Dr. Reinhorn – Boston
06/10/2020 at 10:22 am #26712
Does anyone here have any experience with Dr. Reinhorn at Boston Hernia? It appears that he offers an open mesh repair that is placed posterior, using local anesthesia. Curious to hear what Dr. Towfigh and other doctors here think of this approach.
06/10/2020 at 12:53 pm #26713Good intentionsParticipant
His method is a variation of other mesh methods. The mesh is pushed through the defect from the front and the device has a ring that causes it to expand and open up once it’s inside. The Kugel method and device. So it is in front of the peritoneum but behind the abdominal wall.
Here is a fairly recent paper about his method. He falls in to the same trap of reporting actual numbers, percentages, when talking about the problems with other methods but falls back on vague terms like “vastly improved” when describing the benefits of his method. Unfortunately, people often do this when the actual numbers do not support what they had hoped to show. Some of his statements are little unclear, but he does not provided a measure of chronic pain from his method. He might not know.
In the end he says that his method has similar outcomes to laparoscopic repair as far as chronic pain is concerned. Earlier in his paper he said that the chronic pain rate could be as high as 17% for any mesh repair. So, therefore, his rate would be about 17% also.
“Traditional hernia surgery carries a high risk of chronic pain. As many as 17% of patients can have significant pain for years after traditional hernia surgery. This high incidence is likely secondary to the location of the mesh used for this kind of surgery. ”
“vastly improved” below…
“With this surgery, three hernia defects are repaired every time: direct, indirect and femoral. Our series of Kugel repairs now extends to over a thousand hernia patients. In our experience, the recurrence rates are similar to that of published series of anterior approaches, with vastly improved postoperative recovery times, including time to return to work, use of pain medication, and chronic pain complaints. This is in line with findings regarding outcomes after laparoscopic hernia repair for primary hernias6, 7 of which our approach is a variation.”
- This reply was modified 1 year, 1 month ago by Good intentions.
06/10/2020 at 1:47 pm #26716
Thank you for all of that information. Very helpful. Leaving aside the mesh/no-mesh argument for now, and just focusing on the mesh technique, I wonder if that technique as described above does result in a lower chance of chronic pain and a shorter recovery time than a standard laprascopic mesh repair. If so, I wonder why more surgeons don’t use it.
06/11/2020 at 11:02 am #26724DrBrownParticipant
All the mesh procedures have similar recovery times.
The surgeon you choose is more important than which operation is performed.
Bill Brown MD
06/13/2020 at 11:35 am #26749drtowfighKeymaster
The Kugel patch and On-flex are both mesh products used for open preperitoneal repairs. None of us who do hernia repairs for a living use these products, as they are stiff (aka chronic pain) and can wrinkle (aka pain, recurrence). In fact, I think Kugel patch is no longer marketed and the On-Flex is considered the next generation for this product.
06/13/2020 at 12:12 pm #26752
Thanks Dr. Towfigh… I don’t think he uses either of those mesh products. He says he uses the Ventrio ST. Have you heard of that mesh? What do you think of the procedure itself vs a traditional laprascopic repair?
06/13/2020 at 1:42 pm #26758drtowfighKeymaster
Ventrio ST is intended for use in laparoscopic ventral hernias, such as umbilical hernias. It is meant for intraperitoneal placement, which is why the “ST” portion of the mesh is added. ST mesh is not intended for use in extraperitoneal repairs, such as with the Kugel type repair or open preperitoneal hernia repair. Studies show using mesh with ST or other barriers in the extraperitoneal space actually hinders the healing process.
Perhaps the surgeon is using Ventrio mesh because the Kugel patch is no longer being sold (for the reasons outlined above). The Ventrio mesh is less stiff than the original Kugel, but the concept is the same. It has a ring that keeps it open and it has 2 layers of mesh, not one, which makes it very heavyweight.
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