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Finding good non-mesh hernia surgeons
As I’m working on sorting through non-mesh hernia repair options and surgeons, I’ve come to a point where I’m curious about how to best evaluate surgeons who offer non-mesh hernia repair. Some surgeons (Dr. Brown, Dr. Kang, Dr. Petersen, Dr. Tomas, etc.) have websites with lots of information about themselves, hernias, mesh/non-mesh repairs, etc. These can be very helpful to the long-distance patient trying to find a surgeon. Additionally, there are often patient stories and reviews online that can speak volumes about a surgeon and his/her skill and dedication.
Other surgeons offer little or no information online. For illustration purposes I’ll use the Indiana Hernia Center (IHC) as an example, as they’re mentioned on this site and their “website” as doing non-mesh repairs and is relatively close to my location, and for that reason could be an attractive option. I’m not trying to single them out – it just happens that I’ve been trying to gather information on the IHC as a possible option so it’s fresh in my mind.
The IHC webpage and Facebook page offer almost no information for patients – about the surgeon, hernias, different procedures/types of repairs, or anything else really. I’m guessing he’s probably plenty busy and doesn’t really need to try to attract new patients with a significant web presence, but it doesn’t give patients much to go on when trying to choose a surgeon. From what I’ve been able to piece together from different sources, IHC appears to favor mesh (and/or OviTex?) over tissue repair (feels it’s stronger with less recurrence) and feels that lap repair (and thus mesh) is the best way to avoid chronic pain. They offer non-mesh repairs, but apparently they’re not their first choice. The surgeon says he has been “one of the leading hernia referral surgeons in Indiana for nearly 6 years, speak[s] regularly on hernia repair, and perform[s] the most advanced repairs in the state. We are the only team in the state of Indiana that can offer you from open no mesh repairs, to hybrid mesh open, Lap, robotic, and what are referred to as eTEP minimally invasive repairs”. While this sounds very impressive, I have no way of knowing how, or whether, it translates into a quality non-mesh repair. Revision surgeries are likely more difficult/complicated than first-time repairs, but I assume most if not all are also done with mesh. I’ve not been able to find any patients that have had an IHC non-mesh hernia repair and has written anything about it. As best I can tell IHC started offering non-mesh repairs a couple of years ago as an addition to the other methods they offer, and has done somewhere around 200 total non-mesh repairs.
I write all this because I’ve read repeatedly that if you want the best outcome from a non-mesh repair, you need to choose a surgeon that specializes in non-mesh hernia repair, who truly believes in it, and who has a lot of experience doing successful non-mesh repairs. Based on this, and with all due respect, none of these really seems to fit IHC (and some others I’ve looked at who offer non-mesh hernia repair) all that well. They, like other surgeons I’ve found, offer non-mesh repair but would apparently rather do something else if given the option, which certainly (whether rightly or wrongly) gives reason to question the quality of their non-mesh repair. I’m wondering if that might indicate that those seeking non-mesh repairs are better off looking for surgeons more focused on and committed to mostly or only non-mesh repairs. I’m not stating this as fact by any means. I’m just asking the question. From what I’ve been able to find IHC has a very good hernia surgeon, is very patient-centered, and is very much in demand, but does that make them a good non-mesh hernia option? They may very well be. For all I know they may do the best non-mesh hernia repair in the country – I just have no way to make that determination based on information available to me.
I’m not naive enough to think that a good web presence with lots of info for patients guarantees a good non-mesh repair, or conversely that a poor, low information web presence with little or no useful information means a poor-quality non-mesh repair. But I’m wondering if quality of web presence (at least for surgeons offering non-mesh repairs) may be an indicator of how much a doctor invests in and values their patients (specifically their patients looking for a good non-mesh repair) and how much they believe in what they’re doing and how they’re doing it. Anyone have any thoughts?
