Reply To: Non Mesh Repair Questions

[drkang]

I totally agree with your assessment of mesh hernia repair.
I myself have seen many patients suffering from mesh pain as a surgeon, although I have not experienced it directly as a patient.
In addition, I have repeatedly experienced how difficult it is to remove mesh and how dangerous it is because the inserted meshes have been terribly clogged between many important structures including the muscles, vessels and nerves and so on, through about 40 mesh removal procedures. (I remove only the inserted mesh with open hernia repair)
It seems rather strange that not everyone who has undergone mesh operation experiences chronic pain.

I think that the recurrence rate of tissue repair and the incidence of its chronic pain are over-exggerated
Clearly, there are tissue repair methods, such as shoulder repair, that you mentioned, which have a lower recurrence rate than mesh repair.

The frequency of chronic postsurgical pain of such tissue repair is, as a matter of fact, lower than mesh repair.
Although tissue repair has the potential to cause nerve injury, it cannot produce mechanical pain caused by the mesh itself.
And the possibility of nerve injury can be minimized in the tissue repair as it is performed under direct vision, as can be seen by common sense.

In addition, nerve injury or nerve irritation in mesh repair can occur after a period of time after surgery due to time-consuming mesh folding, mesh migration and mesh contraction, etc, which does not happen in tissue repair.
In this way, the possibility of pain due to nerve injury is much higher in mesh repair than tissue repair, besides mechanical pain by mesh itself

Nevertheless, some surgeons claim that tissue repair also has as many problems as mesh repair
I think the reason is to defend their position in performing mesh repair with possible obvious complication.
Most of them simply cite what they say without a deep understanding and experience of tissue repair.
I think through this repeated quotation process they build up exaggerated figures that are favorable to them and that they wish it to be.
This is clearly wrong and very unfair to mislead the patients’ decision.

What is really sad is that there are fewer surgeons who can do tissue repair, and younger surgeons only have to learn about mesh repair.
If this time runs a little longer, even this controversy disappears, and mesh repair may be the only surgical option for inguinal hernia repair.
When mesh complication is considered serious, it will be a tragedy for future hernia patients.

In this sense, the role of few surgeons, including Shouldice hospitals, who strive to demonstrate the benefits of tissue repair, should be very important and encouraged.
I am ready to play such a role though it is very small.
For my brief introduction, I have performed more than 6,000 my own non-mesh tissue repair treatments so far and have had a recurrence rate of 0.5% and a mild chronic pain incidence less than 2%.
All my procedure is done under local anesthesia with 3-4cm skin incision and takes only 20 minutes.

Thank you for your passion for non mesh repair!