American Hernia Society 2019 Conference Presentations and Notes?

[drtowfigh]

[USER=”2042″]Jnomesh[/USER] I completely agree with you. And it’s so frustrating that change and education/training is such a slow process.

we are in discussion of having a course on mesh complications and how to treat them. I give talks on this, as some others do, and in fact will be discussing it next week at our SAGES meeting, but I think a fully dedicated course is what we need.

[Jnomesh]

Thanks for posting Chaunce and Good Intentions thanks for all your input. You both are great contributors to this site. Just want you to know although I don’t respond to all of your posts indonread them all as I’m sure many do.

Although I am not anti mesh (it has its place ) I am totally against the way the current climate regarding hernia repair and the overuse of mesh, it’s comlicstins, lack of oversight, and lack of patient choice and care post surgery that gets me very inflamed.

we know that mesh is the standard practice used for hernia repairs.
we know that at the very best the majority of med students are not sufficiently trained on pure tissue repairs or not trained at all.
we know that mesh is either the sole cause or pmaysba role in many patients who have pain issues post mesh surgery. And these % are growing as more problems are coming to light.
we know most surgeons out there do not know how to do a pure tissue repair and many of the surgeons who feel they can do a pure tissue repairs as a matter of practice don t do many leading to a reduce quality of care to the patient.
Many surgeons refer to the inguinal region as one of the most complex anatomies of the human body-so I’m not sure how a conference can really help surgeons to learn more about pure tissue repairs. It’s trsining, supervised surgeries, and plenty of practice that leads to expertises.
so the field is interwoven and set up to use and promote mesh.

Howeber, I want to shed light on another area of this topic that is totally unacceptable especially when mesh is the gold standard and being used 99% of the time in the US: Patient care post mesh surgery.

since my mesh nightmare I have vowed to be there to help people who have had surgery with mesh and are struggling with pain issues. I probably hear from and speak to on average 4 new people a month who are having issues post mesh surgery.
A common theme I find in all these people stories that echoed mine to the T is that all these people went back to their original implanting surgeon either weee dismisses right away or over time by their implanting surgeon.
like my situation and theirs-it usually goes something like this:
return to surgeon to complain of pain
surgeons says give it time
after some time return to surgeon
surgeon does a physical exam, days no hernia recurrence and either rx more time or a making test (MRI, CT, or ultrasound )
imaging comes back no hernia recurrence and mesh is placed appropriately
if pain symptoms suggest nerve entrapment
nerve block is rx or its off to pain manegemt and our is rx to see other specialists:hip, back, Gzi etc.
By this time patient gives up in going back to original surgeon and lives with pain symptoms or explores other options with different surgeons .
Implanting surgeon has a clean record no issues of pain due to the mesh.
To me this is a tragedy but is common practice form my experience and the majority of others I speak to.
The implanting surgeon either doesn’t want to hear it Bc they know they can’t do anything since mesh is made to be permanent or they are truly untrained in mesh complications.
mesh complications aren’t only obvious infection or nerve related. As we now know we see patients with migration of the mesh, folding of the mesh, balling up of the mesh, attaching to and or perforating the bowels, latching on to many unwanted structures-bladder, neves, arteries, spermatic coed, autoimmune disorder, fibrosis, Sheila ge of the mesh and many more.
Mall these symptoms can mirror other issues so the patient goes through a carousel of doctors often ignoring the root cause-the mesh.
This to me is the final cherry on the proverbial sundae: predominately using mesh, not offering adequate alternatives, not warning of all the complications mesh can cause and then of the patient comes back with pain issues they are dismissed and hands are wiped clean.

if mesh is going to continue to be the gold standard which for the near term it looks like it will be then there has to be a suitable humane protocol for people who are experiencing problems post mesh implantation with impnatkng surgeons as requirements to be extensively trained on mesh removal and trained in mesh issues and trained on how to read a imaging test as it pertains to mesh. To me that’s a start.

Althougg helpful and beneficial I don’t think a few conferences are going to touch the problem.

[Chaunce1234]

My opinion is that the spread of knowledge is good, so the more information sharing that can occur the better. It might be less than ideal but even a very low-budget solution like recording the conference presentations with an iPhone and putting those videos onto YouTube would be better than nothing. I know the larger an organization with the more members and players involved, the more difficult this kind of thing can be, but I think it’s worth the effort anyway.

I do want to thank [USER=”935″]drtowfigh[/USER] for the work that you do. From the outside looking in, it appears that [USER=”935″]drtowfigh[/USER] is one of very few speakers at the Americas Hernia Society meetings to regularly raise awareness about potential issues with mesh, with a strong focus on the patient, while also promoting tissue repairs as valid for many patients. Why those views are not widely adopted by everyone is a mystery given the evidence. So thank you again Dr Towfigh, please keep up the good work.

