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Mesh removal is becoming a mainstream procedure
I might have posted something similar in the past but i can’t find it. Here is a study comparing different ways to remove mesh. The problem has become big enough that it cannot be ignored anymore. SAGES has given the topic a platform. Looks like just an abstract, probably a poster in the exhibit hall, but still a start.
Excerpt –
“Dr. Huynh noted that mesh removal is safe and effective for treating chronic postoperative inguinal pain in the right patients, regardless of the approach taken. “Due to the reoperative setting and distorted anatomy, these cases should be approached judiciously by surgeons who are practiced in it,” Dr. Huynh said. “Based on our group’s own experience and trends in this data set, we prefer a robotic approach when appropriate. However, we continue to regularly employ the open and laparoscopic techniques when necessary.” “
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6 Replies
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It must be stressful to implant mesh using today’s state-of-the-art technology, knowing that the same technology might be used to remove it. The next step, obviously, it to plan for removal as the the mesh is being implanted. Like a surgeon using a screw to set a bone.
If you know it might have to come out, do certain things to make it easier. Do certain things that won’t result in more damage during mesh removal.
It’s good that this conflict is being shown. It just seems very strange.
Here is another article from the references of the article above giving instructions for mesh removal. It’s rare to see the cause and effect relationship stated so clearly by experts in the field.
https://link.springer.com/article/10.1007%2Fs00464-018-6558-5
Excerpt –
“Conclusions
As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.” -
I did just notice one thing about the article that is very disappointing. The first reference is the “International Guidelines” which have been called in to question by professionals, and are generally suspect since the effort was sponsored by mesh makers, and started with the premise, stated in the publication, that mesh was the preferred method of hernia repair. An example of how the framework for mesh usage persists, despite much evidence suggesting that it causes more harm than pure tissue repairs.
Laparoscopic/robotic methods need mesh for hernia repair. Without mesh those businesses will suffer greatly. The authors had to show that mesh was “preferred” by citing the “Guidelines”.
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Thanks for the reply MarkT. My comments are meant to be more rhetorical and general, about how the typical patient does not have easy access to the knowledge necessary to be “informed”.
Removing mesh is just described as another procedure to be performed, like some sort of natural occurrence to be dealt with. Imagine the doctor describing how the same tools used to implant the mesh can be used to remove it, at a hernia repair consultation. That would be an awkward conversation.
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A quick note on study ‘paywalls’…
If you know anyone who attends a university (or has a kid in a university), you can ask them to try and pull a copy of the study through their school library’s online database. It is free for them, takes literally a few minutes to find and download/print, and they can do this from home. Not *all* studies will be accessible by students at any given school.
Alternately, virtually all studies include contact info (email + school/institution) for the authors and a primary contact is often indicated for correspondence (otherwise, contact the first author). More often than not, they will be willing to email you a copy of the study and they are typically happy to learn that someone is interested in their work. They might even point you to some additional resources.
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The first comment to the GSN article is interesting. The doctor missed the opportunity to describe the method and materials that have worked over the years for him though. But his point is valid.
“Rafaellugomd wrote on: 1/11/2022 3:21:02 PM (EST) 2 days ago.
I looked at the numbers and what stands out to me is that in 23 years doing inguinal hernias in the same city and practice, I have never removed a single mesh and this group has all these patients to remove meshes. The question I have is why? Why so many? Is there a problem with the technique when these are placed? “ -
Here is a publication by the authors on the subject. More good places to consider for mesh removal. Dr. Towfigh is a co-author.
Unfortunately, despite the efforts to make patients responsible for being “informed” so that they can take responsibility for their decisions, the main article is a pay-per-view article. Everything comes back to money.
https://link.springer.com/article/10.1007/s00464-021-08963-4
Three of the authors are from Cedars-Sinai Medical Center, and two are from the Beverly Hills Hernia Center.
Here is the head author’s address:
Desmond Huynh, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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