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A “New” Nonmesh Technique for Inguinal Hernia Repair – 1895 method
I came across this new article about a very old pure tissue repair technique. It made me wonder why so many professionals are still researching pure tissue techniques if the huge extensive study by the European Hernia Society (aka HerniaSurge) clearly showed that a mesh repair gives the best results and that Shouldice is the only pure tissue repair that should be considered if mesh is not available.
Are these professionals chasing popular opinion for business reasons? Are the law firms skewing perceptions of reality with their lawsuits? Is the focus on pelvic prolapse repair mesh problems skewing the perceptions of hernia patients? I have seen all of these possible reasons proposed by various other professionals who attempt to support the use of mesh. Many of these professionals seem to consider recurrence as more important than chronic pain, to the patient.
It goes round and round and seems to always end up with the patient saying that they don’t want pain (that’s why they went to the doctor, to get rid of the pain), and the surgeon telling them that recurrence is what they should be worried about. The patient wants pain relief and renewed functionality, the surgeon just wants to get the abdominal contents back where they belong. What one feels, verus what one sees.
Anyway, here is an interesting 20 patient (tiny) study about a minor modification of a technique from 1895. Apparently the authors felt the work was worth doing and the editors of the journal felt it was worth publishing. It looks like it has a little bit of Desarda in it, I’m not sure, I don’t know the methods very well.
It’s in their “SURGICAL RETROSPECTION (HISTORICAL)” area, whatever that is, but the work was done on real patients in 2019 and beyond. I kind of feel bad for the patients, it looks like they have been used on a whim. If the method has validity it should be in the main journal, not the trivia section.
SURGICAL RETROSPECTION (HISTORICAL)
A “New” Nonmesh Technique for Inguinal Hernia Repair: Revisiting E. Wyllys Andrews and His Imbricating Operation
Yerxa, John MD*; Wang, Hanghang MD, PhD†; Pappas, Theodore N. MD‡
Author Information
Annals of Surgery Open 4(3):p e310, September 2023. | DOI: 10.1097/AS9.0000000000000310“…
CONCLUSIONS
We have described a technique for inguinal hernia repair without mesh. Our technique is very similar to an operation originally described by Andrews in 1895. This operative technique combines elements of both the Bassini and the Halsted repairs. This method is easy to teach, and we believe that the recurrence rate may approximate that of the Shouldice repair. Further prospective studies will be required to validate these assumptions, both with regard to teachability and durability.
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10 Replies
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I think there were a lot of other patient he “experimented” on similarly as this poor woman always thought she was alone until she heard about them. Very very scary. Theres also just been another NHS doctor who falsified age and qualifications and who killed (murdered) a woman by using a controversial puncture technique near her heart.
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William, scary, scary story that one. You often come up with these scoops from the other side. 🙂 At first I thought of the possibility of an agreed experiment with the patient but she made clear that wasn’t the case. Understandably there are times “experiments” happen when patients agree to an unorthodox, last ditch medical effort. But without patient consent it is surely unethical. This is a reason we hear of the advice to steer clear of teaching hospitals. You are likely going to either help break in a new technique or a new surgeon or both.
GI’s call received was likely a tip-off. The surgeon’s reaction suggests the call wasn’t routine, so we must think the caller was motivated by a slip up or failure of some kind. A weird question, how’s the mesh?
Could it be the nurse was in disagreement with surgeon in some way? Once I had gastroenteritis but a doc misdiagnosed it and gave me worthless meds. Luckily a nurse on the side tipped us off that the doc was clueless. If GI reported a problem to the nurse, she might have spilt her beans if in a rift with the doc. Or some words of advice.
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This reply was modified 9 months, 3 weeks ago by pinto.
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This reply was modified 9 months, 3 weeks ago by
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Thanks for posting that William I probably would have missed it. Besides the terrible behavior of the surgeon, the fact that everyone around him was afraid to report it is the most concerning. The parallel with hernia repair is remarkable. I am certain that PA’s and nurses and anesthesiologists and imaging specialists are all aware of the hernia repair mesh problem. They are all actually present as the initial reports are made and along for the ride as the delay and deflecting occurs, sometimes leading to treatment including pain treatment and mesh removal. But they have bills to pay and lives to lead so they stay quiet.
