Dr. M. Pawlak – a new surgeon worth following (and hoping for)

[William Bryant]

Ah right, well if the mesh makers are involved indirectly vis sponsorship etc, there would be bias.

I’ve found that documentary on medical implants on Netflix, think it started with knees and a surgeon who found there were issues. Think I’ll watch that..The only thing putting me off is I’m squeamish.

[Good intentions]

It sounds like he is questioning the validity of the data used to create guidelines. Others have done the same.

https://herniatalk.com/forums/topic/new-article-questioning-the-validity-of-the-hernia-guidelines/

New article questioning the validity of the Hernia Guidelines

[William Bryant]

Thanks Good Intentions, I think I may have mentioned before that I just don’t have your intellectual capabilities, sorry to say. If it’s not too much trouble, could you put in simpler terms what Dr Pawlak means. Thank you in advance.

I’m hoping that more NHS surgeons are learning tissue repair. If you look at Dr Pawlak and Dr Light, both NHS, both doing a limited number of tissue repairs alongside mesh on NHS. Both young. Much younger than most consultants I’ve seen.

[William Bryant]

Shouldice website mentions natural tissue repair here 👍😁😊

https://www.shouldice.com/natural-tissue-vs-mesh-hernia-repair-surgery.html

[Good intentions]

I think that you meant “pure” tissue repairs, which really just means suture only repair. Another name for no-mesh repair.

Here is something that caught my eye in one of his publications, excerpted below. It will be interesting to see how deep he goes as his career progresses, in discerning what is real and what is not, in the various talking points about the superiority of mesh repairs. The Guidelines use the old studies as the basis for the claim that mesh is the obvious “first choice” over pure tissue repairs.

https://www.herniasurgeryjournal.org/article.asp?aulast=Pawlak&epage=77&issn=2589-8736&issue=3&spage=75&volume=2&year=2019

“Evidence itself is going through its own development. Many papers published in years past would not be accepted for publication today, because of their methodology failings, bias, lack of patient follow-up and the definitions of any complications reported not given. Indeed, one of the most cited papers relating to hernia surgery[13] would have unlikely been published in its current form today. Yet, the Lichtenstein inguinal hernia repair is now in use worldwide and sometimes referred to as the “gold standard.” Many guidelines based the strength of their recommendations on the so-called hierarchy of clinical evidence, from systematic review of randomized controlled trials at the top to expert opinion at the bottom. However, this approach has been questioned and in many cases superseded by other ways of assessing medical knowledge which will be discussed further below.”

[William Bryant]

Ha ha! Weird you said that as I ummed and ahhed over what to put, tissue or natural tissue! Guess I went wrong!!!

Anyway just to confirm, certain patients in UK can ask NHS to refer them to Dr Pawlak for appraisal and possible non mesh repair.

Thats 2 NHS surgeons who do non mesh now.

[Alephy]

What are natural tissue repairs? I have heard of tissue repairs, but not the natural type ones 🙂 you get vegi sutures?:)

[William Bryant]

Funny you should mention Dr Pawlak, Good Intentions, as I believe he does, in a limited number of cases and if patients condition allows, perform natural tissue repairs. NHS only not private.

Based in north Devon, Barnstaple.

Website also mentions chronic pain management I believe.

[Good intentions]

Current trends in hernia surgery in NHS England
M Pawlak, B Tulloh, A de Beaux

https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2019.0118

Guidelines in hernia surgery – friend or foe

M Pawlak1, B East2, H Gok3, AC de Beaux1

https://www.herniasurgeryjournal.org/article.asp?aulast=Pawlak&epage=77&issn=2589-8736&issue=3&spage=75&volume=2&year=2019