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Dr. Bachman discusses more people inquiring about no mesh repairs
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@ DrBrown, Fascinating! Thank you.
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Dear Pinto.
The anatomy does vary from patient to patient. The nerves are often in different places. In heavy patients the muscles are pushed so that they are orientated anterior to posterior rather than superior to inferior. During the repair knowing how far apart to place the sutures. How many knots. What to do to relieve tension. Where are the femoral vessels.
So it is important that the surgeon does the operation frequently.
Regards
Bill Brown MD -
@ Chaunce1234
Would you mind expounding on this: “….complex anatomy which differs per patient“?
Really, how much do people differ anatomically, such that it complicates surgery? I am assuming “normal” structures, nothing congenital or diseased. -
Without practicing the non-mesh repair, those who do not know how to perform a non-mesh repair will not know how to perform a non-mesh repair. Sort of a self-fulfilling situation which maintains the status quo, or worse as the skilled non-mesh surgeons continue to retire in the USA. Admittedly, it is complicated and requires a very strong understanding of complex anatomy which differs per patient, but as Shouldice has shown repeatedly, practice makes perfect.
As to why patients are seeking non-mesh repairs… I think that is fairly obvious. Not everyone wants a permanent implant in their body, particularly an implant that is associated with known significant risk and is also incredibly difficult to remove if there is a problem with it. How and why patients come to that conclusion varies greatly, but the idea that patients are being misled by legal ads is fantasy and denial.
Interestingly, I stumbled into a slide from the recent AHS 2019 conference that appeared to be from a talk focused on protecting from lawsuits by disclosing all the possible mesh risks in fine print of consent paperwork before surgery. So liability is the main concern for some. Think of that what you want, but regardless many patients will read that fine print and then ask for a non-mesh repair as a result.
So for hernia surgeons, I strongly think they should be able to confidently perform both a non-mesh repair and a mesh repair. Then the surgeon and the patient can make a decision together based on their specific case, preference, risk profile, concerns, comfort, etc. One size does not fit all.
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Totally understand and totally agree. And what makes it even more frustrating is that I’ve seen her name pop up form other people who have had their mesh removed by her which means she knows first hand what this stuff can do to some people. I have a feeling she mostly removed o it infected mesh as that is known th be easier to remove and can be used as a excuse of why mesh needs to be removed when there are so many other reasons.
The Salt on the wound is that she is basically also saying that she doesn’t really do non mesh repairs Bc she doesn’t really doesnt do many non mesh repairs and because of this it’s ok to tell the patient no if you don’t feel comfortable doing one.
Just so frustrating and pre-k logic. -
And, a review by an impartial professional is typically a great starting point for any research.
Professor Emeritus at a top medical school and editor of Journal of the Society of Laparoendscopic Surgeons seems good.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
Sorry jnomesh I might be overdoing my response. That video is frustrating to watch. So recent.
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Here is an example of what a person might find on the internet if they search “chronic groin pain mesh”. Dr. Bachman may have overlooked also that a person who works for NIH might have direct access to these papers through an internal database search. No need for Google. Most professionals would use Google Scholar anyway. Still surprised that she discounted the opinions of the very educated people she mentioned at the beginning of her presentation.
https://www.google.com/search?hl=en&authuser=0&ei=jyeZXMrVH4mLr7wPjeuziA0&q=chronic+groin+pain+mesh&oq=chronic+groin+pain+mesh&gs_l=psy-ab.3..33i22i29i30.16781.17798..18192…0.0..0.67.289.5……0….1..gws-wiz…….0i71j0j0i22i30.y-40gGBN-q0
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That is a great presentation to watch for someone who wants to see how to convince yourself that what you’re doing is right. She seems very conscientious and gives a nice presentation but she never even got close to answering her primary question. “Why are more patients asking their surgeons for non-mesh repairs?”.
She, instead, suggested that some of the most intelligent people in the world, scientists working at some of the best research organizations in the world, were being swayed by law firm web sites on Google searches. Overall, actually, a poor presentation, whose actual result was to personalize the use of mesh, with the story of the young woman, but avoid answering the real question of why we ask for non-mesh repairs. She asked the right question then diverted to supporting the use of mesh as the core of the presentation. It might even be subconscious, she might think that she actually addressed the question.
It is actually a fairly standard boiler-plate mesh-use support presentation. Not patient-centered, but surgical practice centered. Justifying past and present behavior.
And, as everyone seems to do, she balled all of the different types of mesh and different repair methods in to “mesh”. She was aware of the differences but still referred to everything as “mesh” versus non-mesh.
Very discouraging that this is a “Masters Hernia” presentation in July of 2018. Not even a year ago. Thanks for posting that link.
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