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Dr. Voeller Review Article – end result – toss-up
Dr. Voeller wrote an article for General Surgery News. IT is voluminous but at the end he summarizes things in a way that both illustrates and shadows the true state of the business. 35 years and this is where he stands. For whatever reason.
The article is worth reading because it shows how interwoven so many different things are, that have created the current situation. And, at the end, of it all, he suggests that surgeons learn non-mesh repairs, that might have a slightly higher chance of recurrence. And the same chance of chronic pain. So, the best that can be said is that mesh is essentially the same as non-mesh. Which begs the question of “why use mesh then”. Slightly less chance of recurrence?
You can almost feel bad for him. He wrote a novella but couldn’t sell the mesh story at the end as hard as other doctors like Dr. Felix, of the Ten Commandments, does. You have to respect that anyway. Maybe he’ll come around eventually, he almost wrote what he probably realized.
Dr. Voeller is the President of the Americas Hernia Society Foundation. The place that collects the “support” from the various companies, so that the Society can pay for their meetings.
https://americasherniasociety.org/ahs-foundation/
Excerpt –
“Certainly, there are things that I think will need to be addressed in the next few years. I think with the issues around mesh that are common today, it is critical that surgeons learn an open autogenous repair so they can offer patients a non-mesh option. This calls for what Dr. Adrian Park and his colleagues recently wrote about: true engagement with the surgical patient (Surgical Innovation; June 15, 2020; doi.org/ 10.1177/ 1553350620936004). The patient may want to take on a slightly higher chance of recurrence in exchange for avoiding mesh use for whatever reason.
In addition, as AHS President Ben Poulose makes clear in his address, cost containment will be more and more of an issue in hernia repair. Bundled payments will come to hernia repair just as they have with heart bypass, total joint replacement and other operations.”
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7 Replies
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I agree that most published medical research is not terribly useful in practice. Partly, this is due to the difficulties involved in doing large-scale medical studies. But, some of it also has to do with financial incentives.
This situation actually is not unique to medicine. I work as an academic in a scientific field and I can tell you that most of the published peer-reviewed work I read (and write) has very little to do with what happens in industry. And, financial incentives often result in unintended biases.
I do think most doctors have their patients’ best interests in mind. But, they are limited by what the field teaches and allows. Unfortunately, as a patient, it is very difficult to know which doctors provide truly exceptional care until one actually goes through a procedure, and by that time, the damage has been done.
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A doctor who had a shouldice repair. They don’t take chances with mesh when it comes to their own body or their families, but no problem promoting it and inserting in others.
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I find it interesting and worrying that there is still a discussion on whether mesh or non mesh repairs are more at risk of chronic pain….I am sorry to say this but I am starting thinking that an awful lot of scientific papers in the medical science field are garbage. Personally I think that there are some situations where mesh is the best option. For the rest there is a financial side that has nothing to do with the science. Incidentally I also think that in the long term the ideal solution goes beyond a repair towards a regeneration, if you know what I mean (don’t know if this is a mesh in the end)
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Hi James – how did your removal go? What were the details? Always interested in stories as I’m considering finally scheduling my removal. Thanks.
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Like @drbrown, I have to disagree with the statment that teh chance of chronic pain is the same with and without mesh. Having had two hernia (with with mesh, one without), the difference could not be more stark; massive pain with mesh for 6 months until it was removed, no chronic pain with the tissue repair. Moreover, both in online forums and in-person, I have run accross hundreds of people who have suffered with mesh pain and have encountered almost nobody that is suffering chronically due to a non-mesh repair. It astounds me that there is such a stark contrast between what doctors’ data say and the reality that patients deal with.
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@good-intentions
I agree that his funding sources limit his ability to fully endorse pure tissue repairs.
I disagree with the statement that the chance for chronic pain is the same with or without mesh. I almost never have any chronic pain problems after pure tissue repairs. If you review the literature before the 1980s there only a few articles about chronic pain after hernia repairs. It is also not mentioned in the surgical textbooks from the 1980s.
Thank you for helping us all stay up to date.
Regards.
Bill Brown MD -
Actually never mind 😉
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