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Alternatives to mesh
I have bilateral inguinal hernias. I’ve talked to three surgeons, but none have been able to satisfy my concerns regarding having these repaired with synthetic mesh. As you must know using synthetic mesh to repair hernias has a commendably low reoccurrence rate, however there are numerous studies associating mesh with chronic pain. Some studies put the risk of this as high as 30%.
There’s some evidence that slim, fit and active people are at a higher risk of this, which applies to me. Also after 60 years first hand experience with my body I have learnt it objects to foreign body implants. The critical factor for me, while there are numerous surgeons more than happy to put mesh in, taking it out seems to be major undertaking with some real dangers. Additionally, there’s a real possibility removal won’t stop chronic pain. I’m not prepared to take that risk.
With reluctance, two of the surgeons I spoke with are prepared to use older surgery techniques such as McVay or Bassini techniques, but both warned of permanent stiffness, loss of function, pain and 20% to 30% likelihood of reoccurrence. None of which appeals to me, I don’t want to have to go through bilateral surgery, then have it fail and have to go through it again.
It seems every road has major drawbacks for what should be a relatively minor surgery. I am at my wits end. Do you have any suggestion as to what I could do?
John -
33 Replies
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I just came across this old Topic. It’s very relevant to some very recent discussions on the forum. Several surgeons contributed but they have not been back since, as far as I can tell. The date range is right in the middle of when things were the worst for me in my Bard Soft Mesh ordeal.
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Alternatives to mesh
Simpsom
The TelaBio product is completely different in that it combines a biologic product with a synthetic product. We do not know many of the answers to your questions. If you would like more infor I would be happy to discuss with you. I have used it for ventral hernia repair and in fact we put the first piece in about a year ago.
I would be happy to discuss your case in detail. Feel free to shoot me an email and we will set up a phone conversation or you can come see me in the office.
Dr. Szotek
pszotek@gmail.com
http://www.indyhernia.com -
Alternatives to mesh
In regards to TelaBio, is it considered a lightweight mesh or a mid-weight mesh, in regards to its tensile strength, and furthermore, what is its pore size? Reason I ask is because Physiomesh was just recalled because it was too lightweight and from a lot of recurrences, from what I’m finding online, and I just worry about macroporous mesh(es) now being weak. Have you used TelaBio for ventral repair(s) yet? Is there a macroporous mesh with mid-weight strength characteristics? I know you’ve all said there isn’t a lot, if any, long term data on the subject, but surely there’s a way to test the tensiel strength of macroporous synthetic and biologic mesh(es) to see which is going to as comfortable as it is strong…. I hope
I am trying to do research because I myself have a hernia that needs repaired and I’m a worrier; but I digress. In regards to patient pain after a hernia repair w/ mesh from the foreign material in the body: shouldn’t I be looking at the contraction rate(s) of all the different mesh(es) on the market to find out which one reacts best in the human body?
I say this because in my mind… A hernia is a hole, like a blown tire w/ tubing sticking out, and you need something to cover said hole. So if the mesh used contracts, shrinks, and balls up after its implanted in the body. Wouldn’t the mesh need to be a lot bigger to compensate for said contraction/ shrinking/ balling up to ultimately make sure the hole is covered up? Thus, you have more foreign material(s) in the body because your body is rejecting the mesh. Wouldn’t this be the best factor?
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Alternatives to mesh
John,
My apologies for the delay. The two products that Dr. Earle has mentioned are 2/3 that I was referring to. I have not put either of those products in for an inguinal hernia. The 3rd product that I was referring to is one by a new company called TelaBio that Dr. Towfigh, Dr. Stephen Ferzoco from Boston, and myself have all used and recently just had a poster at the American Hernia Society regarding. This particular product combined biologic with a sewn in macroporous permanent synthetic mesh. In my experience it was pliable and we did not see any ill affects. Dr. Ferzoco put the largest number in inguinal hernias out of the 3 of us I believe and he reported no issues up to this point at about a year out. I will say that these meshes are unproven for long term results as Dr. Earle so eloquently pointed out. I will say that I will be launching this mesh again in my practice in the next 2-4 weeks. The first product will be completely resorbable/remodeled without synthetic mesh at all. I plan to combine this with a traditional tissue repair for added strength. In the 4-8 week time frame I will be once again using the bio+sythetic mesh again hopefully. If you know anyone needing a hernia repair that is interested in this type of mesh and being part of the initial experience please have them contact me. In addition if you would like to speak with Dr. Ferzoco directly about his patients experience in more detail let me know and I will see if I can arrange with him. Indiana Hernia Center 317-660-5326 pszotek@gmail.com -
Alternatives to mesh
The two products that would fit best in to that category would be Synecor (WL Gore) and Zenapro (Cook). Both are combo products, and new. Both are probably safe, but have unknown long term results.
