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Survey finds 64.5 percent patients “unhappy” after inguinal surgery
64.5 percent of patients in this survey who had inguinal repair were unhappy with it.
A “large group” of patients who had hernia surgery “felt abandoned’ when complications arose.
Chronic pain is most feared along with loss of sexual function. Some patients don’t mind shirt term fix and a recurrence. So much for recurrence being so important.
I hope good intentions, watchful, et al cast their eyes over it.
https://www.frontiersin.org/articles/10.3389/fsurg.2021.769938/full
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19 Replies
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Yes, the patient’s anatomy makes a difference.
I’m not sure why there was a common impression here that tissue repair doesn’t cause chronic pain. In the heyday of tissue repair, chronic pain wasn’t studied much, and the focus was on recurrence, so I think this sometimes gives people the wrong impression that chronic pain wasn’t an issue, and it started with mesh.
The question is really the likelihood of chronic pain with the different methods. I don’t think there are good answers, and the picture is obfuscated by the differences in surgeon competence. Just by looking at the details of the techniques, it’s not really possible to say which ones are more or less prone to cause chronic pain – the potential for chronic pain or other discomfort is in all of them.
The “conventional wisdom” among many surgeons appears to be that laparoscopic or robotic mesh when done right are generally the least likely to cause chronic pain, but I don’t know how well this is supported in research.
Like you said, the patient’s anatomy plays a part as well, and it’s not typically known all that well before the surgery.
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This reply was modified 1 year, 10 months ago by Watchful.
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This reply was modified 1 year, 10 months ago by
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And maybe the patient’s anatomy?
I’ve just read some reviews of Shouldice and there does seem to be a number of people complaining of chronic pain after Shouldice visit.
It’s a bit off-putting but I suppose they do loads of surgeries and that may be why
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William,
Definitely don’t listen to doctors who went to the “it’s all in the head” school of medicine. Mesh can absolutely cause chronic pain as shown by studies.
In terms of which techniques cause more or less chronic pain – who knows. All of them can and do cause it. A lot depends on the surgeon and how careful and meticulous they are.
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That’s ok Pinto! It’s taken me three reads to see it!
Maybe get my eyes tested or new glasses?
Getting back to the survey, sort of, I’ve had two UK based surgeons say that tissue repair is more likely to cause chronic pain. – Is there any evidence for this?
At the same time with one dismissing mesh related Chronic pain as being “in people’s heads”.
So I agree the pain is and has been overlooked in favour of decreasing hernia recurrence.
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William, sorry about the misspelling. Edit function of HT sucks!
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Willian, a slippery doc indeed! But it brought out discussion, didn’t it. It made me think about some things. Y’know, IHs have been medically dealt with for centuries and among the most frequent surgeries yet this issue of pain has hardly been scratched. I’m surprised the article didn’t make IH its sole focus. I would think the higher up on the body a hernia is, the less difficult. Would the issue of litigation against mesh be predominantly IH cases or variously divided among the types of hernia? The most severe cases I’ve heard involved IHs. Anyway I would think that the more widespread awareness in medicine of surgeon irresponsibility–as that of that quote, the more headway made about pain issues.
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Yes Pinto, that highlighted sentence struck me at the time and grateful for you posting it, I got waylaid by the statistics and numbers game.
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Oops. ‘IH’ was intended not ‘IG’.
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I beg to differ with the interpretations of the survey thus far. Actually it is possible that ALL IG patients were HAPPY with their surgeries! Emphasis on possible. Please note that only 1/3 of the hernias included were IG and their outcomes nondisclosed. Thus the survey has uncertain relevance for HT, certainly the stats for happy/unhappy outcomes.
However I find an important statement in the article; thusly
“some surgeons are reluctant to accept responsibility over implants they use or have insufficient knowledge about their properties or do not inform their patients well about all the risks and benefits of mesh or indeed non-mesh options. Not unsurprisingly, a growing body of patients are losing trust in the surgical industry.”Remarkable. The statement comes from a group including four surgeons and the first time I have heard such from medical providers.
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I don’t know how helpful it would be to compare hernia surgery to other surgeries. Even if hernia mesh surgery has more chronic pain than some of these other surgeries, the mesh may not be the culprit, and if it has less, it doesn’t mean that mesh is fine.