Again, I used IHC as an example because it’s closest to me and it’s fresh in my memory, but it is representative of several others I’ve come across. I’m just trying to figure out how to find the right surgeon when I can’t easily meet with them face to face. And even face to face doesn’t always tell the whole story, which is why it’s so helpful to have as many other pieces to put together as possible. It’s a huge and frustrating challenge…
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9 Replies
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I also second that the topic of pain from mesh and that of pure tissue repair is really a apples to oranges comparison. And that is not to de-emphasize pain from a non mesh repair but rather to highlight that mesh is a permanent medical device is large in size and has the propensity to cause pain and damage to so many other structures not to mention the ordeal it causes if it needs to or it is decided that it needs to or should be explanted.
peoles lives are being ruined by mesh related problems: perforated bowels, twisting of tissues and muscles, migration, attached to bladder just to name a few. A suture repair just can’t come close to the wide array of damage mesh potentially can.Dr. Towfigh I’m just curious if the two non mesh repairs that you are repairing-were they from nkkn mesb repairs you did or are the patients coming to see you had the pure tissue repairs from other surgeons.
The patient may never know if they had a recurrence due to the tissue repair not being a good fit for their circumstances or because the surgeon who did the repair does not specialize in or do many non mesh repairs.
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It is much much easier to repair a suture-repair recurrence than to fix the damage from mesh-induced chronic pain. I doubt that the recurrence repair takes 4-6 hours under general anesthesia, with all of its associated risks, plus the extended years-long healing time from mesh removal.
Oversimplifying the damage that mesh can cause is one reason that progress is not being made. It’s not just “pain”. I’m not surprised that people don’t understand that damage, if they haven’t had it. It’s hard to comprehend, by itself, let alone understanding the difficulty in finding a solution if you have it, including the resistance to dealing with it from most surgeons who encounter it in their patients. It’s a nightmare.
Rand Paul’s decision to have a Shouldice repair makes sense. If his Shouldice repair fails, he can have a mesh repair, as you are doing for your two patients. But if he had chronic pain from a mesh repair it would probably be permanent in some ways, even after mesh removal. Neurectomies and mesh removal are both drastic attempts to fix the problem that “mesh” caused, and they often aren’t enough. Why start with the riskiest procedure, the one that causes the most damage if it fails? “Mesh” should be the last resort.
The results of “failure”, recurrence or chronic pain, from “mesh”, versus sutures is vastly different and not really comparable.
I’m sorry Dr. Towfigh, but I’m still in the middle of recovering from a top-notch state-of-the-art best-methods mesh failure – mesh-induced chronic pain. My diagnosis and surgeon’s choice of repair method is perfectly described in the Guidelines. Checked all of the boxes. Perfect candidate, very healthy, non-smoker, no history of health problems. The procedure went perfectly and I had chronic and increasing problems as soon as I became active again. I know how bad mesh can be . I should have had a suture repair.
I don’t like to argue, I just would like to see my comments stand for what they are. The rebuttals just aren’t very substantial and seem to downplay the damage that mesh causes.
I posted the link to Doctor’s Suicides to express some empathy, as a patient who thought a lot more about suicide while dealing with the mesh-caused chronic pain. Lucky 46 was not being overly dramatic in his past posts. I hope that he is still alive. If you can’t work and you can’t think and you’re in constant pain, there’s little point in being. Those three things are probably the most common topics you’ll find in a suicide note, and those three things are what you’ll have if you have a mesh reaction. Please don’t try to compare a suture-based recurrence to mesh-induced chronic pain.
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Let’s not forget that non-mesh repair also causes chronic pain. It’s just the pain cannot be attributed to the mesh.
Thats not including the pain associated with recurrence.
This week alone, I’m repairing two patients with recurrence because they didn’t want mesh and their repairs would have done better with mesh, and now they require mesh.
There is is no perfect answer. We should tailor the repair to the needs of each patient.
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I think the idea that “mesh is best” hardly constitutes an adversarial relationship between surgeon and patient. More likely it stems from:
1. Confirmation bias. We all do it. We all do it “the best way we know” and therefore however we do it is best. Not exclusive to any one group.
