Ileostomy reversal and MESH, URGENT

Hi all,

I know this is very last minute, I am due an ileostomy reversal tomorrow morning and I have been researching and deciding if I should have a prophylactic biological mesh put in because I am a very active person and don't want to risk getting an incisional hernia. The surgeon is happy to put one in.

Any experience?

From what I have read there is quite a high incidence of incisional hernia following ileostomy closure, and a mesh is effective in preventing this happening. My worries are any complications (which I have asked the surgeon about bowel adhesions etc. and he said because it is a biological mesh it shouldn't happen), and also not sure if I could do abdominal exercises with the mesh attached to the rectus muscle (i.e. with hypertrophy and all)..

If anybody who has had a mesh put in please share your experiences!!

Many thanks

I had mesh put in following an incisional hernia repair. Had a very minor problem with wound healing (but I usually do heal slowly), otherwise problem free. Didn't even create problems when I had to have another op (unrelated)

dxw said:

I had mesh put in following an incisional hernia repair. Had a very minor problem with wound healing (but I usually do heal slowly), otherwise problem free. Didn't even create problems when I had to have another op (unrelated)

Click to expand...

Thanks so much for the quick reply! Do you know any more details about the mesh placement or if it is synthetic or biological? If you don't mind all my questions, can I ask how long you had the mesh in for and was you able to do ab strengthening normally without feeling pain or anything? Can you feel the mesh inside?

Kind regards

Sorry, don't know what type of mesh. It's been there about 10 years or so, no problems. Mesh used now is probably better. I'm not the best person to give advice about abs, I'm more a lounger than an excerciser. I have never been told to avoid any particular activity or exercise. Do you have a physiotherapist you could ask? They are good with that sort of advice.

Just noticed your last question, no you can't feel the mesh. I only remember I have it when I see a different doctor or I have to have some sort of imaging done. You can see lots of clips on the xray etc.

I've heard that people can feel the mesh briefly in hospital during recovery and then during the healing process you longer feel it. My surgeon was concerned about infection for folks with Crohn's disease.

So I'm 1 day post op now just thought I would post an update (still in the ward!)

From reading the evidence and weighing up pros and cons I decided not to go for the mesh, as although the reported incidence of incisional hernias is around 30percent which is a lot, I don't fit the demographic which were used in the studies (i.e. obesity, age, smoking etc), and was put off with the potential (unknown) risks such as visceral adhesions and mesh migration. For those interested I will edit this post later and include the references. Most currently, Birmingham University are conducting a trial regarding the use of biological mesh for prophylactic incisional hernia prevention called the ROCSS trial for anyone interested! My aim is to gradually strengthen my abdominal muscles as much as possible (and I am a physio in training )

Regarding the surgery - it went well. Was hooked up to catheter, drain, PCA (morphine). Day 1 i'm already getting out of bed, catheter removed, drained removed (probably was the most uncomfortable). In terms of pain im not in much pain, especially since the drain was just pulled out I can walk more comfortably.

In terms of BM, I just went to the loo and did a no1 and no2! It wasn't urgent as i was dreading pooping my pants or something and asked for a bed pan..I just decided to go sit on the toilet then stuff just started coming out (sorry for TMI)..

Will keep posting for those interested as I found it difficult to find information pre-op.

FYI I have crohns and had most colon removed (tiny bit left above intact rectum apparently), so have small bowel connected to whats left!

Happy to answer any questions!

Kind regards
P

Please do keep us posted about your recovery and exercise program. I am interested in the problems and promise of mesh for hernias. Currently I'm trying to design the best exercise for the post-recovery period.

All the best!

Sifu, was your rectum in good shape before the reversal?

Day 2 post op update:

Biggest concern at the moment is not pain - not even using my PCA anymore, given paracetomal and ibuprofen regularly but feel like i don't even need these!

Biggest problem for me at the moment is BM, have gone maybe 7-8 times since opening my bowels yesterday. Consistency is watery, first few times were fresh blood which nurses/doc said was normal due to the surgery, now not really noticing blood but well see if that continues. Usually I am actually able to hold it in until I get to the loo - there is no desperate urgency, but once I sit down i release it straight away. One thing that sucks though is last night when I was sleeping had a bit of an accident and didn't even realise til I woke up and went to the loo - although the consistency was very water like and didn't have much of a smell, it wasn't a LOT either just a fair bit on my underwear..I think maybe it leaked because of the watery consistency. Will mention these problems to the docs at ward round and see what they can give?

Any advice? I know immodium, metamurcil...also heard probiotics? kefir?

@bluesky in terms of exercise for post recovery I have read in places that you should not initially overwork your abdominal muscles as it may risk causing hernia. From my perspective, this sounds plausible as the muscles are at a weakened state and if you liken it to post exercise DOMS where the muscle fatigues and has associated muscle inhibiton, it could put you at risk of herniation. I will chat to some other physios/read around for more info regarding this. Although with any muscle strengthening it is a gradual progressive process so I would assume normal activities of daily living i.e. walking etc would help with initial phase of strengthening of abdominal muscles, then when they have time to recover a bit i.e. in a few weeks then progressive targeted strengthening. Will get back to ya.

@crohn2357 Doctors said my rectum was in good shape before the reversal and had a bit of colon left attached to it. Pre-op colonoscopy if i remember correctly showed that it was normal and no inflammation (will check when I see the report at home). Although, I did have peri-anal inflammation in the past but my consultant doc said that there had never been any significant rectal disease or small bowel disease which is why they are hopeful for this reversal to hopefully keep me going for the long term with medication to control the disease.

