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Current State of Non-Mesh Inguinal Hernia Repairs, SAGES 2019
I just came across this presentation from the SAGES 2019 meeting, “International Hernia Symposium: Progress Through Collaboration” session.
It is a good review of hernia repair techniques in general, with the goal of comparing mesh repair to non-mesh repair. Watching the video you can feel the pull to supporting mesh repair over non-mesh. He tries. But the data he presents does not support that conclusion. The presentation ends weakly, with no real conclusions drawn.
I feel bad for the presenter, but have to respect the fact that he let the data speak for itself, for the most part. It’s a good example, I think, of the basic conflict that the hernia repair industry faces today.
At about 5 minutes, even though his slide says “significantly higher” he says “may be slightly higher”.
At about 6 minutes he compares Shouldice to minimally invasive repair, conflating MIS with mesh. In his mind, MIS and mesh repair are the same thing, I think. Which they are, in essence.
At 11 minutes he blames chronic pain on fixation. Says that now “we” tend not to fixate mesh, “at least some of us”. I think that many surgeons do still use fixation.
If you watch the slides without the audio you would probably get a different end impression than with audio.
Fascinating, from a psychology perspective. Worth watching, to get a feel for how things are viewed from inside the profession.
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1 Reply
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Brilliant example. It’s like the fox speaking for the hens. 😀 😀 From the start he clearly puts himself in the ring of mesh proponents, which makes me wonder why in the world does this conference choose a mesh provider to give us the state of the art for tissue repair??? (He stated he was invited to speak on the topic.) Oh but he states he does tissue repair. But that’s an afterthought. For unwittingly later he shows the truth: “When a patient comes to me, I tell them, y’know, we do use mesh to repair.” (So if you don’t like it, there’s the door. 😀 )
The y’know signals a collective unity with his audience, which is likely mesh providers and a sentiment he signals prior to talking about the apparent rampant litigation against mesh providers and then he says, “What do we do?” 😀 :D. So rather than a pres on the state of the art of tissue repair, he already has set the pres up as one highly favoring mesh. Or could mesh providers be thinking of switching ships to tissue repair and need affirmation? 😀 Seems funny but actually the litigation he shows is likely to scare mesh people. So more and more the fox sheds his chicken appearance!
Amazing to me is that the conference organizers would invite this fox to present if they really wanted an authoritative pres on tissue repair. I think it is likely that they felt compelled to keep it “in house,” for various reasons make it difficult for them to “cross the aisle” to invite a true authority on tissue repair. So we see how everyday actions maintain a rigid division between mesh surgeons and tissue repair surgeons. Complete separation likely exists, preventing advancement of surgery that would likely occur if there were more cross-fertilization!
Amazing as well, for I didn’t know: tissue repair, as he says, is “really cheap” compared to going mesh. There you have it folks: the cash cow is threatened, so taking stock is necessary, if not to switch ships then it’s to strengthen their rear guard. “Man your battle stations, we’re heading into rough waters of the backlash to mesh. We had better fully know about the alternative tissue repair if we’re going get out of this unscathed!” At the very least we see that the mesh community has been affected by the growing concern about mesh. Bravo, @good-intentions for his intel.
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