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Alternatives to mesh
To Dr Pszotek and his comment “In addition I am looking at combined products that have both biologic and synthetic products in a single mesh.”
Can I ask what combined products are you looking at, and have you used any combined products in inguinal hernia repairs? Any results/thoughts on combined mesh products?
Thanks in advance -
Alternatives to mesh
I would agree with Dr. Earle. Long term follow up is needed and unknown and unfortunately we cannot give you an accurate answer that would be beyond speculation for your questions. In fact speculation is even hard to give because the use of the biologics/hybrids/absorbable synthetics in the groin is extremely rare. I will say that even though I make an effort to follow up my patients for at least two years, it is extremely rare that they actually do return long term as Dr. Earle pointed out.
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Alternatives to mesh
Chaunce123 – Nobody knows the answers to these questions. Long term follow-up is key, but is very difficult to get. I still hear surgeons tell me their results are great, and they have little or no recurrences, only to find out that it is only their impression. They are convinced every patient with a problem would return to them because they have a good reputation and work in a small town. This of course is not correct, as we know most patients with problems don’t return to their original surgeon for a variety of reasons. DE
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Alternatives to mesh
Under what circumstances would these alternative / biological / dissolvable meshes be appropriate for a patient?
Is there any way to find ongoing trials for these alternative products for inguinal hernia cases?
Are these alternative remodeled mesh options better choices than a traditional bassini tissue repair?
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Alternatives to mesh
Agree with Dr. Towfigh and Dr. Earle. In addition when you analyze the Gore BioA study the data is questionable because the exact types of hernias within the study is u clear. If you look at the range for time of surgery and size of hernia defect you are quick to question whether there is some padding of the data going on with small, easily repaired defects. In my experience there is no abdominal wall reconstruction hernia that take 60 minutes or has a defect size in the 10cm2 range. I plan to continue aggressive selection of patients and use permanent as much as possible. In addition I am looking at combined products that have both biologic and synthetic products in a single mesh.
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Alternatives to mesh
Agree with Dr. Towfigh. Biological prosthetics don’t actually absorb, rather than remodel with tissue – the same tissue that was likely the cause of the hernia. I like to use the term “non-permanent” when referring to these products as a group.
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Alternatives to mesh
The short answer is: yes. Phasix mesh lasts longer than Tigre, which lasts longer than BioA. Surgimend and other Biologics start absorbing around 3 months and are gone around 8. Phasix is supposed to be absorbed by 18 months.
At this time, I am not convinced that any of these mesh products are superior to synthetic mesh (which doesn’t absorb). I feel perhaps recurrences are just being delayed with them. The Gore study with BioA is promising, but longer term followup may prove my point. Phasix data will be out in a year or two.
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Alternatives to mesh
Hi Dr Towfigh
In your experience is there a significant difference in reoccurrence rates between the likes of SurgiMend,and the later types such as Tigre/Phasix/Bio A meshes? The manufactures of Tigre, Phasic and Bio A all claim their products “remodel”, i.e. generate new collagen, as they dissolve away, which can take up to three years. Any thoughts?
regards
John -
Alternatives to mesh
At this point, there is too high of a hernia recurrence with dissolvable mesh. The studies that show good numbers with dissolvable mesh all end before the recurrences present themselves (i.e., need longer term followup).
