larger and more insistent.

    I have done a lot of research on this and I don’t want to have permanent synthetic mesh implanted. I have looked into biologic mesh and also just found the Novis Tigr product as another alternative. The issue is that with a femoral hernia the standard of care is a plug and the absorbable mesh products will not perform as intended with this application because they perform best when fully in contact with tissues. I also understand that primary repair of femoral hernias is discouraged because of the lack of flexible tissues in the area that can be sewn closed without creating a great deal of tension that will likely lead to tearing and a reoccurrence.

    I would like to know if anyone has found a creative solution for the natural, not overly invasive repair of a femoral hernia?

    I thought that perhaps a solution could be to create something resembling a mesh plug with two layers of, either biologic or absorbable synthetic mesh, attached near the center and then the back layer is pushed through the hernia hole, with the second piece of mesh extending out of the hole as a handle. Then the small amount of tissue that can be found between the ligaments that border the opening can be sewn to the internal mesh. Closing the hole as much as possible (without creating much tension) and creating that necessary contact with living tissues necessary to facilitate the tissue ingrowth. Or perhaps there is other tissue in the area that could be directed to the area before sewing the second piece of mesh over the outside…or something like that.

    I would also be interested in a repair using exclusively my own tissues. I also think that the low approach that does not cut into the abdomen (like they do to repair an inguinal hernia) makes the most sense for me since my hernia is not strangulated.

    I have been very frustrated by the lack of information, research and solutions for femoral hernias because of the relative infrequency of their occurrence.

    I live in northern California but am willing to travel to find the best surgeon and method of surgery for my situation.

    Do you have any help in the way of a referral or information for me?

    • R.Bendavid says:

      I have been in touch with Stephanie and provided her, hopefully, with useful information on which she should be able to make a suitable and informed decision. Good luck. RB.

  4. Martin Brill says:

    I am searching for the right doctor to ooerate on an indirect inguinal hernia. I located a surgeon who performed a study on Biomimetric mesh and had very good results. He is now using this mesh in his patients. I was a little suspicious but after reading your essay I don’t think I am going make 350-mile trip to see him!

  5. Richard M Howden says:

    Dr. Ben David, Bruce speaks very highly of you and what you are accomplishing with your clinic and Shouldice repair.

    I wish there was a way to remove the Kugel Small Oval w/Ring I have now. But, every surgeon I have talked to say’s that I already have too much damage to my right inguinal area with the loss of my right testicle, Nerve damage, scarring etc. So, I will be like I am for the rest of my life, dealing with the pain and disfigurement. Bruce is pretty much in the same boat as I. There is not much that can be done for us after all the surgeries and mesh placement.

    Thank you for all you are trying to do for those mesh victims that can be helped by you expertise. We need more Doctor’s like you. Best Wishes and God Bless……….

  6. Dr.Leonardo Arias says:

    Dear profesor,

    i know you a few years ago in a hernia congres in havana

    I work with profesor Eduardo Molina , And i am here in misisagua visiting a friend

    Iam returnig to Cuba on july 25 And i wish to visit your clinic to learn more about your

    tecnique that is well known in Cuba but

    Not carried out as you Do.

    I am very sorry to bother you

    Thank you

  7. angie says:

    I had a mesh put in for a herna repair it’s been giving alot of problem inguninal laparoscoptic tension repair the company name EthIcon part of johnson and johnson family of company i seen and heard alot of people having a lot of problems with the mesh i had mine put in 2011 and ever since it’s gave me problems

  8. Jenny Bills says:

    Dr. Bendavid, where do you currently practice? I live in Atlanta, who would you recommend for hernia mesh removal?

    Thank you,

    JB

    • Jane Akre says:

      Dr. Bendavid is at Shouldice in Toronto and is an excellent surgeon. Bruce Rosenberg would know more 954-701-5094. He is hernia mesh injured and has a nonprofit helping hernia mesh folks.

  9. Rachel says:

    Dr. Bendavid,

    Does the mesh pain also apply for women who have had umbilical hernia repairs? I have a friend who is suffering terribly…

    Thank you!

    • Jane Akre says:

      Rachel- Dr. Bendavid says:

      11:37 AM (20 minutes ago)

      to me
      Dear Jane

      Pain is always relevant wherever there is a nerve! It would be difficult to have an area of the body without nerves! Following surgery, even when nerves have been divided, new ones will grow. Some will reconnect with existing trunks, others will continue growing on their own. It is a teleological phenomenon. Nerves, even before other tissues because they are a protective mechanism against injury! In the paper which will soon be coming out, we have correlated the degree of pain with the number of nerves ingrown in the mesh. I hope your question is answered. Kind regards. Robert.

