All in one mesh technique

Hernia Discussion Forums Hernia Discussion All in one mesh technique

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    • #26645
      Alephy
      Participant

      Has anyone heard of the all in one mesh technique? It is done in italy apparently and also with bio meshes…

    • #26646
      Piffleder
      Participant

      I have never heard of all in one mesh technique.

    • #26653
      Alephy
      Participant
    • #26655
      Alephy
      Participant

      And here is a video

    • #26657
      Good intentions
      Participant

      It’s just another surgeon’s best guess at the source of chronic pain, proposing that direct interaction of mesh with primary nerves is the cause, avoiding the idea that the mesh itself causes pain no matter where is located. By “all-in-one” I think that he means “combined”. He is combining suturing methods with mesh implantation.

      At the end of it all though, there is no data supporting his premise, or his new method. It’s just another cobbled together way to do a hernia repair, no evidence shown at all that it works, let alone does not create a whole new set of complications. It’s how new products are developed today, around the world.

    • #26659
      Alephy
      Participant

      I found this paper on this method

      https://pubmed.ncbi.nlm.nih.gov/28851612/

      I am just wondering whether they also use bio (absorbable) meshes too….as long term any mesh is likely to cause problems no matter what, I am just wondering whether a method that would protect the sensitive parts long enough for the mesh to go away might work at least better than the current options…

    • #26661
      Good intentions
      Participant

      Thank you for that link alephy. I located the full paper and have linked it below.

      The results do look good, in their paper. But, like many research reports, it ends with “more work needs to be done”. At the long-term interviews they apparently just relied on someone to ask the patients some questions. And ended up with “All patients seemed satisfied with the operation, the recovery and the final result.” All of that work and the end result is “seemed satisfied”. Hard to know what to think about that.

      Also, they only interviewed less than half of the original group at 24 months. 104 patients out of 240 starting. “24 months (104 patients)”. It is common for disappointed patients to avoid the surgeon who performed the first procedure. It could well be that the other 146 patients were disappointed. It’s unknown.

      It is not a terrible research paper though, they just weren’t very diligent at the end. It could be much much better. It’s unclear how or why a surgeon would choose that method over any other mesh-based method. They all say that they are good.

      I see also that the average age of the study group is 61.7 years old.

      Here are some excerpts:

      ” From September 2012 to August 2015, we treated 250 adult patients for primary inguinal hernia, 241 males and 9 females with an average age of 61.7 years (range: 22–90). Hernias were classified according to the European Hernia Society criteria ”

      “Patients underwent to planned follow-up at 3 months (50 patients), 6 months (35 patients), 12 months (25 patients), 18 months (35 patients + 1 patient lost) and 24 months (104 patients). Average follow up 15 months. None of our patients suffered from postoperative neuralgia, sensation of foreign bodies or even simply discomfort. One recurrence was seen. The patient was re-operated by laparoscopic approach (TAPP). All patients seemed satisfied with the operation, the recovery and the final result.”

      “A multicentre study, with long term follow-up, is needed to compare this new procedure with the most common techniques.”

      https://www.sciencedirect.com/science/article/pii/S1015958417301628?via%3Dihub

    • #26664
      Alephy
      Participant

      Yes, and I am also wondering whether they are continuing with this method trial fashion or whether it is now regularly used. I will try and find out. I would still object to a permanent mesh though…

    • #26665
      Alephy
      Participant

      I watched a public appearance on tv of the doctor that invented the technique: he said that the mesh they use is 1. smaller 2. of a particular shape so tailored to the area 3. 70% reabsorbed so only 30% is left in the end.
      Their aim was to reduce chronic pain (he mentioned a 10% rate of chronic pain with the normal procedures/protheses, acknowledging that it is a real problem) and the sensation of foreign body presence, as well as having a simpler procedure (they seem to have an easier life avoiding to touch the nerves, also the mesh is not in contact with them somehow)

      I will send him an e-mail, I wonder if they can also use fully re-absorbable meshes (if so I would consider them).
      I think I read somewhere that the recovery time they observe is quite fast too. I have also read that the head of the hernia center is also an advocate of tailored surgery, and they also include tissue only procedures when warranted. Considering that it is not far, and possibly not too expensive it might be a good option

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