BARD mesh

[T. Hayano]

I have inguinal hernia and my doctor told me that he will implant BARD mesh in my body. But it seems there are many problems associated with BARD mesh, according to website https://www.shouselaw.com/herniamesh/lawsuits/bard/.
1. Is BARD still using Chinese substandard polypropylene to make the mesh?
2. Have BARD recalled the meshes made of Chinese polypropylene?
3. Is it possible to confirm that the mesh to be implanted in my body is not made of Chinese substandard one?

[pinto]

I regret I can’t answer your questions but here is an informative website: https://www.drugwatch.com/hernia-mesh/polypropylene/

BTW, would you happen to know if hernia mesh problems are generally known in Japan or China? They seem well publicized in English-speaking countries but I couldn’t find much about in Japanese or Chinese media. I suppose especially in Japan, mesh is the main method so am surprised little is found about it.

[T. Hayano]

Yes, you are right. I have not found any negative information about the mesh in Japanese media. But I found it on BBC documentary posted on YouTube. I don’t know why these issues are not well known in Japan. As you said, the mesh is common method to fix the hernia here. I found two people, who had the mesh hernia repair, among my approximately 50 colleagues. They told me that they are happy for their treatment. (Though, one of them also told me that it is not serious but he feel something in his groin) We have culture like “Don’t make a fuss”, so I’m not sure if the problems really does not exist or just have been hidden.

[William Bryant]

I believe Forum members Chuck and Good Intentions had bard of one type of another. They may post their experiences but both are against mesh as most on here are.

Perhaps if you searched the forum for bard it may help.

[Good intentions]

Avoiding “Chinese substandard polypropylene” will not remove the risk that the use of mesh carries.

I am not “against mesh”. I am against its overuse and the apparent acceptance of its major flaws by the medical community, plus the obscuring of these flaws when the mesh product is promoted to the patient as a cure. Any surgeon today that implants mesh without clearly explaining the potential problems with its use is participating in a fraud. The literature, from the scientific journals all the way down to the simple trade journals, has produced a constant stream of studies showing that there is a substantial probability of chronic pain if mesh is implanted in the body for hernia repair. The pain is not easily resolved if it occurs.

Nobody should be fooled by the premise that the bulk of mesh problems are caused by counterfeit products or “substandard polypropylene”. Polyester meshes have similar problems. The knitted fabric pattern and the nature of the textile itself seem to be the cause. Not the chemistry of the polymer used to make the fibers.

[William Bryant]

Thanks Good Intentions for the correction re anti mesh. It was just shorthand really. And I’d put myself in that category too.

[Good intentions]

It is a topic of study in Japan. Here are some links. I assume that “rescue analgesics” might be a term for “pain-killer”.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=japan+inguinal+hernia+mesh&btnG=

https://link.springer.com/article/10.1007/s00595-012-0153-5

https://journals.sagepub.com/doi/abs/10.1177/17504589211054371

[T. Hayano]

Thank you for your replies. I thought the mesh is strong enough to last for rest of my life, but it seems that the standard polypropylene mesh last only for 10 years and after that it probably erode and become weak.

According to my doctor, my abdominal wall has large enough gap, so that the risk of strangulation is little. In this case, what will you recommend?
1. How about Shouldice method? (I don’t know where I can find a doctor who can perform it in Japan, and I think the gap on the abdominal wall is big, so I might have issue of tighter abdominal wall after surgery.)
2. There is a risk but should I have surgery to implant the mesh in my body? (I’m 49 years old, so I might have complication when I am around 60 years old.)
3. Leave it untreated. (My hernia might get bigger and I may have difficulties in future. Or leave it untreated until a better kind of mesh will be invented.)

[Herniated]

The following paper from Japan compared a type of tissue repair (Marcy) against mesh for treatment of indirect inguinal hernias (“diameter of the internal inguinal ring was up to 3.0 cm (I-1 or I-2 of Japanese Hernia Society Classification)”). You could try contacting them to ask if they know of surgeons in your area with the tissue repair expertise you are seeking.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778839/#:~:text=Evaluations%20of%20inguinal%20hernia%20surgery%20in%20randomized%20controlled,does%20not%20use%20a%20mesh%20%5B%205%20%5D.

[T. Hayano]

Thank you very much for the information. It seems that there is no statistically different in complications occurrence rate between non-mesh and mesh treatment.

