Mesh-Free Hernia Repair
By Fred Amir
About 30% of men and 3% of women develop inguinal (groin) hernias in their lifetime. Some 750,000 inguinal hernia operations are performed in the United States each year.
What you are about to read will provide you crucial information about inguinal hernias and how you can protect yourself from months of chronic pain, recurrent infections, fistula, and other complications associated with the most common treatment administered. You will discover:
Crucial medical research your doctor may not know or might not tell you
The most common type of surgery you may want to avoid
What a mesh is, and why you don’t want one placed in your body
A proven, innovative, mesh-free, tension-free procedure
How to prevent an inguinal hernia from developing
The above is presented in the same format as in my book, Rapid Recovery from Back and Neck Pain: A Nine-Step Recovery Plan. As such, the information is intertwined with a brief account of my personal experiences with an inguinal hernia, the medical system, and my search for an effective treatment. In order to keep it as brief as possible, I have placed the relevant research information in the reference section.
How It Happened
Sometime after April 15, 2010, I noticed pain on the right side of my abdomen when stretching. (I am not blaming taxes for my pain!) I thought it was probably a pulled muscle and continued to do my morning stretches and exercises but avoided exercises that caused pain.
For the next few nights, I woke up to the same pain but did not think much of it. I also noticed that when I coughed or sneezed I really felt it in my entire abdomen. However, as I continued with my exercises and walking on the treadmill, the pain subsided—so much so that, two weeks later when my wife and I bought heavy pots of trees, I squatted and lifted them several times without hesitation.
The following day, I was fine. However, when we returned from the farmers’ market, where I had carried heavy bags filled with fresh produce for several blocks, I began to feel a lot of pain and noticed a bulge the size of a small egg in my groin.
I saw my primary care physician the next day. He diagnosed me with a right inguinal hernia. This was the first time I had heard the term inguinal, which was to become a very familiar word to me. According to the Mayo Clinic’s website, “Inguinal [groin] hernias occur when soft tissue — usually part of the intestine — protrudes through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful — especially when you cough, bend over or lift a heavy object.” Here’s an illustration of an inguinal hernia from Mayo Clinic’s Website.
“Fred Amir…did not want to have mesh inserted inside his body for repair of his groin hernia because it is a foreign substance. In this well-written and well-researched book, he recounts the challenges he faced finding a mesh-free repair. Fred explains the complications associated with the use of mesh and how published research clearly shows that a mesh repair is not superior to a mesh-free repair. His detailed account of his surgery and recovery gives you an excellent road map to help you get your hernia repaired without mesh and to have a speedy recovery.”
–Prof. Dr. Mohan Desarda, Chief of Hernia Center, Poona Hospital & Research Center, Inventor of the Desarda Repair
"Protect yourself from mesh complications. Read this book!”
–Jane Akre, Editor, Mesh Medical-Device News Desk
"This is a MUST READ book before you have Hernia surgery!"
–Daisy S., Hall of Fame, Top 50 Amazon Reviewer
My doctor told me that I should have surgery as soon as possible; otherwise, the bulge would grow to the size of a fist. He referred me to a surgeon whom he called a professor, who had taught at medical schools and had recently started his practice. “He will fix you up, and you will be back to normal in a couple of days,” the doctor said.
What Should Have Happened
According to at least one medical textbook on the diagnosis and treatment of inguinal hernias, my doctor should have tried to push the bulge in. In some cases, this is all that is needed, along with wearing a hernia support belt (also known as a truss) and avoiding lifting or carrying anything heavy for a month. That might have been all I needed. In fact, later I met someone whose doctor did exactly that, and he recovered completely without surgery.
My doctor could have told me about the study published in the Journal of the American Medical Association in 2006 that concluded, “Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.”
There was also no need to make me feel that surgery was urgent. A study published in the American Journal of Surgery in 2008 concluded, “Delaying hernia repair in patients who are minimally symptomatic does not have an adverse effect on the subsequent operation and on other outcomes.” One of my relatives waited eight years before he had his operation and had a good outcome.
It’s in the Genes
While waiting to see the surgeon, I asked relatives and friends who had hernias in the past. They all had laparoscopic surgery done with mesh and were satisfied with the results. I discovered that my paternal grandfather also had developed an inguinal hernia and wore a truss for many years until he finally relented and agreed to have surgery. My older and younger brothers had also developed inguinal hernias.
The First Surgeon
Frankly, this whole matter came at a very busy time. I only had time to do a brief search on the Internet on “hernia surgery” (better known as “hernia repair”). I discovered that in England, where hernia repair is an elective surgery with a fairly long wait time, patients wear a truss for many weeks until their surgery date. On mesh, I discovered that some patients continue to have pain and/or feel the presence of the mesh for a few months.
I checked the surgeon’s bio online. He was young and appeared to be very talented and qualified. Since he had taught at two prestigious medical schools, I expected to have a very lively and intellectual discussion with him.
When I went for my appointment, the surgeon examined me carefully and told me about laparoscopic surgery and how the mesh works. He gave me a plastic mesh to hold, and, while I was holding it, he brought out a denser and heavier one to hold with my other hand so that I could feel how the new, improved one was so much lighter and less dense. “Is he a mesh salesman?!” I wondered to myself. “Why does he keep old, useless mesh in his office?” When I asked him what his thoughts were about wearing a truss, he said, “C’mon, you are not 99 years old. Why would you want to wear a truss?” I was frankly taken aback with this manipulative, salesman-like approach. I guess he had just started his practice and was eager to sell me on the most profitable treatment option.
I left the surgeon’s office feeling very uncomfortable about him. I realized I needed to do more in-depth research to find the best option for treating my inguinal hernia, and definitely to find a different surgeon!
What Should Have Happened
The surgeon should have explained to me that, for a small hernia like mine, an open repair under local anesthesia—where an incision is made in the abdomen and the hernia is repaired—would have been the safest and best treatment. Laparoscopic surgery is riskier since it is done under general anesthesia, and the sharp probes used in the procedure may damage internal organs and cause other, more serious complications. One of the largest studies comparing the two types of repair, published in 2004 in the New England Journal of Medicine, concluded, “The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.”