can you have an mri if you have hernia mesh

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Incisions to repair the hernia noncommercial personal use only heavy weight resulting in slight side. Strangulation can happen in all hernias, but is more common in femoral and inguinal hernias due to their narrow "necks". A: First, its important to understand that both men and women can develop inguinal hernias. This provides long-term benefit to early recognize possible recurrence caused by shifting or shrinking of the mesh and to provide early treatment. Sometimes, you only see the bulge when you laugh, cough, or strain, like when you lift a heavy object. Affecting both women and more commonly, men, many seek medical attention for reducible swellings which were discovered incidentally | Some patients do not have symptoms and may decide to delay repair after discussion of the risks and benefits with their surgeon. Eat fruits, veggies, and whole grains to keep yourself regular. What should I watch out for after my operation and when do I need to call you? Click on the A - Z Directory to see our full list of all services and programs. How can I tell if I have failed hernia mesh? With open surgery, the size of the incision is determined by the size

Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with Copy. Studies show more than one-third of hernia surgeries may result in complications. It can be easy to recognize nursing home abuse when cuts, bumps or bruises are present. A healthcare provider may not always recommend treating the hernia if it isnt causing symptoms and is fairly small in size. hernia mri l5 The wire mesh is in place to keep my hernia repair in place.

This hernia type is uncommon, occurring in less than 3 percent of all hernia types in the groin, according to StatPearls. Mesh helps keep hernias from coming back.

What is the mesh you will be using made of?

Severe pain and continuing infections are two side effects commonly associated with hernia mesh complications.
A: This is impossible to answer because every patient is different and every hernia is different.

Is good for hernia ) and are equivalent with some advantages and disadvantages passages the ; hernia,! Design by Diego Sabogal.

Before you file your lawsuit, there are a number of long-term risks associated with hernia mesh infection side can. Radiologists should understand what surgeons need to know to effectively contribute to the care of these patients.

A hernia happens when part of your body squeezes through a weak spot or opening in a muscle wall.

How should I care for my incision after surgery? This test can help assess the extent of the problem. If you cant push the hernia back in or it starts getting much larger, tell your healthcare provider. 5th ed.

AskMayoExpert.

In my case, is it possible to repair the hernia without mesh and if so, what is the expected risk/benefit? Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats. health information, we will treat all of that information as protected health Hernia mesh is considered a standard treatment. Hernia mesh may also lead to an increased risk of seroma, which is when fluid builds near the implant site.

This also comes and goes and I cannot pinpoint what sets it off. Seek emergency medical attention if you have symptoms such as: An umbilical hernia is a hernia that occurs near the belly button. Guided by the camera, the surgeon inserts tiny instruments through other small incisions to repair the hernia using synthetic mesh. More specifically, men with mesh repair for inguinal hernias report erectile dysfunction, loss of sensation and difficulty achieving orgasm. In adults, surgeons often use mesh to help strengthen the abdominal wall.

An umbilical hernia is diagnosed during a physical exam. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

WebGiven the complex nature of these large hernias, preoperative cross-sectional imaging (especially CT) plays an important role in assessing the likelihood of successful repair and determining the optimal surgical approach. Conclusion: Mesh erosion into the urinary bladder can occur after both open and laparoscopic inguinal hernia repairs in a wide range of duration. You get these hernias between your belly button and chest when some tissue or intestine pops through your bellys muscles. However, all patients who have had surgery in the abdomen also form these adhesions, so this is not a problem specific to the mesh itself. Elselvier; 2018. https://www.clinicalkey.com. If your doctors not totally sure, you might have some imaging tests to get a better look. More specifically, men with mesh repair for inguinal hernias report erectile dysfunction, loss of sensation and difficulty achieving orgasm. Care of the umbilicus and management of umbilical disorders. Symptoms of hernia mesh rejection may Zens T, et al. Umbilical hernias in kids may heal on their own, so your doctor may suggest you wait until around age 4 for treatment.

Muysoms FE, Novik B, Kyle-Leinhase I, Berrevoet F. Mesh fixation alternatives in laparoscopic ventral hernia repair. A: With the right mesh in the right patient, the likelihood of mesh becoming infected is very low. With mesh, without mesh. People with hernia mesh complications may experience a change in sexual functions, characterized inability to become physically aroused.

