Dr. Bendavid et al’s paper on “Mesh-related SIN syndrome”
08/12/2023 at 1:30 pm #37740Good intentionsParticipant
I was re-reading Dr. Bendavid et al’s paper and am still struck by how well he summarizes the general situation of the changes in hernia repair.
It’s worth reading for anyone who hasn’t read it. It was published just months before I had my laparoscopic mesh repair.
Oddly though, if you search for the title using Google Scholar it does not come up. Kind of disturbing. I had been trusting Google Scholar to find all relevant and bona fide research articles but now I have doubts.
Here are two links, to an html page and pdf file. The journal seems reputable.
08/12/2023 at 1:59 pm #37742WatchfulParticipant
I’ve always found things to be a bit questionable and biased with him. Some examples… He was very liberal with cutting nerves without paying attention to the risk of neuromas and other issues. He claimed 1% chronic pain at the Shouldice Hospital even though this wasn’t really studied, and even they quote higher numbers now (which aren’t based on a study either). He switched from steel to prolene sutures because he found prolene to be easier to handle, but without study of what’s best for the patient. In particular, I found his statements about chronic pain with the Shouldice procedure to be misleading and lack a solid basis.
08/12/2023 at 4:31 pm #37746Good intentionsParticipant
Everybody has flaws. If you focus on the flaws you miss the good stuff.
The Discussion section of the paper is very relevant even today. When I was studying the situation back in 2014 I thought to myself that “there is no way that this could be continuing. The errors must have been solved by now”. It is now nine years later and nothing has really changed at all, except for more lawsuits. The new products are just small variations on old products, and copies of competitors products. No product has been identified as bad enough to be removed from the market. Laparoscopy is growing, making mesh problems even more difficult to solve. The studies keep coming back with the same approximate 15% percentage for pain problems.
The paper is worth reading because it shows that today’s problems were recognized and well-defined almost a decade ago.
I wonder what happened to the Mesh Retrieval Registry. Maybe Dr. Koch knows. He is a co-author.
A “Mesh Retrieval Registry” has been set up by the present surgeons and pathologist and several colleagues have volunteered to participate for an in-depth study of the “Mesh-Pain” problems. A protocol will be addressed to all who would be willing to participate and contribute. Reports of such a surveillance are sure to find their way, on time, in the surgical literature. For a certain, very small segment of the surgical population, prostheses may be here to stay and it then behooves all of us to understand their pathophysiology. The next step will be the correlation of histology/pathology to the clinical presentation and severity of pain. This is presently being done and will form the basis of a later publication.
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