I remember days after the mesh implantation I got a call from a nurse at the ambulatory surgery center asking me “how’s the mesh?” in an aggressive irritated tone. I was so shocked that I could barely comprehend what she meant and had to ask her to repeat the question, and ask if there was something wrong with it. She said “how is it, how is the mesh doing”” and I replied that it had only been a few days, “how would I know?” I then called my surgeon to ask what was going on and he was kind of flustered and said it was nothing and he would deal with it. It’s always been in the back of my mind that something wasn’t quite right about the surgery, but the surgery notes said that everything went according to plan. A perfect implantation.
Also shocking that the brain surgery story happened in Scotland where they banned transvaginal mesh, or tried to, because of the numerous problems. So on one side you have proactive actions and on the other you have inaction. All in the same system.
https://www.parliament.scot/~/media/committ/552
They fell back on the “removal will return the patient to normal” fallacy.
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Ms Todd said the Scottish Government has made “significant progress” on transvaginal mesh as she said “everything is being done” in negotiating contracts to assist those with mesh implant removals. The Minister said she hopes to update parliament on the negotiations soon.Ms Todd said: “We’ve established a national service for the management of mesh complications and women have options with regard to their treatment which can be undertaken in Scotland, elsewhere in the UK and also with an independent provider if desired.”
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Ref experiments, I thought no, surgeons would never do that.. then saw this, not hernia but brain, shocking all the same
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Quote: “The work itself in this paper is obviously of little value….”
Not so. It reinforces in me that my hernia was a godsend! Living a perfect life in perfect health and so with little medical experience, I never would have imagined the realities of medicine today. That is what this article A New Nonmesh… reinforces in my mind. Our @Chuck can be so funny as in a recent thread:
“lap surgeons [might do] unnecessary surgery under the guise of saving you in the future then they get a double payment—-daughters wedding coming up -—better double mesh a few suckers.” Over the entire stretch of the medical world, there must be some unethical acts as those. There must be.Perhaps poor writing of A New Nonmesh… accounts for the suspicions raised but I don’t think so. “Publish or Perish” pressures may have been involved that led these medical professors to do what appears as an experiment possibly unknown to the patients. The paper can be useful in an unintended way.
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To be clear, I posted this mainly as a discussion point about the fact that pure tissue techniques are still a major area of study. The work itself in this paper is obviously of little value except that it reintroduces an old technique to the community of hernia repair surgeons, and shows that some surgeons have not accepted the view that mesh is the best starting point for hernia repair.
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If I read correctly, bladder patients were not “selected.” The issue is what happens when mesh cannot be used—either by wish of the patient or mesh is “contradicted,” a patient condition that rules out mesh. But here is where the article gets messy. It is unclear how many if at all were contracted cases prior to surgery. The article states that there were four cases that developed complications—presumably after surgery—two of which had chronic bladder “dysfunction” known before surgery. So we can surmise that at least two of the cases were ruled out for mesh.
The authors are also unclear about what tissue repairs were offered these patients. The authors merely say that “Patients were offered tissue repair.” That seems to skirt ethics because there is tissue repair and then there is tissue repair. The modified-Andrews hardly can be claimed a proven method; thus it becomes experimental. Were the patients offered a standard tissue repair as well or was modified-Andrews only offered as well in the guise of standard repair? Scary!
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Yes Pinto I thought similar. Also why select patients with chronic bladder dysfunction too? Id still like that know that is. Is it enlarged prostate or defuser muscle loss with some degree if urinary incontinence?
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INVESTIGATION REQUIRED! Did these patients know surgery was likely experimental and principally done by an intern?
This is a very weak paper considering the authors are unclear why they chose Andrews’ method, apparently unvalidated modifications or explanation missing, follow-up mean is only 13 mos., and possibly authors’ unacknowledged real motivation was to find an easy but yet debunked hernia method.
I would like to know the social status of the patients, for I fear they may have had uneducated, indigent backgrounds without the wherewithal for optimal decision-making.
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Really interesting. Good find.
Just wondering…
What is chronic bladder dysfunction?
And what would conservative methods to relive pain be?Finally, I have often wondered why the medical profession is so obsessed with recurrence risk rather than pain risk. It seems it’s time and money. This was highlighted in a video someone linked to, think it was a comedy sketch. Possibly Pinto or Watchful. Be good to see that again.
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