Actually, even getting data from billing databases using ICD and CPT codes is very difficult. And it’s impossible to get good data. A single.integrated medical record would allow us to get good, real world data. I respectfully disagree with the notion that medical device manufacturers dictate surgical procedures. That is generally the last thing in a surgeon’s mind when seeing a patient. And mesh choices are often dictated by hospital administrators, without, and even ignoring surgeon input. I have seen this first hand. Finally, the sutures are made out of material very similar to mesh, and I have seen plenty long term problems from suture repair in my career. Not as many as mesh, but that’s because the numbers for suture repair are lower. If 90% of groin hernias were repaired with permanent sutures, we would certainly see more problems from this. Some technique related, some anatomic related, some infection related, some related to foreign body reaction to the suture material, and some related to recurrence. And that is exactly why we need long term outcome data. By the way, I know a surgeon that had their inguinal hernia repaired at Shouldice, and ultimately had a good long term outcome, but the experience there was terrible, and there has never been a follow-up survey or contact of any kind from Shouldice. I am not advocating for or against Shouldice Clinic, but anyone claiming near perfection simply is not telling the truth. From their website: “Our 99% lifetime success rate for repairing primary inguinal hernias sets the gold standard.” This type of statement is no better than a mesh company saying the same thing about mesh repair. Nobody is perfect, but we could all be honest.

By the way, this is a very good discussion, and I appreciate you all taking the time to respond.