[USER=”2029″]Good intentions[/USER] I think you are hinting at a valid concern, it would be obviously problematic if industry was improperly influencing conferences, talks, decisions, studies, education, or medical care in any way that distracts from the benefit of the patient. Ultimately the patient and patient quality of life must always come first.

[drtowfigh]

The Hernia Compact course was very successful. It was focused toward residents, fellows, and junior practicing surgeons. They were taught open, lap, and robotic surgery techniques, including both mesh and non-mesh options. They had anatomy reviewed, imaging reviewed, and then a hands-on course for the open and robotic techniques with and without mesh.

[Good intentions]

quote Good intentions:

There is even have a special Hernia Compact course to teach a new crop of mesh surgeons how to do it. I wonder if the course material includes tissue-based repairs? I would like to see the course material, it will tell where the industry is going, good or bad.

“Hernia Compact

The Americas Hernia Society is pleased to announce the first US “Hernia Compact” Course for young surgeons interested in direct interaction with international leaders and experts in the field teaching the fundamental concepts, anatomy, and techniques of Hernia Repair and Abdominal Wall Reconstruction. The program will be offered as a closed concurrent session during the 2019 AHS Annual Meeting at the Aria Hotel in Las Vegas on March 13, 2019.

Hernia Compact Registrtion if full!“

I wish we could see what is being taught. Why not publicize it, to combat the fears of the patients?

https://twitter.com/Herniadoc/status/1108818200441978881

Yes! The Hernia Compact course at this year’s @AmericasHernia annual meeting last week taught exactly that!

Stay tuned for more such courses. #shouldice #nyhus #AHS19 @BKP_Columbus @davidcchen

— Dr. Shirin Towfigh (@Herniadoc) March 21, 2019

[Good intentions]

“Unapproved”. Here’s a start for anyone interested.

https://twitter.com/Herniadoc/status/1108782585834954753

I gave a talk to #herniasurgeons at our annual Americas Hernia Society meeting #AHS19 titled “Perceptions of Mesh Use in Hernia Repair.”

Here are some of my takeaways:

- We are using too much #mesh. Non-mesh tissue-based #herniarepairs are perfectly adequate for many #hernias. pic.twitter.com/AuBBM5ndPa

— Dr. Shirin Towfigh (@Herniadoc) March 21, 2019

[Good intentions]

I, personally, am just looking for ways to access the information. Words, video, audio…

Chaunce1234, Twitter seems to be the communication platform of the day. Very brief bits of information, but still better than nothing, and typically has comments from others. I think that I’m going to collect/create a list of Twitter accounts to track.

Here are Dr. Towfigh’s comments on the presentation I asked about. Thank you Dr. Towfigh.

https://twitter.com/Herniadoc/status/1108782585834954753

https://twitter.com/Herniadoc/status/1108782695419543552

https://twitter.com/Herniadoc/status/1108782762310266880

https://twitter.com/Herniadoc/status/1108782792224067584

I gave a talk to #herniasurgeons at our annual Americas Hernia Society meeting #AHS19 titled “Perceptions of Mesh Use in Hernia Repair.”

Here are some of my takeaways:

- We are using too much #mesh. Non-mesh tissue-based #herniarepairs are perfectly adequate for many #hernias. pic.twitter.com/AuBBM5ndPa

— Dr. Shirin Towfigh (@Herniadoc) March 21, 2019

[drtowfigh]

As you may know, most surgical societies are poor and/or struggling to stay afloat financially. Making presentations publicly available is costly. We have looked into various avenues of doing so and just can’t afford to do so. Videotaping is super costly. Live-streaming is even more costly. The society does not own the presentations, so each surgeon must agree to provide them publicly.

It it was quite an amazing meeting this past year.

[Good intentions]

Dr. Towfigh, could you share your presentation? Or suggest a way to see the other presentations? Chaunce1234 was right, the topics are very interesting. [USER=”935″]drtowfigh[/USER] [USER=”1916″]Chaunce1234[/USER]

Session 5: The Great Debate: Mesh, Litigation, Petrochemicals and the Patient (Panel Session) Moderators: Michael Rosen, MD & Sharon Bachman, MD

Perceptions of Mesh Use in Hernia Repair Shirin Towfigh, MD

[Good intentions]

Sorry Chaunce1234 I got carried away in studying how one of these organizations work.