2. We all respond to incentives, based on what metrics we are judged by. If that is recurrence here, then preventing that becomes the primary objective.
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Sorry Dr. Towfigh. What I’m suggesting is that because the specific cause of the 10 – 30% chronic pain rate is unknown, apparently, that it is “baked in” to the International Guidelines. Only the plug is called out as one “mesh” method to avoid, and even that reasoning is based on gut feel by some committee members. So if a person’s surgeon says that they use the Guidelines, or “mesh” because it is the state-of-the-art, they are saying that you have a 10 – 30% chance of chronic pain if you get a repair from them. It’s just how the numbers and logic work out. If they say that you’ll “be fine”, you can’t trust their words, because they can’t know that, they don’t have a basis to say those words, unless they know more than the Guidelines suggest. So don’t trust blindly, ask specifically. It’s more skepticism than cynicism.
My comment about the doctors being “against” the patients was extreme, but that’s what it looks like from out here, for certain doctors. Dr. Voeller’s comments about 4 – 6% debilitating chronic pain not being an epidemic, so it’s no big deal, and Dr. Ramshaw’s comment about “mesh clearly not being the cause of pain”, are examples of “protecting mesh”. Accepting the high pain levels as part of a mesh-based hernia repair. The “state” of the art. My statement is too broad, it should have been specific to the apparent leadership, the vocal representatives, of the community of surgeons. Maybe it’s time for new leadership, more vocal representatives?
I’m just trying to make it clear to any future patients that come to the forum that they have to do their own research, because there is no clear way to avoid chronic pain if they have mesh implanted. It’s a gamble. You can’t trust what the common surgeon tells you unless they have their own numbers to back up what they do. I have not seen any surgeons clearly state that they know that what they do causes less chronic pain than anyone else’s method/materials. 10 – 30% chronic pain is normal. The surgeons are accepting the Guidelines and the Guidelines have 10 – 30% chronic pain as normal.
Trust but verify, in simple terms. Everyone, including the surgeons,will be better off.
I wish it was easier. It should be.
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[USER=”1391″]UhOh![/USER] youre very correct. The fact that a surgeon even has a website nowadays is unique. Most don’t.
[USER=”2029″]Good intentions[/USER] thats a very cynical viewpoint. I don’t believe it to be true. -
There’s also the issue that, plastic surgeons and cosmetic dermatologists aside, physicians are by and large terrible at sales and marketing. It’s just not something taught as part of their training, and isn’t second nature to most. It probably never occurs to those who still do tissue repairs to “market” such and tap into the growing demand for such procedures. The idea of “customers” not only wanting something they consider second best but actually marketing that, is a foreign concept. Then again there’s a reason I’m a marketing consultant, not a physician…
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I think that the reality is that the “mesh” situation has become self-reinforcing. Because the chronic pain problem has grown so big and will supply many lawsuits for years to come the community of surgeons feels compelled to gather together and become unified. Closing ranks against the outside forces. The recent “surge” for International Guidelines is an example. In the medical practice the best defense is that everyone else does it this way.
So, now it has become the community of surgeons against everybody else, including the patients. Many individual surgeons know that ‘mesh’ is a big problem and harming many people. But it’s not a problem that just a few individuals can make headway against. So they conform and lower their expectations for helping people.
It’s part of the general degradation of society that we see on the news everyday, I think. Hard to see where it will end, but the days of just trusting what your doctor says, blindly, because they are the professional physician, are over. Too much conflicting information for that to be a rational thought process.
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Thanks. I too have contacted IHC and it seems he prefers lap to open non-mesh repair. I too share all your concerns. As far as I can tell Dr. Brown, Shouldice, and Dr. Thomas are the people who really do no mesh consistently. If it weren’t for the fact I’m freaked out by general anesthesia and gas pumped into my stomach I think I might for the lap at this point with 95% absorbable.
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