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To Mesh or Not to Mesh, That Is the Question Dr. Bendavid vs. Dr. Voeller
I just came across this article even though it’s almost a year old. I was struck by how the authors tended to choose past research that supported their opinions. Objective science is hard to do. I was also struck buy a statement from Dr. Voeller, that “ It is most certainly higher, but we will never know the truth in a country with a population of more than 300 million like the United States, since long-term follow-up is impossible.” The sentence is actually, literally, nonsensical. Follow-up is just asking questions at a later date. More people means more data is available. Hard to believe that he would say that, let alone have it printed. I can’t even try to interpret what he actually meant.
I also found it interesting that Dr. Voeller sidestepped the issue of chronic pain from mesh implantation, and mainly attacked recurrence rates, with just a few unsupported opinions about chronic pain. “I do believe that mesh, while it can cause problems in a minority of patients, in and of itself is not the predominant cause of CGP in the majority of patients.” He has a belief, but no real explanation for where it comes from.
Dr. Voeller seems like a conscientious surgeon but it looks like he is not up to the task of understanding this complicated issue. It’s a shame that he has become a representative of one side. Also a shame that there are even sides. Finally, he also blends all of the different types of mesh in one big mesh blob. No distinction at all. Very simple thinking. Disappointing.
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9 Replies
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responded in the dedicated post about this.
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Dear DR drtowfigh what you think about the article ?
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Hi,
Thanks, I would love to answer your questions in future also in the interest of hernia patients.
Many surgeons and especially Dr Kang is talking about the transversalis fascia role in hernia repair. I would advise to read our latest published article about that. Article no 13 at http://www.desarda.com/articles article013 Desarda MP. New Theory Ann of emerg surg 2017;2(1);1007.pdf
Prof. Dr. Desarda M. P.
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Dear drtowfigh What do you think ? Hi,
Thanks, I would love to answer your questions in future also in the interest of hernia patients.
Many surgeons and especially Dr Kang is talking about the transversalis fascia role in hernia repair. I would advise to read our latest published article about that. Article no 13 at http://www.desarda.com/articles article013 Desarda MP. New Theory Ann of emerg surg 2017;2(1);1007.pdf
Prof. Dr. Desarda M. P.
MS;FICS(USA);FICA(USA)
Chief of Hernia Center, Poona Hospital & Research Center
Mobile: 0091 7738181022 or 0091 9373322178
Email: desarda@gmail.com
Website: http://www.desarda.com -
“however for those whose lives are forever altered they will continue on and spend every ounce of energy on not giving up.” So true!!
I don’t understand how some doctors can be so dismissive about pain after mesh implantation. The pain and problems weren’t there before the surgery and after the surgery they are. It has to be either the surgical method or the mesh itself, but it certainly is related to the surgery. To tell patients who are suffering life altering consequences that it is all in their heads is cruel!! I really feel sorry for those who don’t have the time, energy or money to pursue a cure. I pray for us.
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Good intentions-the other flaw in “supposed” follow up is I’ve come across many people who had similar experiences as mine in that when we went back to our original surgeons (and later different surgeons ) complaining of pain post surgery we were told the pain was not due to the mesh or the surgery. For me and many others the only “test” done was a physical exam to see if there was a occurrence followed by maybe a imaging test that showed no recurrence.
So how is pain even being recorded when so many patients are being told their pain has notjkng to do with their mesh or surgery???!!!
surely it isn’t being reported of the surgeon doesn’t believe or doesn’t want to believe their is any correlation.
in my case my mesh was balled up so tjere isn’t any confusion whether my pain was caused by the mesh or not but so many surgeons told me the mesh looked good on the scans and no recurrence so it had to be something else.
this is one of the travesty’s with the mesh epidemic-how many others are out there who are trusting their surgeons that their pain symptoms have nothing to do with their mesh surgeries.
if the pain isn’t destroying their lives many people just accept this from there surgeons and move on.
however for those in whose lives are forever altered they will continue on and spend every ounce of energy on not giving up. -
A good time for patients to push their surgeons to submit their data to the AHSQC. See pinned post about this.
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On the other hand, Dr. Bendavid seems to be thorough in his research but also seems very biased. He could probably persuade more people to examine their methods and materials if he was not so critical of the surgeons who use mesh. I suspect that he offends many surgeons that use mesh, which makes them more defensive, resistant to exploring the possibility that some or all mesh devices might be bad. Closing ranks, as they say. Dr. Bendavid might actually be contributing to the continued use of mesh by polarizing the subject, instead of fostering an objective analysis.
Although his comments about conflicts of interest are probably very relevant. Many surgeons who support the use of mesh are getting paid by the device makers that provide it, apparently. Consciously or subconsciously, they have a financial interest in promoting its use.
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The comments at the bottom of the article are worth reading too. One is a student of Dr. Voeller, who “attests” to his method and says that he has a low chronic pain results. But he offers nothing to support the statement. He does seem to be aware that there is little followup, for recurrence, but seems to overlook that the same lack of awareness applies to chronic pain. Almost like he doesn’t really know what it is, or that it can manifest years later. He might be using the two week followup as evidence of no chronic pain, or “nobody has mentioned it” as evidence.
“I’ve copied Dr Voeller’s approach in over five hundred TEP repairs with two recurrences (that I’m aware of) to date over eight years and can attest to the lack of chronic pain with this repair with mesh and glue alone.”
Another surgeon comments about removing mesh, and avoiding plugs. But he still seems to assume that his method works well, not discussing his method’s chronic pain level. John Morrison might be a good surgeon to contact for mesh removal, since he seems to have experience.
” I do not advocate using mesh plugs in any patient.”
“My referral practice is almost entirely devoted to the care and treatment of hernias and their complications. Make no mistake, chronic pain is a major problem with devastating results. I spend a lot of time in the OR removing these patients meshes, with the majority having their VAS score reduced from 6-8, to 1-2”
It’s good to see individual surgeons thinking about these things but the lack of organized research is incredible. So many individuals making their own guesses, experimenting, but no quantifiable evidence of effectiveness.
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