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Dr Ulrike Muschawek on Hernia Talk 20th September
Just in case anyone hasn’t spotted it and would like to ask a question, the well renowned tissue repair hernia specialist, Dr Ulrike Muschaweck is on @drtowfigh’s Hernia Talk this week, so should be well worth a watch.
Dr Muschawek appeared on a BBC documentary about issues with mesh use for hernia repairs and has apparently operated on many top athletes/sports people, including premier league England international footballers (soccer players).
I’ve posted some questions in a reply to Dr Towfigh’s post above (not sure how else to ask them!?) in the hope that Dr Towfigh will be able to ask them. I won’t be able to watch it live so will check it out on Dr Towfigh’s YouTube channel.
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18 Replies
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I also enjoyed hearing Dr. Muschaweck’s very logical thoughts on placing a stiff inflexible material in an area of the anatomy that has to be flexible to function properly. Why do that?
Most mesh surgeons will acknowledge that the mesh becomes stiff after it becomes “incorporated”. But they don’t seem to make the connection between the loss of flexibility and the groin discomfort that results.
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I can’t speak to anyone’s confidence in statistics. That’s a whole separate issue, personal to the person.
The main thing that I enjoyed about listening to Dr. Muschaweck was her very logical and rational decision-making process. There was no hand-waving about recurrences, or “what-aboutisms” about pure tissue repair pain occurring also. Just a simple description of choosing the simplest most effective repair method based on the patient at-hand, eventually leading to the simplest most effective mesh repair if the pure tissue repairs did not work. Her choice of repair method is based directly on the type of damage that she sees. It is never the one size fits all maximum mesh coverage repair that is used in today’s laparoscopic mesh implantation.
It was most interesting to see two surgeons on opposite ends of the hernia repair method spectrum having that discussion. Dr. Towfigh is a LAP TEP repair surgeon, which means large pieces of mesh covering the whole of myopectinaeal orifice. I actually felt a little bit uncomfortable watching Dr. Muschaweck describe her methods, knowing that Dr. Towfigh’s first choice is LAP TEP.
But that is the state of the hernia repair world today. Anybody just entering it would have no idea of how to choose a surgeon or repair method. It is chaos.
I stumbled across another of the biblically themed guides for mesh-based hernia repair. This is what you’ll get if you choose a LAP mesh repair surgeon and the surgeon is a follower of the latest and greatest ideas.
https://link.springer.com/article/10.1007/s00464-020-07449-z
“Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide”
“Rule 8: A large mesh (usually at least 10 cm craniocaudally?×?15 cm medio-laterally) may be placed covering the MPO (Indirect, Direct and Femoral triangles) with overlap of at least 3–4 cm (Fig. 9).”
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Puts me in mind of a chant, “one glen Murray, theres only one glen Murray”…
I take your point and agree it’s a shame almost every surgeon has some bad reviews…. Which makes it very difficult deciding.
By the way don’t forget Dr Muschawek had 2 goes at Murray, and the experience of the poster on patientinfo forum too. Would that double or triple your percentage calculation… Miniscule although it may still be, it’s a doubling of disatisfsction. Is that a 100 percent increase? I’m not good at maths.
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“Don’t let perfect be the enemy of good” is a quote that I hear often.
When looking at any of these techniques or repair options or surgeons I think that the best that you can do is to try to assess the odds, the probability of a desired outcome, and the weight of solving any problems that might happen. For example, Dr. Muschaweck has, if I recall correctly from the video, done 29,000 hernia repairs. So, one Glenn Murray out of 29,000 is a tiny tiny number. 3.4 x 10^-5. 0.000034. 0.0034%. And he is a professional athlete in one of the most physically demanding sports, over time, in the world.
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Is his hospital not carrying on the Desarda repair? I believe his son also was a surgeon.
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Maybe not pain but this patient wasn’t very impressed:
It’s from patient info
“Dr Ulrike Muschaweck is the problem here. She is a very careless surgeon.
Her surgery on my hernia in late 2015 left me with sexual dysfunction, incontinence and numbness. Google her with the word “problem” and you will find other cases where her surgery has wreaked havoc on hapless patients.”.Such a shame that it seems no surgeon has no bad review. It is really a gamble.
From a previous research I believe Glenn Murray (Crystal Palace) had 2 surgeries with her that didn’t work and eventually was treated in UK by Prof Lloyd.
On the other hand I also just read about an American who can’t praise her enough.
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Watchful have you got links for Desarda studies at all?
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The difference between a sports hernia as she defines it and a regular direct hernia wasn’t clear. When asked, she said it was just fat without intestine, but a direct hernia doesn’t need to contain intestine to be a hernia, so I didn’t get that. I also didn’t understand why the genital nerve would get damaged by the sports hernia. I understand why there would be pain (protrusion pressing on the nerve), but not nerve damage unless this was some truly severe compression.
Her objections to Desarda didn’t seem all that solid. Surgeons who practice it have had really good results with it, and the studies have been great so far, including a couple of long-terms studies. Surgeons who don’t practice it come up with all kinds of theoretical reasons for not liking it, talking about possible issues which don’t seem to be seen in practice.
The most surprising comment she made was that she has never seen chronic pain resulting from surgeries that she did.
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This reply was modified 2 years, 3 months ago by Watchful.
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This reply was modified 2 years, 3 months ago by
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Thank you for that interview Dr. Towfigh.
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She does not like the Desarda technique. She gives reasons.
@drkang might be interested in Dr. Muschaweck’s views.
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She said that she does not remove laparoscopically-placed mesh. Too difficult. So glad I found Dr. Billing.
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39 minutes and on gets interesting, re mesh. It starts with “sports hernias” but ends up talking about all hernias. Dr. Towfigh put up written questions about “sports hernias” but was talking about all hernias. Good to see that normal hernias got some discussion.
We need more Dr. Muschaweck’s. She covered just about all of the issues. She also echoed Dr. Kang’s thoughts about using different techniques for different types of hernia. There is no “one-size-fits-all” method.
She also talks about mesh removal.
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Dr. Towfigh posted the Youtube link already, at the top of the page. I have not watched the whole thing. Over an hour.
Here’s the link since sometimes the “pinned” stuff at the top is not obvious when it changes.
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Thanks Gdi can see them now
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They are in the reply to the interview notice.
HerniaTalk **LIVE** Q&A: Sports Hernia & Minimal Repair Technique 09/20/2022
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Where are the questions Jack? Cant see them!
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Thanks for posting this Jack2021. I might actually watch and ask questions, knowing who is being interviewed. I have noticed that many interview subjects defer to Dr. Towfigh’s area of expertise, at the expense of their own standing, but Dr. Muschawck has built her own reputation, world-wide. I hope that it is a good conversation.
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This is one reason why I have delayed fixing my hernias for so long: inability to find a really good surgeon who would do it local. Before I wanted no mesh, but I am reassessing the problem of reoccurrence which I now think may be more likely that reported from Desarda. Remember Desarda was a MASTER surgeon. You just have to watch his videos to see that even as a layman. Not a missed move, no stumbling, everything precise, almost robotic in measure, even pace, methodical.
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