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Best mesh material and technique – worst material and technique
Rather than go round and round about mesh versus pure tissue, a topic that will help a patient choose the best mesh and technique seems useful, combined with advice about to avoid the worst.
For example, the only type of mesh repair that the popular “International” “Guidelines” recommend against is plugs. So any patient who needs a repair and has to choose mesh, should probably avoid a surgeon who does any of the plug repairs. This would be the Kugel repair and variations of the Prolene Hernia System. If you are referred to a surgeon who does a plug repair beware that surgeons consider it one of the most difficult to deal with if there are problems.
Another example would be coated materials. Coated materials are generally unproven, and some have been discontinued and their manufacturers are being sued. Atrium Medical produced C-QUR coated mesh, which has had major problems and is being discontinued. So, considering the lack of long-term information, avoiding the coated materials makes sense.
This Topic could just end up as a collection of bad materials to avoid but that would still be worthwhile, I think. If you have to get mesh at least avoid the really bad ones. Although, this would not have helped me back in 2014. I chose the “state-of-the-art” lightweight polypropylene Bard Soft Mesh and had it implanted via the state-of-the-art TEP procedure and still had major problems.
Anyway, this is a place to make mesh recommendations if anyone has them. Maybe a story about an athlete or a friend who had a mesh repair, and knows what was used, and has had excellent results. Any stories that can help separate “mesh” in to useful subcategories. The combining of all mesh and mesh techniques in to one word only helps the mesh-makers, giving them all cover. Whatever anybody has, feel free.
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8 Replies
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Here is an interesting but frustrating article about athletes and inguinal hernias. It goes in to depth about using unltrasound and Valsava to diagnose hernias. The frustrating part is that they do not describe at all the hernia repair method, but do report that the repairs seemed to alleviate pain and allow the athlete to continue in their sport.
But they do use the word “herniorrhaphy” which, by definition means no mesh is used. So, even without the details, here is a small positive study showing that non-mesh repairs can be successful for the athlete. Off the topic of the thread title but it follows from the discussion. The authors would be worth seeking out if you’re in the upper midwest area of the US.
Excerpt –
“Clinical Relevance:
Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.” -
There have been comments about how surgeons use mesh in athletes but, so far, no specific success stories. Not even anonymous stories. If you follow sports you’ll often see stories about athletes who go to specific clinics to have their knee, ankle or shoulder repaired. Or stories about sports hernias. But no stories about inguinal hernia repair. The one common thing you’ll see about the clinics that operate on athletes is that they avoid mesh.
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I think that I would focus less on the fact they specialize in athletic pubalgia and more on the fact that professional athletes seek them out for their core injuries. To them a common inguinal hernia is probably simpler to repair than a “sports hernia”. They all avoid mesh for any purpose in repairing an injury. I think that that is telling. The common man/woman gets mesh, the elite athlete avoids it. Search “dai greene mesh” to see what happens when an elite athlete gets the run-of-the-mill repair.
Dr. Brown also has athletes that seek him out and, as you probably know, avoids mesh, even though he was in the original group of surgeons who used the Kugel plug repair method. He saw firsthand the damage that mesh causes and stopped using it. Dr. Kang also used mesh and stopped using it because he had too many patients returning with pain.
Those are basically the two types of surgeon that are out there. Those who know mesh causes more damage than a pure tissue repair but say “oh well, that’s just how things are done today”, and those who see the damage and refuse to participate. People who just do what they’re told and collect the paycheck and those who control their own lives and destiny, doing the things that made them want to become surgeons. So that they can help people.
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Thanks Good Intentions. When I first started looking into non mesh repair and see Lampard et al, I thought wow if it works for them, it’d be brilliant for me.
It was only later, I discovered sports hernia and hernia are not the same.
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Dr. Muschaweck is known for repairing hernias, groin strains, athletic pubalgia (sports hernia), and other ills of the professional athlete.
My reference to the porcine material was because the article mentioned specific people with “hernias”, then started talking about porcine mesh. A typical lazy journalist method of trying to add interest to to an article. But the lazy comment led me to the Biohernia site when I started researching Lampard’s injury.
It looks like Lampard’s injury, and Glenn Murray’s, were both of the “sports hernia” type, maybe leading to full tears in the groin area.
Dr. William Meyer of the Vincera Institute is also known for working on professional athletes, with an emphasis on “sports hernias”. I think that he also avoids the use of mesh, but it looks like they have hired others that do use mesh. I’m not sure how they use it though. I’ve had correspondence with the Institute and asked if they could share their knowledge but, unfortunately, in today’s world, knowledge is money. If they show everybody how to do a better repair they’ll probably lose business. Capitalism.
https://vincerainstitute.com/core-muscle-injury-treatment/mesh
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This reply was modified 3 years ago by Good intentions.
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This reply was modified 3 years ago by
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I’m not aware biohernia use porcine mesh Good Intentions and it isnt made clear if all those football players, including Lampard, had ‘conventional’ hernias as opposed to “sports hernia”.
In searching for mesh repairs I came across this article about Glen Murray footballer (Crystal Palace and also Brighton teams). He was seen twice in Germany by Dr Muschawek but whatever was done didn’t work so he went to Prof Lloyd in the UK. In the article Prof Lloyd states Glen Murray’s injury was sports hernia which in Prof Lloyds view shouldn’t be viewed as a hernia or called hernia… I suspect most of the other athletes had sports injuries not inguinal or femoral hernias either.
Heres the link, you’ll be able to decipher it better than me!!!
https://www.express.co.uk/life-style/health/265218/Glenn-Murray-My-fans-will-see-the-best-of-me-now
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I saw your post about porcine mesh material and read the attached article. It led me to look for more about Frank Lampard’s hernia (Lampard is a famous soccer player). The article seems to imply that maybe Lampard had porcine mesh used to repair a hernia. But it turns out that he had Dr. Muschaweck (I think) repair his hernia.
The Biohernia project is getting very sophisticated. Here is the latest from their web page.
https://biohernia.com/en-ie/inguinal-hernia-elite-athletes/
https://biohernia.com/en-ie/inguinal-hernia/non-mesh-hernia-operation-methods/
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Absolutely brilliant idea. A basic requirement I’d have thought for all concerned.
Using best mesh ie least problematical is better for patient to minimise post op problems.
And better for surgeons, health care saves time, repeat or required additional surgeries. Builds patient confidence.
How are meshes selected anyway? By cost?
Saw a video, I think by Dr Towfigh, that have the impression it was down to hospital purchasing and not so much surgeons.
Dumbfounding that a list of least problematical has not been compiled considering mesh has had recognised “issues” for some time.
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