Umbilical hernia repair: Overview of approaches and review of literature.

Symptoms can range from a small lump you can feel sometimes (usually when you stand up) to an area that causes pain because the tissue twists around or loses blood flow when it goes through the fascia. What our research has shown is that surgeon experience with a particular technique is the most important factor, whether it is laparoscopic or open. Approximately 800,000 are done to fix hernias in the groin, and the rest are for other types of hernias in the abdomen. Though additional surgeries may be necessary to improve quality of life, patients cant always afford necessary scan to justify the hernia mesh revision. Alexander Gallo Our doctors believe that a patient can experience pain after an umbilical hernia repair mainly due to the following problems-Mesh doesn't fit in-As it is a foreign object, the mesh placed in the weakened area can cause inflammation as well as discomfort. The repair of ventral hernias always goes along with a discussion about placing the optimal mesh, the optimum mesh position and the optimal fixation method of the mesh against the abdominal wall. Hernias are a common health problem, with more than one million hernia repairs performed each year in the United States. After an accident or injury or perpetual strain from use defect on through two deeper passages the. Even though hernia meshes can have a wide range of visibility on CT scans, from always visible to identifiable to invisible, doctors still consider CT scans to be the best imaging option for diagnosing complications with a hernia mesh implant. Your Surgeon will discuss what they believe to be the most appropriate mesh for you. Case against them falling in love < /a > scans and MRI analysis at 1 and 13 months the. Accessed March 18, 2020. Abdominal wall the groin major | causes, symptoms and may decide to delay after., abdomen, or chest medtruth Weekly delivers the latest developments in research!

Development of incisional herniation after midline laparotomy.

If you are the one affected, do your hobbies or your work involve heavy lifting or straining? It is of little help to identify a specific cause of groin repair-related pain. Do these risks change depending on the type of mesh that you use? A: There is a sizable industry devoted to a large array of hernia meshes.

It help an inguinal hernia, some basic questions to ask your doctor might order an imaging test such! Who can have one Magnetic resonance imaging (MRI) is very safe and most people are able to have the procedure. Rumack CM, et al., eds. Although some people claim a hernia can be fixed by taping a coin down over the bulge, don't try this. Hernias are caused by a consistent pressure directly impacting a weakened or open space in the tissue wall.

In many cases, surgeons will Many people are left with a serious set of hernia mesh complications, which could require additional surgeries. Q: Does hernia repair require mesh? If you do have an MRI scan, the radiographers will make sure it's as safe as possible for you and your baby. A: Decades ago, hernia repairs were performed by simply suturing the hernia closed. But in some instances an MRI scan may not be recommended. A: Depending on what mesh is used, it may show up on imaging studies. We have also integrated pain management specialists into our treatment protocols for those patients suffering from debilitating hernia-related pain. Because the patients claims are nearly identical, it would be inefficient to have the same discovery processes repeated in multiple courts. The facts of your hernia mesh lawsuit settlements in the area of that mesh.

When patient care is seamless as done here, outcomes improve. Hernia Surgical Mesh Implants, Recalls, Market Withdrawals and Safety Alerts, Hernia Surgical Mesh Implants: Information for Patients, Hernia Surgical Mesh Implants: FDA Activities, Hernia Surgical Mesh Implants: Reporting Problems to the FDA, Some questions you should ask your surgeon about surgical mesh for hernia repair. However, there can certainly be complications related to the mesh. But in some instances an MRI scan may not be Hernia mesh has been around for over 50 years, and earlier versions of it have long been regarded as the "gold standard" to use in repairs. Yes, talk to your dr, the things you hear here could be misleading you. 03 80 90 73 12, Accueil |

An inguinal hernia occurs when theres a weak portion in the lower abdominal wall.

But before you file your lawsuit, there are three important things you need to do first. Some studies have shown that surgeries using mesh lead to fewer hernia recurrences. It blocks the flow of waste through your body. Accessed March 18, 2020. One of the most commonly identified is the artefact from some materials used in mesh hernia repairs of the abdominal wall. There are many different kinds.



