Powerlifter Wife Hernia Repair - No Mesh?

[MDR2]

Hi Mark. It's been a long time since I've visited the board. Thank you for all you do.

Background on my wife:
11 years ago... 23yo, 5'6" competitive powerlifter 148lb weight class, 420 deadlift, 335 squat, 205bench, 145 press, lifted pretty heavy. She developed a large umbilical hernia that only got larger over the years and after pregnancy in 2016.

Today:
34yo, hasn't lifted in about 4 years, job has her sitting all day, very detrained. The hernia is a major barrier to getting back into lifting or working out in general, so she wants to get the hernia repaired. She works for a health insurance company helping members get their care, and what she is exposed to has convinced her that meshes are dangerous and she should not get a mesh. Not having the mesh sounds like a bad idea to me considering she likes to lift heavy, especially after reading all the hernia stuff on the forum (however, I was not able to consume all the video content where hernias are mentioned, yet).

Questions:
1. Is there a mesh brand and model that is better or preferred over other brands? I saw Ventralex mentioned on the board in a positive way, but that information is a bit older now.
2. Based on current procedures, is it still your opinion that getting a mesh is the recommended route for heavy lifters?

Thank you again.
-Matt

[Mark Rippetoe]

What is dangerous about the mesh?

[Jason Donaldson]

She works for a health insurance company helping members get their care, and what she is exposed to has convinced her that meshes are dangerous and she should not get a mesh.

What is the full context of what she's been exposed to? Sounds like you're saying she's dealt with health insurance customers having bad outcomes after mesh repairs.
She is in a position that will inherently select for her only seeing the ones who have bad outcomes. No one's calling her up to say everything's fine.

How many of them were healthy and fit? How many obese and sedentary for long periods of time? What lifestyle changes did they make? What comorbidities did they have? I'm sure that her sample is largely, if not overwhelmingly people with extreme degrees of risk factors. This will tend to distort anyone's views, especially if that's the only exposure they have to the procedure.

At its root, it's a matter of risk analysis. Which means it's not just the number of people who've have bad outcomes, but what percentage of those who've had the procedure have had them. That's a fundamentally different thing.

Consider lumbar spine surgery, where it's about an even shot between worse/no change/better outcomes. It's an awful bet to take.

Now compare trimming toenails. Sometimes, people develop an ingrown toenail from that procedure. Every once in a while, one gets infected. In a very small percentage of THOSE cases, people end up dead or worse. And yet, most people cut their toenails (or have them cut). Those who do have complications usually have multiple contributing health and lifestyle factors. The skill of the cutter is also a major factor in a negative outcome occurring in the first place, as is the choice of tools....

Important caveat: I am NOT advising that you just lay out such points to her. It is almost impossible to reason someone out of something they didn't reason their way into. Especially at first. She's still your wife, and you still live with her and love her. You're in a position to know how she ticks, and what will help her in the context of that relationship. Part of that is empathy for her and her concerns. She's the one who'll have to have surgery for this, and that can be daunting. Human beings are emotional creatures, and that requires handling at least as much as bringing logic into play.

The logic behind this should help inform the process of discussing it with her, but is probably not going to work as an opening salvo....

Your asking here is a good move. If her apprehension is coming from exposure to negative outcome anecdotes, this is a great place to acquire positive ones to balance that out.

[Will Morris]

I’d certainly defer to any general surgeons in the population here that has more actual experience in the surgical procedure itself, as my experience has been simply rehabbing upwards of about 100 post operative hernia repairs over the last decade or so. In the vast majority of the cases of active individuals, mesh was used. I can count on one finger the number of people I saw have a bad outcome with the mesh. I have, however, seen several people who had bad outcomes with a non-mesh repair and every single one that had a non-mesh repair desired the non-mesh repair due to horror stories they heard about the mesh. It was a decision on their part to have the surgeon attempt to either sew two hair brushes together or two blocks of hamburger meat or a block of hamburger meat to a hairbrush.

Every single surgeon I worked with categorically used mesh implants for someone who was athletic, high functioning, or even had the capability to be high functioning. The mesh provides a much more secure purchase for the suturing, and especially (in my experience) ProGrip mesh was very, very strong. I believe another one that was used was something like 3D Max, but, most of my surgeons had a preference for ProGrip and it was standard purchase order for the general surgery service.

Look, I’m not a very intelligent dude, but physical activity is very, very important to me. If I had a large hernia that impacted my ability to train and it needed to be repaired, I know enough to know that I want a sturdy mesh repair. I wouldn’t even consider a non-mesh repair. But, that’s just me.

