Hernia mesh removal is major surgery. All major surgery has a long list of potential risks, but being able to rationally assess the risk benefit ratio requires knowledge of the real world odds. Many of our most valuable procedures today were once considered impossible. Open heart surgery for example, was considered impossible. It is now routine and has a risk of death of about 2% but for many patients has huge benefit which which rationally out weighs the risks.
Many patients have told Dr. Petersen that they are being told by other surgeons that safe removal of hernia mesh is not possible and that the return of their hernia is a certainty. In his experience with over 500 hernia mesh removal surgeries this is very safe. The following is his experience.
He has had no deaths in my 28 years of doing hernia mesh removal. For his first case in 1995heI had to tell the patient he had never done this before and and had never seen it reported in the medical literature. This patient was experiencing disabling hernia mesh pain. The first time this problem was acknowledged in the medical literature was not until 1998 but hernia mesh mesh had been in widespread use since 1992. He told him he thought he could remove it safely because there was nothing he could get himself into that he could not get himself out of in surgery. He removed his mesh with a 90 minute operation and cured his pain. After being 100% disabled he was able to return to work and support his young family.
Early in his hernia mesh explant career he was removing bilateral groin mesh in a single sitting. He was seeing deep venous thrombosis(DVT) in patients post op in spite of standard medical and mechanical prophylaxis. He stopped doing bilateral explants and started staging the procedure into 2 operations separated by 6 months. This eliminated the DVT problem.
He has had one femoral vein injury which was quickly, identified, controlled and easily repaired with minimal blood loss. Vein injuries are one of the most feared complications in surgery because blood loss can be massive and difficult to quickly control.
IHe has had one full thickness bladder injury which he recognized immediately and easily repaired with good results. Delayed recognition happens in other operations and is very dangerous.
He has seen one bladder wall hematoma and hematuria likely the result of retraction. It resolved with conservative measures.
He has had no wound hematomas in any surgery since he adopted the use of DDAVP in surgery whenever he sees unusual capillary bleeding. von Willebrand disease, an inherited defect in blood coagulation, is present in about 1% of the population. It is clinically insignificant in many patients but may lead to minor bleeding and wound hematomas in surgery. DDAVP is the antidote.
He has had only 2 minor wound infections. He is very careful with sterile procedures and everybody gets antibiotic prophylaxis. High blood sugar is a significant risk factor for surgical site infection(SSI) so any patient with uncontrolled blood sugar gets sent home until their blood sugar is under control.
His hernia recurrence rate after mesh removal is 6%. He does redo hernia repair without using mesh.
He has had 2 cases of ischemic orchitis resulting in severe testicular pain and loss of a testicle. This was early in his experience but not in his later experience.
He has had no bowel complications. Bowel adhesions with mesh are common but very careful dissection can avoid any surgical bowel complications.
That's it.
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