To your original question – it seems like the AHS would make their presentations open to the public so that patients can be well-informed and up to date. jnomesh just posted a topic about “why patients ask for non-mesh repairs”. The AHS should be an educational resource for patients, since they are the ones who sign the informed consent forms. If the research supports the use of mesh for the patients long-term benefit, let it out where people can see it.

They can’t be the world wide authority unless their work is known. Shine a light on the problems.

“The vision of the Americas Hernia Society is to be the world wide authority on hernia.”

[Good intentions]

And finally, the American Hernia Society is also a not-for-profit corporation. Interesting to see the three branches defined like they are.

https://americanherniasociety.org/uploads/files/AHS_Bylaws_Amended_and_Restated_2018.pdf

[Good intentions]

And here is the Corporate Alliance statement. Similar.

“The Americas Hernia Society (AHS) Corporate Alliance (CA) is a group of manufacturers who provide service and/or materials to assist professionals in the diagnosis or treatment of disorders of the abdominal wall. The Corporate Alliance is committed to supporting scientific programs of the organization.”

The corporations must have influence. And the device maker corporations are not going to be supporting tissue-based repairs. As opposed to government funded research, which focuses on cures, the device makers are looking for consumers and market share. It’s like training a fox to guard the hen house. They are what they are, corporations with a responsibility to share holders to maximize return on investment.

[Good intentions]

Sorry, it’s difficult to see the distinction on the web page. The headings stay the same no matter what page you’re on.

Here is the AHS statement. It looks similar.

“Our Mission & Vision

The mission of the Americas Hernia Society is to advance the science and treatment of hernia. The vision of the Americas Hernia Society is to be the world wide authority on hernia.

AHS fulfills its mission and vision by, among other things:

a) hosting periodic meetings for open presentation and discussion of scientific material concerning subjects of common interest,
b) cooperating in educational endeavors with groups of similar interest throughout the world,
c) initiating and cooperating in the publication of a journal and/or newsletter on the subject or hernia/abdominal wall abnormalities, and
d) undertaking projects of scientific interest to seek information and otherwise serve the mission of the organization.”

[drtowfigh]

[USER=”2029″]Good intentions[/USER] you have mixed the mission of the AHS with the AHS Foundation.

I believe the Hernia Compact course was funded by 2 companies in efforts to help subsidize the registration fee charged from the residents, fellows, and junior practicing surgeons who signed up for the course.

[Good intentions]

I think that I have figured out how to avoid “Unapproved”. “Paste as plain text”.

And the corporations.

Corporate Alliance Members include:

Bard Davol
Cook Medical
Ethicon
General Surgery News
Getinge Group
Gore & Associates
Insightra Medical, Inc
Allergan
Medtronic
RTI Surgical

Corporate Alliance Fees:
$25,000 initial joining fee
$15,000 3-year renewal fee

[Good intentions]

Too many odd formats in the text, apparently. “Unapproved”. Here is the bare facts part.

Here is the “Corporate Alliance” side. Probably the sponsors for the Hernia Compact Course.

https://americanherniasociety.org/corporate-alliance

[Good intentions]

Here is the “Corporate Alliance” side. Probably the sponsors for the Hernia Compact Course.

https://americanherniasociety.org/corporate-alliance

“Corporate Alliance

The Americas Hernia Society (AHS) Corporate Alliance (CA) is a group of manufacturers who provide service and/or materials to assist professionals in the diagnosis or treatment of disorders of the abdominal wall. The Corporate Alliance is committed to supporting scientific programs of the organization.”

And the corporations.

Corporate Alliance Members include:

Bard Davol
Cook Medical
Ethicon
General Surgery News
Getinge Group
Gore & Associates
Insightra Medical, Inc
Allergan
Medtronic
RTI Surgical

Corporate Alliance Fees:
$25,000 initial joining fee
$15,000 3-year renewal fee

[Good intentions]

quote Chaunce1234:

Is it possible for the general public to view the recent American Hernia Society 2019 conference presentations and notes somewhere online?

I saw a few interesting slides from different presentations and it looks like some interesting topics were discussed.

The AHS is a not-for-profit organization. They have a somewhat odd mission statement, with “devotion to the advancement of the diagnosis and treatment of abdominal wall abnormalities and to seek projects of scientific interest to AHS to fulfill this mission.” as the core of it. It looks like corporate funded R&D to get new products to market.

https://americanherniasociety.org/ahs-foundation

[drtowfigh]

AMERICAN Hernia Society is the original name of the founding society. However, it truly represents the Americas and not jus the US. Thus, about 6 years ago, we voted to change the name to the Americas’ Hernia Society.

[Good intentions]

Odd that they have two names. They must have kept the web site but changed the organization name to be more broad-based.