American College of Surgeons (ACS) – Very strange “Bulletin”

[drtowfigh]

– he is right that little is known about patient perspectives in an objective studied manner. There are very few publications addressing it. He is not referring to patient perspectives on social media and online, if that’s your take.

– there are so many reasons for chronic pain postop. How the nerves are handled is considered one of them, as first proposed by Dr Amid, Dr Poulose’s study hints it may not be an important factor. Other causes can include too tight a repair or other surgical technique problems, choice of repair, hernia recurrence, infection, and mesh related problems.

[Good intentions]

Here is a new article with Dr. Poulose as co-author. I have to assume that the other authors are the ones recognizing chronic pain as a major issue.

There seems to be some slight avoidance of an obvious conclusion – if nerve management during surgery is not a cause of pain, then what else could it be? Could it be caused by the mesh itself?

https://www.sciencedirect.com/science/article/abs/pii/S002248042200734X

Are Nerves Left In Situ Associated With Less Chronic Pain Than Manipulation During Inguinal Hernia Repair?
Emily George MD, Molly A. Olson MS, Benjamin K. Poulose MD, MPH, FACS

“Conclusions
Although guidelines emphasize three nerve preservation, the management strategies evaluated were not associated with statistically significant differences in pain 6 mo after operation. These findings suggest that nerve manipulation may not contribute as a significant role in chronic groin pain after open inguinal hernia repair.

…

Introduction
Chronic pain is defined as pain that persists for more than 3 to 6 mo past the appropriate healing time for an injury.1 Pain can be neuropathic, which is defined as nerve damage, either via entrapment or dissection, or nociceptive, which is a peripheral sensory stimulation from localized inflammation.2 The rates of chronic pain after inguinal repair can be as high as 18%-51%.2, 3, 4 Given that more than one million inguinal hernia repairs are done in the United States every year, this rate of postoperative chronic pain leaves much opportunity for improvement.5

…

Disclosure
Emily George, MD: Nothing to disclose.

Molly A Olson, MS: The ACHQC has contracted with Weill Cornell Medicine to provide biostatistical support for ACHQC projects. The work provided for this manuscript was performed under the umbrella of the Weill Cornell Medicine and ACHQC collaboration plan.

Benjamin K Poulose, MD, MPH, FACS: Receives salary support from Abdominal Core Health Quality Collaborative (ACHQC). Receives research grant funds from BD Interventional and Advanced Medical Solutions.”

[Good intentions]

Here is a fairly recent paper with Dr. Poulose as co-author. They seem to be living in a completely different world. Hard to understand. It’s published in Hernia, I assume that he reads the journal. Published April 2022, claiming that “little is known regarding the patient experience of mesh-related complications…”. Where have they been?

https://www.sciencedirect.com/science/article/abs/pii/S0039606021009429

Hernia
Patient perspectives on mesh-related complications after hernia repair
Madison A. Hooper MA, MEd, Savannah M. Renshaw MPA, MPH, Benjamin K. Poulose MD, MPH

“Background
To explore the thoughts, feelings, and experiences of patients with mesh-related complications after hernia repair. The rate of long-term mesh-related complications requiring procedural intervention after abdominal core surgery, including hernia repair, is unknown. Determining this rate is challenging due to its anticipated low chance of occuring and historically poor systematic long-term follow-up in patients’ hernia repair. The lived experience of these patients is also not well understood.

…

Conclusion
Despite the widespread use of mesh in abdominal wall operations, little is known regarding the patient experience of mesh-related complications. …”

[Good intentions]

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.”

[drtowfigh]

The “ACS Bulletin” is the name of their monthly newsletter. It does not function as a bulletin, per se. It’s just the title of their newsletter to members.

Also, the way the video was edited is not clear. Read the full article, which provides much more clarity and description about hernia surgery and mesh and the current status of things. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/march-2023-volume-108-issue-3/new-approaches-trends-are-emerging-in-hernia-repair/