  10. Sandra Aadland says:

    Dr. Bendavid,

    I have incisional mesh from an infection after sigmoid resection. I also have mesh used in the resection, which has failed. To date, treatment has been meds and two injections- an SI injection and a sacral promontory injection. Mega drugs, I am off, however, I have not had one doctor know my history; test after test and, finally, through Bruce Rosenberg, am more educated about mesh than any doctor I’ve met. The pain is excruciating and my insides feel “sick” I’m on lists to be checked, however, I am pretty much homebound and am worried that nobody seems concerned about the urgency; but, as I said, the entire history isn’t known. Motility changed after hernia repair and immediately and I knew, after hernia repair, that the site, deep, was bothersome and now, two years and 5 months later I have no idea what to do. I also have bladder sling and an MPATHY mini; I’ve literally been so lost in the cracks with the idea that I need multiple disciplinary help, but this is most difficult to find. I had a trauma surgeon look at a year old CT scan and say mesh is fine. At that time I had no knowledge of the devastation mesh can do, but, being poked, pulled, feeling like pins are poking me and the terrible motility issues after the surgery, frightens me. It is with trepidation that I seek doctors; and, if I find one or two who have good ratings, the wait is extremely long. My life has been zapped from me. The night I had the repair, the epidural for surgery pain was placed near nerves that caused my back and leg to be in such awful nerve pain I moved constantly; could I have disturbed the mesh? Can hernia mesh cause pain in the sacrum area or would that be from the mesh tacked to the sacral promontory? It seems inhumane that, because of the system, I am in so much pain; no life, to speak of unless I’m around family, I can “fake it” for a short time. Why wouldn’t the awful side effects of my intestines be of concern to anyone in the medical profession? It is obvious few know how to check if it’s mesh or not. Has a test been developed for this. I can go anywhere to get help, but I won’t allow just anyone to practice on me again….sigmoid resection was not a good choice = biggest mistake I’ve ever made. I’ve written to so many people; but, I just get worse. Pulled rectal and bladder mesh. This sounds like a bad novel – it’s a life of hell. Appreciate the research you are doing and wonder if I”m in danger regarding my intestines and whatever else the mesh could be damaging. Thank you.

  11. Jenny Bills says:

    Sandra, your story mirrors mine in so many ways, please contact me through email at jennyisingeorgia@gmail.com.

    I would love to be in touch with you.

    Blessings,

    Jenny

  12. Marina says:

    Dr. Bendavid, is mesh removal done at Shouldice in Toronto? My family doctor is to find a surgeon in Toronto who does remove mesh. In my case, Marlex Mesh implanted for obturator hernia in 1990. Caused sciatic injury, for which I still suffer. Now mesh has migrated: pain in pubic bone, groin, inner thigh, upper thigh, side up to iliac crest. Thought it couldn’t get worse than sciatic neuropathy and paresthesia — now this.

  13. I am feeling as though the throes of death are gripping me very tightly.. I’ve had the Inguinal (x1), Incisional(x3), Hiatàl (x3), and other hernia repairs-and “catching HELL” would be welcomed, considering the misery that I’m going through.. ALL DAY, EVERY DAY!!!… LORD, I’m SO very tired.. Crying and lamenting isn’t getting it, and to say I rue the days of giving definitive answers to surgical questions is an understatement.. My body has withstood upwards of thirty procedures-all necessary-but the six for hernias are without doubt, the most devastating.. My will is almost gone, as it’s just following my body’s train wrecked path of thought.. I’m not descriptive as far as this pain is concerned-there are NO WORDS to actually relate such agony-therefore I’m just writing something before my mind takes a long walk off a short Pier.. You all take care and stay safe..

  14. Michelle says:

    Hello Dr. Bendavid, I am a 36 year old woman and was told yesterday in the ER that I have a small inguinial hernia. I was referred to a surgeon bc 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 nongold jewelery. 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.

    • Jane Akre says:

      I sent your question to Dr. B in case he didn’t see it here….. hope that’s okay.

    • Jane Akre says:

      Robert Bendavid
      6:37 AM (2 hours ago)

      Dear Michelle

      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 . If you decide on New York, you may contact Dr Samer Sbayi at . He did train with us and can be recommended. Good luck. R. Bendavid MD, FACS.

  15. Renae P says:

    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.

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