News Feed Discussions American College of Surgeons (ACS) – Very strange “Bulletin” Reply To: American College of Surgeons (ACS) – Very strange “Bulletin”

  • Good intentions

    March 10, 2023 at 10:50 am

    Thank you for the explanation and the link Dr. Towfigh. I read through the article several times and have to say that it is depressing to read. It has all of the hallmarks of “gaslighting”. Making statements with no foundation in fact and ignoring major issues that have been well publicized for decades. Suggesting artificial intelligence and robotic surgery methods will solve the problems.

    Downplaying the rate of problems and suggesting that a solution is on the way by reducing “overlap”. Pretending that pure tissue repairs are some sort of new development, “becoming more popular”. Ignoring the fact that the use of mesh has grown so quickly that it is has become the cause of the new problems.

    Dr. Poulose seems to be a new “mouthpiece” for the mesh industry and the ACS is supporting his/their efforts with the article interview and the weird video. Contrast this article with the Editorials by Dr. Campanelli in Hernia and the complete special issue of Hernia dealing with chronic pain from hernia repair. The word pain was only used one time in the article in reference to post-operative pain and that was with the absurd proposal that “overlap” is a cause of pain.

    I feel embarrassed for Dr. Poulose, and the community of surgeons as a whole. Stuck with these problems and with no apparent solution except giving up the bright lights of new technology. Dr. Poulose is either completely ignorant of what’s happening to patients in the field of hernia repair or he has convinced himself that the scientific studies published over the decades in the refereed journals are false. And he publishes himself, so he must know.

    “Tackling the Problems of Mesh

    But using mesh to repair hernias is not the permanent solution that it was intended to be. Mesh occasionally can get infected, and hernias can recur even if permanent mesh is used. In addition, mesh-related complications are increasing in frequency as more patients live longer. Mesh also can grow into the small intestine, colon, or bladder, Dr. Poulose explained.

    “Although these complications occur at a low rate, if you have one, it is obviously a big deal to you as a patient,” Dr. Poulose said. “

    Just as permanent mesh was once seen as a durable solution, it also was once thought that more mesh overlap is better than less. Recent research, however, does not necessarily support this assertion. The more overlap, the more likely there is to be postoperative pain for the patient, according to a study recently published in the Journal of the American College of Surgeons (JACS).4

    Finally, “no mesh” repairs are becoming more popular, especially when it comes to inguinal hernia or umbilical hernia surgery. Some repairs—such as with the Shouldice technique—can be done successfully without mesh. Even when no-mesh repair presents a higher chance of recurrence, many patients are willing to make the tradeoff, Dr. Poulose said.”