I found a surgeon in Kyoto, who claims was trained in Shouldice Hospital, Toronto. I’m thinking to contact him for consultation…

[Herniated]

Great! It is important to ask how the surgeon performs the Shouldice repair. Also ask what “trained in Shouldice Hospital means?”. The following is from the Shouldice Hospital web site FAQ. Note what they say about training:

Can I get the Shouldice Repair done elsewhere?

At Shouldice Hospital, we set high standards. Our surgeons are fully qualified and licensed to perform surgery by the appropriate Canadian authorities. Then they are required to spend up to 6 months of intensive training in the Shouldice Technique to perfect their skills before they are approved to lead a Shouldice surgical team. Only surgeons practicing at Shouldice Hospital receive this training. The Shouldice technique is very detailed and must be practiced in high volumes to ensure consistently superior results.
Most general surgeons will repair 20 to 30 hernias in a year. Shouldice surgeons average over 700 cases a year, which provides the highest level of practice and experience in the world. This is why Shouldice surgeons are the world‘s most experienced leaders in hernia repair
Surgeons come from around the globe to observe the Shouldice technique. For two or three days, they can watch as the Shouldice repair is performed by Shouldice specialists. However, this is not training. Although many surgeons perform hernia repairs, we cannot offer a training program for them. As a result, we cannot guarantee the quality of any hernia repair said to be a Shouldice repair when it is performed by doctors outside of our hospital.

[T. Hayano]

Thank you for the information. I think the surgeon just watched the operation performed by Shouldice surgeons. Below is excerpt from the hospital’s website.

— Translated by ChatGPT —
…The Shouldice method is a complex and difficult surgery with limited reproducibility, and there are no facilities in Japan that have adopted it. Our surgeon, Dr. XXX, visited Shouldice Hospital in Ontario, Canada, where the Shouldice method originated, to observe surgeries. Over the course of three days, he participated in 15 surgeries and received detailed guidance on surgical techniques directly from the staff surgeon. Since then, we have been carefully performing tissue repair using the Shouldice method after discussing it with the patients themselves…

—Original Japanese texts —
…Shouldice法は複雑で再現性が難しい手術であることから、日本で取り入れている施設はありません。
当院外科医師のXXXは、Shouldice法発祥の地であるカナダのオンタリオ州にあるShouldice Hospitalに手術見学に行き、3日間にわたり、15件の手術に参加し、Staff surgeonに直接手術手技を細かく指導してもらいました。それ以降、Shouldice法による組織修復法を患者さん本人と相談の上、慎重に行っています。…

Maybe he is not a real Shouldice surgeon but I guess he is one of the leading specialists of the field in Japan. Because he has published many theses about it.

[Herniated]

The surgeon seems to have honestly presented his background preparation for introducing the Shouldice procedure into the Kyoto hospital. The surgeon also seems willing to discuss the procedure in detail with patients. Both seem very positive signs. If you decide to visit them for a consultation, it would be good to come prepared with a list of questions addressing your concerns.

[NFG12]

Please no matter how it’s not bad this or that to me Bard is the worse! Especially 3dmax, it has messed up so many on this forum. Polypropylene is never supposed to be put in the human body ever! It’s know to get stuck to the spermatic cord, nerves, fold up in you as it did me and causes horrible inflammation and pain. Had mind pit in and pain never went away, it then got flipped, got caught to nerves and caused nerve damage and got stuck to my spermatic cord. Got it removed after being in 18 months. If you can watch and wait do so, look in mesh free repair surgeons etc. Don’t not get bard put in or mesh at all and avoid at all costs, especially bard!

[SN]

Most of the surgeons in my area either use Bard 3D Max Polypropylene or ProGrip Polyester for their laparoscopic repairs. Out of those two, would ProGrip be more preferred then?

[Jack2021]

There are two surgeons in Seoul, South Korea who claim to have very good success rates with their own differently modified Marcy tissue repairs, if you’re happy/able to travel there.

Both have posted on here – Dr Kang at the Gibbeum Hospital and Dr K. Y. Chung (posting as KC) at the Ewha Womans univsersity hospital.

Dr Kang definitely sees patients from abroad, but you’d have to check with @kuyongchung (KC) or contact the Ewha Woman’s Hospital for further information.

All the best.

[pinto]

T. Hirano, my guess is the surgeon is likely a general surgeon and so his surgery record, frequency of Shouldice repairs, I suppose would be important to consider. @Herniated makes a great point there’s training and then there is training. If it’s just observation, then a patient might end up paying for his actual training.

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