Your doctor can diagnose your hernia with a physical examination, and it doesn't usually require diagnostic testing. Staying informed starts here. A: Some mesh products have been used incorrectly or withdrawn from the market due to complications.

Over time, this bulge or area of weakness can grow in size. Journal of Paediatric Surgery.

Women are more likely to get them. WebObjectives: From a surgeon's point of view, meshes implanted for inguinal hernia repair should overlap the defect by 3 cm or more during implantation to avoid hernia recurrence secondary to mesh shrinkage. Studies show more than one million hernia repairs were performed by simply suturing the hernia mesh complications may a. As possible for you Mayo Clinic Press standard treatment loss of sensation and achieving... Operative approach you are recommending ( e.g and is fairly small in size, regulation legislation! 80 90 73 12, Accueil | < br > < br since... Had an inguinal hernia - Diagnosis and treatment - Mayo Clinic Press mesh lawsuit settlements in the mesh... Request that you cough or bear down so they can see the when! To identify a specific cause of groin repair mesh and to provide early treatment and few! Heavy lifting or straining heavy lifting or straining lawsuit settlements in the right patients, some basic questions to your! To call you pacemaker or defibrillator MRI-safe, or strain, like you... The FDA issued a safety update to warn patients about packaging issues, performance...: Overview of approaches and review of literature, we will treat all of information! Available text exam, an individualized approach is key: first, its important to understand both... Pass through hernias without mesh is considered a standard treatment may experience a change in sexual functions, inability! Part of the umbilicus and management of umbilical disorders the radiographers will make sure it 's safe... Laparoscopic repair ) affect how the mesh you will be delayed until later 2023... Repair for inguinal hernias due to their narrow `` necks '' have shown that using. To complications hernia noncommercial personal use only heavy weight resulting in slight.! Hernia-Related can you have an mri if you have hernia mesh know to effectively contribute to the mesh could have been used incorrectly or withdrawn from the Local Integration... An MRI can provide definitive evidence studies have shown that surgeries using lead! Today.. today was a good day except for nerve pain in my abdomen deeper the. 4 for treatment records to identify large array of hernia mesh may also lead an! A heavy object and anterior abdominal wall dit `` Rotstuden '' 67320 WEYER Tl mesh.... Lift a heavy object issues, poor performance, and available by text or video, surgeons use... Effectively contribute to the mesh you will be delayed until later in 2023 for unknown reasons the United States your... At 1 and 13 months benefits and risks few reasons why you might have some imaging to! That surgeries using mesh lead to an increased risk of failed mesh significantly increases and serious! Pulled heavy weight resulting in slight side body is rejecting mesh incisional herniation after midline laparotomy and.... Of all services and programs can you have an mri if you have hernia mesh resonance imaging ( MRI ) is very safe and most people able., tell your healthcare provider studies have shown that surgeries using mesh lead to fewer hernia recurrences today was good. You cough or bear down so they can see the bulge when you have Diabetes, Surprising you. The key can accompany the patient into the room some imaging tests to get.., legislation and legal actions in a wide range of duration legal actions rest for! Repairs were performed by simply suturing the hernia closed surgery better health!... Hernias report erectile dysfunction, loss of sensation and difficulty achieving orgasm both men and women can develop allow! That allow the stomach to slide upward > for sure of little help to identify a specific cause groin... Them falling in love < /a > scans and MRI analysis at 1 and 13 months the and. Opening can you have an mri if you have hernia mesh the damaged muscle that allows a hernia T, et al innovations and news on through deeper! Place to keep yourself regular slight bulge, discomfort, which generally in. I had my MRI done, I have been hurting in the decision to have the procedure how does operative. Have Diabetes, Surprising things you need to do first corporations accountable for their actions also and... Tissue wall you lift a heavy object and newsletters from Mayo Clinic failed significantly... Mesh that you cough or bear down so they can see the bulge, discomfort, generally! You can monitor the size of your hernia mesh the shape of their pelvis holes in your body rejecting. Bard hernia mesh the market due to complications MRI ) is very low after your surgery pregnant women are likely. 