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Alternatives to mesh
Why is dissolvable mesh not used more often in inguinal hernia repair? It seems the best of all worlds
Here is an example of one study using a dissolvable mesh that seems promising
https://www.goremedical.com/resources/dam/assets/AK2939-EN2_whitepaper.pdf
Does anyone do surgeries with dissolvable mesh or this just theory and trials at this point?
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Alternatives to mesh
Hi John,
I am a day stay surgical doctor in Auckland and I have started doing Desarda no-mesh reapirs under local anaestehtic with sedation from 2015 . Very good results to date and I have had personal discussions with Professor Desarda about the technique . Contact me via http://www.citymed.co.nz
Regards -
Alternatives to mesh
Hi conniernordan,
Dr Meyers in Philadelphia is a great resource for athletic pubalgia, abdominal tear, and abductor injuries (these conditions are usually the “sports hernia” you hear about on ESPN, despite the naming it is not a typical groin hernia), and Vincera does also have a hernia clinic for those with traditional groin and abdominal hernias as well. My understanding is the repair varies on the patient, and they are able to use no mesh tissue repairs for most patients who are reasonably physically fit and with a reasonable body composition, but on some patients mesh may be necessary for a true hernia and recurrences. As far as I know, the ‘sports hernia’ repair never includes mesh at that clinic, but some other places do use mesh for sports hernias.
Things get murky with groin pain of all types and hernias when there isn’t an obvious bulge. The Meyers clinic will give you an MRI and look at all possible pathology (and look for the sports hernia injuries which many people overlook), whereas Shouldice looks only for the obvious hernia bulge, and if Shouldice can’t see and feel a bulge they do not think you have a hernia regardless of MRI etc. If you’re already on the east coast, the two are a days drive or quick flight apart, may as well visit both clinics if you have the means.
Something else to consider about Dr Meyers impressive success rate is that many of his patients are pro-athletes to begin with. This means they are in great physical shape, they have near immediate diagnosis, MRI, personal trainers, and go through intensive physical rehabilitation starting the day after surgery. Most standard patients and weekend warriors do not have that level of attention from a dedicated team doctor, the same physical stamina, let alone a committed rehab team. I guess my point is, patient rehab should probably be included in ALL patient recovers and not just pro athletes, as it surely must make a difference in loosening up scar tissue and maintaining fitness, which is obviously why the pro athletes have those protocols. Again, the average Jane and Joe may not have that available, but usually a doctor can prescribe rehab and have it covered by insurance for at least a little while.
There is an incredibly helpful and multi-year long internet thread about the “sports hernia” (and sometimes real groin hernias) on a runner enthusiast website, it is a good resource if you are considering going to see Dr Meyers and want to read other patient experiences over many years.
http://www.letsrun.com/forum/flat_read.php?thread=559820
Many patients in that thread have had the sports hernia repair with and without mesh, it is a worthwhile read, all 150 pages of it!!! if you are actively researching the procedure(s) and outcomes.
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Alternatives to mesh
Linda,
Though the only path toward a hernia cure is a surgical procedure, there are activities you can do to reduce your symptoms. Keep thin and athletic. Perform exercises which focus on core strengthening. Don’t smoke nicotine. Prevent constipation. -
Alternatives to mesh
John,
I did not mention Dr. William Myers in Philadelphia who performs the NFL players hernia repairs because I wanted to speak them again. He founded the Vincera Institute and Foundation. I have spoken with them a few times and again recently. Dr. Myers knows all of the pure tissue repairs and can perform a pure tissue repair (without mesh), and with minimal anesthesia if you are a candidate for both based on his evaluation, according to what I was told. He doesn’t take insurance; however, he has to be the best to get the stamp of approval from the NFL and million dollar athletes. Look up Marshawn Lynch surgery (Seattle Seahawks running back) on Google and you will see an article mentioning Dr. Myers.
After fours years of research and living with an inguinal hernia and talking with multiple sources, this is my number one choice for now in the U.S.
I hope this helps.
Best regards,
Connier
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Alternatives to mesh
Thank you Connier, I appreciate your thoughts & insights. I do relate to your choice to live with your hernia & not risk surgery. I wish you well,
best regards
John
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