[Maybach]

Yeah I'm actually struggling to find ANYONE making an argument for a non-mesh repair. Most complications from mesh repairs are either a) much more benign than another hernia, which mesh has been shown to drastically reduce the chance of, or b) not actually unique to mesh repairs. If she's seen a bunch of people dealing with complications from mesh repairs, I can see how this might induce a cognitive bias, especially as someone working on the insurance and coverage side, since the downside of a non mesh repair is usually "the suture busts open requiring the surgery be repeated", which would just show up as "a hernia"

[Johnsonville]

I just did a thread the other week about my own complications with my mesh repair for an inguinal repair. Some people prefer the shouldice repair which has no mesh and is supposed to be very strong, but I am unsure if that is only for inguinal repairs. It might be something to look into, otherwise even though I do have pain and tugging in my mesh repair spot, it really isn’t that annoying.

[MDR2]

What is dangerous about the mesh?

This is the problem... I can't get a precise answer beyond the general idea of recalls, infection risk, rejection of the mesh, and "bad things happen". If it happened with a member she was working with, she would tell me specifically. Especially if she is seeing it with tons of members across the board, and can connect the dots between meshes and common negative outcomes. But she hasn't said anything of the sort.

That fact that you had to ask instead of having a standard understanding of what she was referring to is an answer in itself.

No amount of PubMed'ing has been able to inform me of what specific dangers and likely negative outcomes she might be referring to, either.

[MDR2]

What is the full context of what she's been exposed to? Sounds like you're saying she's dealt with health insurance customers having bad outcomes after mesh repairs.
She is in a position that will inherently select for her only seeing the ones who have bad outcomes. No one's calling her up to say everything's fine.

How many of them were healthy and fit? How many obese and sedentary for long periods of time? What lifestyle changes did they make? What comorbidities did they have? I'm sure that her sample is largely, if not overwhelmingly people with extreme degrees of risk factors. This will tend to distort anyone's views, especially if that's the only exposure they have to the procedure.

At its root, it's a matter of risk analysis. Which means it's not just the number of people who've have bad outcomes, but what percentage of those who've had the procedure have had them. That's a fundamentally different thing.

Consider lumbar spine surgery, where it's about an even shot between worse/no change/better outcomes. It's an awful bet to take.

Now compare trimming toenails. Sometimes, people develop an ingrown toenail from that procedure. Every once in a while, one gets infected. In a very small percentage of THOSE cases, people end up dead or worse. And yet, most people cut their toenails (or have them cut). Those who do have complications usually have multiple contributing health and lifestyle factors. The skill of the cutter is also a major factor in a negative outcome occurring in the first place, as is the choice of tools....

Important caveat: I am NOT advising that you just lay out such points to her. It is almost impossible to reason someone out of something they didn't reason their way into. Especially at first. She's still your wife, and you still live with her and love her. You're in a position to know how she ticks, and what will help her in the context of that relationship. Part of that is empathy for her and her concerns. She's the one who'll have to have surgery for this, and that can be daunting. Human beings are emotional creatures, and that requires handling at least as much as bringing logic into play.

The logic behind this should help inform the process of discussing it with her, but is probably not going to work as an opening salvo....

Your asking here is a good move. If her apprehension is coming from exposure to negative outcome anecdotes, this is a great place to acquire positive ones to balance that out.

This summarizes my thoughts exactly. She's only working people who are in a bad enough health/medical situation to need her help, so it creates a bias. My thought in asking here was to get informed answers from, and about, a population that is direction applicable to her, and biased towards the same desired outcome she is biased towards (wanting to lift). Thank you for your input.

[MDR2]

I’d certainly defer to any general surgeons in the population here that has more actual experience in the surgical procedure itself, as my experience has been simply rehabbing upwards of about 100 post operative hernia repairs over the last decade or so. In the vast majority of the cases of active individuals, mesh was used. I can count on one finger the number of people I saw have a bad outcome with the mesh. I have, however, seen several people who had bad outcomes with a non-mesh repair and every single one that had a non-mesh repair desired the non-mesh repair due to horror stories they heard about the mesh. It was a decision on their part to have the surgeon attempt to either sew two hair brushes together or two blocks of hamburger meat or a block of hamburger meat to a hairbrush.

Every single surgeon I worked with categorically used mesh implants for someone who was athletic, high functioning, or even had the capability to be high functioning. The mesh provides a much more secure purchase for the suturing, and especially (in my experience) ProGrip mesh was very, very strong. I believe another one that was used was something like 3D Max, but, most of my surgeons had a preference for ProGrip and it was standard purchase order for the general surgery service.

Look, I’m not a very intelligent dude, but physical activity is very, very important to me. If I had a large hernia that impacted my ability to train and it needed to be repaired, I know enough to know that I want a sturdy mesh repair. I wouldn’t even consider a non-mesh repair. But, that’s just me.

Thank you for your feed back. This is the exact real-world experience I was hoping to hear. I will look into the ProGrip model/brand.

The bolded part is pure gold!

[Mark Rippetoe]

It might be something to look into, otherwise even though I do have pain and tugging in my mesh repair spot, it really isn’t that annoying.

That goes away after about 9 months. There is no satisfactory non-mesh umbilical hernia repair for a powerlifter. So she needs to either get the mesh installed or stop lifting. Sorry.

And she'll need a velcro belt to wear over the repair for about a year.