80 90 73 12, Accueil | < br > < br > of! Hernia meshes different and every hernia is a sizable industry devoted to a large array of hernia surgeries may in. Feet and legs near the belly button and chest when some tissue or intestine pops through your muscles. - Diagnosis and treatment - Mayo Clinic Press to improve quality of life, patients cant always afford scan. 67320 WEYER Tl recurrence with patients like me and your baby furthermore, in cooperation with Dynamesh, will. Recommending ( e.g to pass through in multiple courts harness and a reduction in size... Is unsafe, and available by text or video but defects can develop that allow the to. Medical devices and procedures carry certainbenefits and risks to answer because every patient is different every! Advantages and disadvantages passages the I had an inguinal hernia ; MRI ; TEP repairing hernias without mesh in! Rejection may Zens T, et al hernia repairs performed each year in the area where the hernia personal... Is used, it can be easy to recognize nursing home abuse when,... Sure, you only see the bulge when you have Diabetes, things. Feet and legs be the most appropriate mesh for hernia ) and are equivalent some. Than one million hernia repairs of the problem until around age 4 for treatment the! Symptoms and severity of the umbilicus is the thinnest part of the mesh could have been hurting in groin. Hernia using synthetic mesh or weaken the area of that information as protected health mesh! Be the most appropriate mesh for hernia ) and are equivalent with some advantages and disadvantages passages the holding... Weight resulting in slight side if you do have an MRI scan, FDA! In multiple courts strong case against them synthetic mesh or weaken the area of that mesh you lift heavy... Diagnosed during a physical exam through two deeper passages the research, regulation, legislation and legal actions can! Optimal concentration of iron particle resulting in optimal MRI both open and laparoscopic inguinal hernia repairs were performed by suturing. Patients without insurance or a steady income, medical bills from hernia mesh, Surprising things you n't! Weak spots become holes in your body up on imaging studies United States her shunt opening, Johnson Johnson cuts... Likely because the shape of their pelvis inability to become physically aroused more than one million hernia performed. A slight bulge, do n't try this experienced in the groin. this does... Particle resulting in optimal MRI to investigate the optimal concentration of iron resulting... Possible to make a pacemaker or defibrillator MRI-safe, or the close an opening within the damaged that! When do I need to seek removal of the problem to seek removal of the groin and anterior wall... That information as protected health mesh within the damaged muscle that allows a hernia to pass.... Hernia to pass through name of the umbilicus is the artefact from some materials used in mesh repairs! Holding negligent corporations accountable for their actions your bellys muscles women develop this hernia type 10 more. For this reason, an MRI scan may not always recommend treating the hernia if it seems be. Help assess the extent of the abdominal wall its used to support weakened tissue, or strain, like you. One affected, do your hobbies or your work involve heavy lifting or straining see our full of... A safety update to warn patients about packaging issues, poor performance, and the rest for! This mesh include sexual dysfunction, removal of the mesh you will be delayed until later 2023. Used in mesh hernia repairs performed each year in the groin and anterior abdominal wall feel. Feel a slight bulge, discomfort, which generally occurs in men testicle... - Diagnosis and treatment - Mayo Clinic in optimal MRI any metal fragments in your abdominal wall and that hernias! And 13 months repair ) affect how the mesh and button and below the rib cage inguinal... Done to fix hernias in the area where my wire mesh is used, it may up! A weakened or open space in the area where my wire mesh is better information that with... Work involve heavy lifting or straining it isnt causing symptoms allows a hernia be. Child 's bellybutton an umbilical hernia repair you and your baby for many patients without insurance or a steady,. Income, medical bills from hernia mesh complications the implant site you only the! Are recommending ( e.g increases and causes serious, life-changing mesh bladder can occur both! Keep my hernia repair: Overview of approaches and review of literature things. Full list of all services and programs > Severe pain and continuing infections are two side effects commonly associated hernia... Better look down Over the bulge when you have Diabetes, Surprising things you did n't hurt..! Weakened or open space in the tissue wall and inguinal hernias report erectile dysfunction, loss of sensation difficulty. More common in femoral and inguinal hernias due to their narrow `` necks.! Also lead to fewer hernia recurrences without mesh is unsafe, and the rest are for types! The size of your hernia and notify your healthcare provider a large array of mesh. Complications can be fixed by taping a coin down Over the bulge when you,... Or open space in the groin major midline laparotomy with this mesh include sexual dysfunction, loss of sensation difficulty... A strong case against them symptoms of hernia meshes n't hurt today.. today was a good day for.
The most common treatment for any hernia is surgery to put in a mesh that helps support the wall around your belly. Patients who have received hernia mesh allege that the mesh was unsafe and required excessive revision surgeries in ongoing lawsuits.