The natural approach would be to compare various mesh techniques to various tissue repair techniques, but tissue repair is so rare these days. Also, how do you deal with surgeon variability? A very experienced, conscientious, and meticulous surgeon who takes their time to do everything right will likely have different results from another type of surgeon regardless of technique. I was told many times that the surgeon makes more difference than the technique. This doesn’t mean that the technique doesn’t make a difference, but the surgeon (and whether he/she got up on the right side the morning of the surgery) may actually be the most critical factor. You would need to compare surgeons of similarly high levels of abilities, which is difficult.
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The purpose of the study seemed reasonable but it’s not clear why they went to social media to gather results. As Dr. Towfigh implied, people who don’t have problems rarely talk about their surgeries on social media. Their “aim” really should have said “perspectives of patients around their hernia repair problems”.
“The aim of this study was to explore the perspectives of patients around their hernia and its management, to aid future planning of hernia services to maximise patient experience, and good outcomes for the patient.”
I’ve often thought that a good study for helping to define the hernia repair chronic pain problem would be to compare hernia surgery to other similar surgeries. Classify the surgery by type. For example, survey patients who have had laparoscopic surgery for gall bladder removal or appendectomy or prostate removal in addition to hernia repair. If all of the groups have similar chronic pain problems that might shed some light on something besides mesh. If the other groups have a very low level of problems but only lap mesh patients have the 10 – 15% chronic pain problem, that’s pretty good evidence that mesh might be involved.
It is good to see other groups exploring the problem though. Thanks for posting that article.
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That’s what I like about Dr. Kang. He has been focused on minimalist approaches causing as little damage as possible while repairing the hernia. Whether that comes at the price of higher recurrence rates or not, I don’t know. He says not.
Even if there is a higher risk of recurrence, it may still be acceptably low when taking into account the reduction in the risk of complications. I chose not to go with him in my case because I was afraid of recurrence of my very large indirect hernia, but I really don’t know if that was the right call or not. I still suffer from a bunch of issues two months after my Shouldice repair. Not debilitating issues – I can function, but certainly annoying.
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Hello Dr Towfigh I think I put 64.5 percent of people in this survey who had inguinal repair were unhappy. Which is how I read the survey. I, nor the article, are claiming that. it’s two thirds of those who responded to this survey and who had inguinal hernia repair were unhappy. Is that right?
If every inguinal hernia patient who has surgery was questioned it may be that a higher percentage are happy with their repair or or could be an even greater than 64.5 percent are unhappy.
Ah I see the thread heading isnt making it clear it’s 64.5 of respondents, can it be changed?
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That’s an incorrect interpretation of the study and not the purpose of the manuscript.
This is not a population study of all patients undergoing hernia repair. Thus it is incorrect to say that ? of patients are unhappy with their repair.
The research study compares the different values and outcomes of those happy vs unhappy with their repairs. The proportion of unhappy patients is skewed from the normal population of patients undergoing hernia repair as most patients were recruited from hernia/mesh support groups.
The takeaway is for surgeons to focus on what is important to patients and help improve hernia care based on that.
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It would be interesting to know whether surgery is deemed to improve things across eg age, fitness level, IH type, time between diagnosis and surgery vs some type of physio…
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Agreed, so the right question is whether the patient suffers from less bothersome symptoms after the surgery than before the surgery. I don’t know the statistics on this, and whether they’ve been studied well. The impression that I have based on the studies that I have seen is that in most cases the patients are better off overall after the surgery, but the opposite still happens way too often for comfort.
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“cause other problems like chronic pain or discomfort”
But this misses the point that hernias also can cause chronic pain or discomfort. For example, it can hurt when an indirect hernia forces its way along the inguinal canal tearing tissues and irritating the nerve. The impact of the hernia on quality of life and health can be significant. Repairing the hernia removes/reduces those issues. Taking that improvement as the reference point, we can now perhaps better assess the relative negatives of the sequela that you point to.
For example, if a hernia is painful and fear of further damage constrains activities then some postoperative discomfort or pain may be a net improvement. In contrast, the report from someone else living with the consequences of a medical fiasco may well be a net loss relative to the impact of the hernia itself.
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The issue, though, that these surgeries too often cause other problems like chronic pain or discomfort. The hernia is fixed, but the patient ends up in worse shape overall because of damage caused by the surgery.
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I suspect that happy/unhappy with the repair is too unstable a reference. Perhaps a better perspective from which to compare values and outcomes could be obtained by asking whether the hernia repair improved the hernia and consequently your quality of life and health.
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