Kind regards
P

Another update:

Having 10-15 BM per day at the moment. Output is watery. Feel like towards end of the day the BM is more fresh blood than stool so hopefully when this settles it will reduce BM. Diet is crap just playing safe and sticking to creamed potatoes, omlettes, rice, yoghurt, so hopefully down the line when adding more fibre into diet this will bulk things up and further reduce BM. Although one of the enhanced recovery nurses said to just try different things and see how it goes I don't want to risk it.

Started on loperamide and Codeine since yesterday to help slow things down which seems to be helping. Not really in pain anymore but they are still giving me paracetomal and ibuprofen. Having ups and downs wondering if I had made the right choice and praying things get better, but happy that I don't have the bag anymore and hopefully can get back to being proper active again as I used to dance a lot! Plan is to be discharged today (this is 5th day i'm in hospital) and continue to loperamide and codeine then come off codeine in a couple days once I get more consistency and see if I manage ok because doc said with codeine you could become dependent but nil serious side effects. Also I think plan is to maintain disease with azathioprine asap with a review in 3-6months time to see if biologics will be needed.

In terms of post-op strengthing for prevention of incisional hernia, i'd contacted one of my senior physio lecturers who is an absolutely legendary respiratory physio who has been incharge of a very good London hosp department for many years and is probably one of the best in the UK (if not the world! ). She had said that my chances of incisional hernia is small due to my incisions being small and I don't meet the risk factors and that having a mesh would complicate things if further surgery was required. So in that regards I think I have made the right choice. In terms of strengthening she mentioned to rest for 6 weeks then start with doing abdominal strengthening in crook lying (i.e. knees bent) via pelvic tilting (NOT abdominal crunches), then can bring knees to either side and do the same. Will meet up with her soon back in university to clarify, but shes absolutely put my mind at rest.

And just finally I just wanted to make a point esp. to younger crohns patients as there is always negative stories written around the internet. I was diagnosed at the age of 18 just before going to a very good university (top 5 in the world to study a difficult STEM subject). I passed the degree with a good grade (2:1) had an awesome social life, was able to work for a while and switched to another degree (physio) and am currently doing really well. Yes, this disease sucks at times, yes at times I cry to myself and ask why me, but just KEEP PUSHING, KEEP FIGHTING, JUST BE OPEN WITH FRIENDS, you can get far in life!

I hope my story/posts will be helpful to anyone reading and just shed some positivity.

My plan for the next few weeks before I go back to uni is to experiment with diet and maybe try some fiber stuff like metamurcil(?)/psyllium husk(?)/research about the role of probiotics in IBD, to help get my BM under control.

Will keep posting

Kind regards,
P

Update:

Things are looking good! Had about 6 BM (tiny bits each time) yesterday including through the night although I did not eat much (maybe it was the hospital cream potatoes that didn't sit well with me). Not seeing any more blood. No leakage at night!

Had a BM this morning when I woke up which is what I always do and was just any remainder build up from the night. Had breakfast and lunch and only had 1 BM. Have good control and not even needing another yet. Also, not even taking loperamide or codeine today to see what my normal is and see if I can cope without. This is really reassuring at the moment (fingers crossed it continues), and I reckon once I start eating normally i.e. adding fiber to bulk things up I can really improve the BM and control.

ps also have hernia prevention belt from when I had stoma and deciding whether I should just wear it for a while just incase..

Update:

Having on average 8-10 BM per day, usually around 6 per day (always one when I wake up and maybe 2/3 before dinner) and having to get up 2-3 times per night to go which sucks as can't really sleep properly. Sometimes feel like I am going bits at a time - is this what they call 'clustering'? No leakage which is great. Slowly trying to get back into a normal diet.

Used some loperamide but recently started using organic Psyllium husk brought from myprotein.com so I stopped with the loperamide now to experiment if I can do well with the psyllium husk as it will be much more convenient to obtain/is cheaper/not a medication per say. Taking 1teaspoon with water/juice every morning before food. It's only been 2 days since using it and it has definitely helped my stool form! This is great because it reduces the butt burn from the acidic watery D.

Not sure if it is having much of an effect in terms of reducing frequency yet, as when I get the urge to go I am able to suppress it but it will keep coming back and I just have to give in...when I do sometimes there is not a lot of stool. So maybe somehow my body can adapt in time to overcome these urges to reduce frequency (as I think my rectum can deffo store more before releasing...)..

In other news having quite a bit of a runny nose which is annoying and not sure if due to delayed side effect of anasthesia, but it is annoying as can't blow my nose properly due to painful wound. Also, in other news it feels really depressing being stuck at home while everyone is enjoying summer..I hope things improve soon

Just a quick update:

Still having on average 8-10 BM per day, but I feel like now I'm not really desperately trying to hold it in I just go when I feel like I should. Tried to take chia seeds with water instead of psyllium husk because it supposedly has more nutritional benefit such as omega3 and protein. I found that even adding up to 3teaspoon to water it did very little for bulking up stool. I believe this is because the relative percentage of soluble fibre is lower than that in psyllium husk (psyllium has around 70 percent soluble fibre whereas chia has a smaller amount). Back to taking psyllium 1teaspoon with water with every meal to help firm things up.

Went out for food and drinks for 2 days this week as was my birthday and had no problems so feeling good . I think I am pretty confident in going out now and it has only been 2 weeks!