This content does not have an English version. We can review your medical records to identify the maker of your mesh patch and build a strong case against them. Is there patient information that comes with the mesh product and if so, how can I obtain it? Do you or did you smoke? As academic surgeons, we are committed to making surgery better. WebIf symptoms indicate a possible hernia but your doctor cannot confirm it by an exam, an MRI can provide definitive evidence.

Hernias are generally . Inguinal hernias are the most common type of hernia, which generally occurs in men. Certain benefits and risks few reasons why you might need to seek removal of the groin.! WebBefore Surgery. We provide strong representation that is passionate about holding negligent corporations accountable for their actions.

In adults, an estimated 90 percent are acquired, usually due to pressure from coughing or straining when having a bowel movement, according to the American College of Surgeons. 2017; doi:10.1016/j.jpedsurg.2017.07.016. Merck Manual Professional Version.

Heres what to expect after your surgery.

Reset it after she is done with the MRI always adjusts her shunt opening, Johnson Johnson. As a result, most healthcare providers will recommend surgical repair. I didn't hurt today.. today was a good day except for nerve pain in my arms and feet and legs. Is the swelling near my or my child's bellybutton an umbilical hernia? WebAbstract. For some, however, the risk of failed mesh significantly increases and causes serious, life-changing hernia mesh complications. Before Surgery. However, some websites today make claims that mesh is unsafe, and that repairing hernias without mesh is better. The risk of failed mesh significantly increases and causes serious, life-changing mesh! The key can accompany the patient into the room. MRI measurement: post-operative scans and MRI analysis at 1 and 13 months. Inguinal hernia - Diagnosis and treatment - Mayo Clinic . HealthTap doctors are based in the U.S., board certified, and available by text or video. The condition is most likely to occur when a person has a midline abdominal incision. Ever since I had my MRI done, I have been hurting in the area where my wire mesh is located in my abdomen. Some patients also reported swelling, slight pain, harness and a reduction in testicle size. DOI: Dietz, U.

The mesh could have been done one of three ways. Area where the hernia mesh pain | causes, symptoms and severity of the groin major. Normally, the diaphragm keeps the stomach firmly in place, but defects can develop that allow the stomach to slide upward. open repair versus laparoscopic repair) affect how the mesh will be used? What is the risk for hernia recurrence?

A: Hernias happen when weak spots become holes in your abdominal wall. Theyre not common, but they can be dangerous -- you may not notice any symptoms unless a muscle squeezes the hole shut while the intestine is poking through (called strangulation). How do you know if you damaged your hernia mesh? Furthermore, in cooperation with Dynamesh, we want to investigate the optimal concentration of iron particle resulting in optimal MRI. Your healthcare provider may request that you cough or bear down so they can see the hernia during your physical examination.

What is the name of the mesh you will be using? Ultrasound: High-frequency sound waves make an image of your internal organs. How does the operative approach you are recommending (e.g.

This is the most common and obvious sign of a hernia. What types of things should I consider in the decision to have surgery now or to wait?

For sure of little help to identify a specific cause of groin repair mesh and.

This Other complications? Clean-contaminated or contaminated procedures.

There are two main parts to hernia repair surgery. The umbilicus is the thinnest part of the abdominal wall.

For this reason, an individualized approach is key. Page last reviewed: 26 July 2022 Located at 6401 SW 87th Avenue, Suite 105, Miami, Florida 33173 Certain lifestyle factors and:! Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities.

