Gentlemen, Good intentions & Watchful: Your thoughts, please …

[pinto]

Gentlemen, Good intentions and Watchful, thank you for your robust replies. If Watchful is correct that there’s “nothing really to debate” because you gentlemen agree that in some cases “mesh is the best option,” then this is a step forward in our understanding of things inguinal hernia. In my opinion, too often this website drones on mesh doctors as a class of villains and that mesh has absolutely no redeeming value. Please don’t take my statement as one in support or against mesh. Unquestionably mesh is intuitively a sound idea; how it is actualized can be a problem.

Again if Watchful’s assessment is correct, then I hope Good intentions remembers that he actually allows for the application of mesh in some cases. Let me point out though that because one has had “experience working for large corporations” does not necessarily “give [one] more insight” into the matter. Belief that it does or “probably” so could unfortunately be self-deceptive by believing major litigation is ipso facto that mesh or its producer is the evil presumed.

Is “hernia repair mesh … part of the club now”? Thus tobacco, like mesh, can be a viable medical remedy? If one allows the use of mesh in some instances, hardly can one claim that mesh is on par with tobacco–that they form a club together. Further to put “guns, tobacco, self-driving cars, opioids, asbestos-containing talc, herbicides (Roundup)” together presumably as a class of evil doers is quite a stretch to say the least. Conspiracy theories are best left in Hollywood yarns than in critiques of medical practices. The more the two separated, the more insightful the critique. Thank you!

[Watchful]

Hi Pinto,

GI and I are on the same page, so nothing really to debate. I also think that mesh is over-used, and there are cases where tissue repair is an excellent solution, and avoids the added risks of mesh.

There are cases where mesh is the best option. I don’t think GI disagrees with that. It looks like mine was one of those. Unfortunately, I wasn’t aware of that when I was planning the surgery. Actually, I should say that Shouldice wasn’t a good way to treat mine. Maybe Desarda would have been ok – I don’t know. I doubt the Kang method would have been good for a very large indirect hernia with deep anatomy like mine, but he says he does large hernias, so maybe I’m wrong – I don’t know what he does for someone who has an indirect hernia with a very large defect.

[Good intentions]

I think that mesh is over-used and I think that the reason is corporate influence. Money over medicine. My posts are very clear on this. My experience working for large corporations probably gives me more insight in to the details of how the business world works, although the news media is full of stories of corporate influence affecting the welfare of the people that they are supposed to be serving. Guns, tobacco, self-driving cars, opioids, asbestos-containing talc, herbicides (Roundup), etc. Hernia repair mesh is part of the club now, there are large class action lawsuits in progress at this moment.

Dr. Towfigh has also suggested that mesh might be over-used in women. I have not kept up with her efforts but I suspect and have suggested that they will have little effect. Once somebody shows that mesh is over-used in one area it will give impetus to reducing its use on other areas. That will be profit lost.

There is a place for mesh in the world of hernia repair. But its over-use is a violation of the Hippocratic oath, because of the harm that is caused in trying to fix the problems that it causes. Although I think that many surgeons are ignorant of what they are doing, or don’t feel responsible, because they have no ready and reasonable alternative. Because they have been trained in the medical institutions that are being supported financially by the corporations that profit from the over-use of mesh, then joining organizations that have established mesh repair standards. They have been captured and are being used.