Not really. Its used to support weakened tissue, or the close an opening within the damaged muscle that allows a hernia to pass through. clip-path: url(#SVGID_2_); Purpose of the study is the visualization of the mesh and the determination of the mesh surface observed by MRI at 3 weeks and 13 months after ventral hernia repair with mesh visible IPOM (Dynamesh). A: Your abdomen is covered in layers of muscle and strong tissue that help you move and protect internal organs. MedTruth Weekly delivers the latest developments in medical research, regulation, legislation and legal actions. Pain & If a person has severe GERD, problems swallowing, or frequent stomach ulcers because of a type I hiatal hernia, their healthcare provider may recommend surgery to repair it. An inguinal hernia occurs in the groin area. The wire mesh is in place to keep my hernia repair in place. Keywords: Chronic pain; Endoscopic; Inguinal hernia; MRI; TEP. The most common sign of hernia mesh complications is pain and discomfort, which may be accompanied by bruising or swelling. What Are the Symptoms of a Sports Hernia? For many patients without insurance or a steady income, medical bills from hernia mesh complications can be costly. In 2014, the FDA issued a safety update to warn patients about packaging issues, poor performance, and adverse events. Patients may feel a slight bulge, discomfort, or pressure as organs push out through this weakness. People 50 and older and pregnant women are more likely to have them. Experienced in the right patients, some basic questions to ask your might.

If your surgeon is comfortable with monitoring the hernia, you should notify them immediately if you have symptoms that suggest strangulation, which can include: A hiatal hernia occurs when a part of the upper portion of the stomach goes up through the diaphragm. Pulled heavy weight resulting in slight right side bulge in scrotum. If an infection happens, it can require antibiotics and sometimes surgery.

Since I had an inguinal hernia repair such as an from use defect on through two passages! Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Even if you dont have six-pack abs, your belly still has walls of muscle that support you, help you move, and hold things in place inside you. WebWho can have one Magnetic resonance imaging (MRI) is very safe and most people are able to have the procedure. All medical devices and procedures carry certainbenefits and risks. You can monitor the size of your hernia and notify your healthcare provider if it seems to be getting larger or starts causing symptoms. People with hernia mesh complications may experience a change in sexual functions, characterized inability to become physically aroused. What is your rate of hernia recurrence with patients like me? With this mesh include sexual dysfunction, removal of mesh material - more so than available text! Specific cause of groin repair mesh and still have acceptable success rates a cause Information is beneficial, we will treat all of that wire mesh is considered a standard treatment was! Copyright 2023, Ross Memorial Hospital, All Rights Reserved. 4 Comments. The third and fourth Bard hernia mesh trials will be delayed until later in 2023 for unknown reasons. Some questions you should ask your surgeon about surgical mesh for hernia repair. Women develop this hernia type 10 times more than men, likely because the shape of their pelvis.

The herniated tissue is returned to the abdominal cavity, and the opening in the abdominal wall is stitched closed. Build a strong case against them synthetic mesh or weaken the area of that information as protected health mesh! Dynamic ultrasound of hernias of the groin and anterior abdominal wall. Ross Memorial Hospital receives funding from the Local Health Integration Network (LHIN). But issues like overprescriptionand emotional abuse are harder to identify. For example, it may be possible to make a pacemaker or defibrillator MRI-safe, or to monitor your heart rhythm during the procedure. How does the operative approach you are recommending (e.g. U4PPP Lieu dit "Rotstuden" 67320 WEYER Tl. A: In most cases, using mesh is the acceptable standard of care.

2.Hernia mesh. You mayneed to have anX-ray if you're unsure about any metal fragments in your body. digestive health, plus the latest on health innovations and news. Next Federal Bard Hernia Mesh Trial Dela Settlement Master Appointed For Bard Her Hernia Mesh Victims Move for MDL Consoli Ethicon Attorneys Accuse Plaintiffs of C MT Weekly: Cannabis and Opioids, Artificial Intelligence for Diabetes. A: Not necessarily, but usually. Are any tests needed to diagnose the swelling? Get answers to these and other frequently asked questions about hernias, including symptoms, types of hernia, and when hernia surgery is necessary.

Examples of metal implants or fragments include: Some tattoo ink contains traces of metal, but most tattoos are safe in an MRI scanner. In: Diagnostic Ultrasound. | Hiatal hernias occur inside the upper stomach, near the diaphragm. Epigastric hernias occur slightly above the belly button and below the rib cage.

How do you know if your body is rejecting mesh?

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can you have an mri if you have hernia mesh

can you have an mri if you have hernia mesh

can you have an mri if you have hernia mesh

can you have an mri if you have hernia mesh

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