Good Intentions –your pain study

[Chuck]

Thanks so much for posting that other pain study —Good intentions — thanks for posting that pain study –once again showing that lap surgery resulted in less chronic pain than open non mesh repair 2 percent vs 14 percent for open non mesh repair. When i looked at the studies and the data before making my decision —i kept seeing this over and over…lap was the lowest risk for chronic pain….Voeller said it …Towfigh Said it….Watchfuls surgeon at the shouldice center said it—the studies i found online said it. I agree with you that mesh sucks and no one should ever use it….But for those wanting to avoid chronic pain —where is the evidence that tissue repairs result in less chronic pain???? I have yet to see a single study that shows that. But you keep telling everyone here that tissue repairs are a much less risk for chronic pain. I am not criticizing you….I just want to know where you are getting the information—because i am just not seeing it. I was terrified of chronic pain and looked everywhere to find the best info on it….of course all my local docs told me that chronic pain risk was higher with open no mesh surgery…with two of them saying they had seem patients with chronic pain from “that clinic in canada”—of course they provided no study info either. ….I know you read and study voraciously —so if that information is out there about the most chronic pain free repair—you would have it. I just cant find it myself The only data cited is from Tissue surgeons just making up numbers on the spot with no data collection at all.

[Chuck]

Any articles showing that tissue repairs result in less complications would be appreciated…I just cant find a thing about it. Its very difficult for someone to make a decision when there is zero data and the doctors you are relying on to give you advice all say that tissue repairs are inferior. But Dr, Belyansky has integrity and genuinely cares for his patients. I asked him about the shouldice and desarda repairs….he said, in his opinion, they were inferior repairs. He does both tissue and mesh repairs….and he is very well respected by the surgical community. Dr, Yunis called him that “fing genius” in maryland. It gets repeated over and over on this forum…mostly by GI that mesh repairs potential life enders and tissue repairs there are rarely any problems….but my own research shows that simply isnt true….I am willing to pay pal anyone who can send me a good study that shows tissue repairs result in less chronic pain or have significantly fewer complications than mesh repairs.

• This reply was modified 2 months ago by drtowfigh. Reason: Disrespectful

[Chuck]

from the voeller bendavid debate

This is why today, by far, mesh-based repairs are the most common repairs done worldwide. This is especially true if one looks at the laparoscopic repair where mesh is a requirement. When one compares the laparoscopic repair with mesh (when properly done) to the common open mesh repairs, almost every good-quality study using evidence-based medicine (Eklund, Jeekel, Eker, Westin) shows the laparoscopic repair has less acute pain, less chronic pain and quicker return to activity than the open approach. So now you combine the benefits of mesh (i.e., lower recurrence rates) as described above, with a minimally invasive approach, and mesh is the clear winner when it comes to recurrence rates as well as discomfort, both short and long term.

[Chuck]

and more

This does not mean CGP was not a problem, it was simply not the main focus. Many years ago, Neil Hagen, MD, of Dalhousie University, in Halifax, Nova Scotia, reported CGP in 11% of patients undergoing autogenous repair. This is supported by more recent data. Aasvang and Kehlet showed no increase in CGP with mesh use. Van Veen looked at 153 patients out to 129 months comparing Lichtenstein repair with McVay, Bassini and Shouldice repairs. There was less pain in the mesh group, and neither group had CGP patients at 10 years’ follow-up. The EU Hernia Trialists looked at 58 studies and over 11,000 repairs and found not only was the recurrence rate less in the mesh group as described above, but so was the incidence of CGP. The SMIL study showed CGP in 8.5% of lap repairs versus 11.4% in the Shouldice repair. Bittner, Koninger and Nordic all showed similar higher CGP in Shouldice repairs when compared with mesh repair. This is especially true if your mesh-based repair is a laparoscopic repair. I do believe that mesh, while it can cause problems in a minority of patients, in and of itself is not the predominant cause of CGP in the majority of patients.

[Chuck]

and another study….mesh superior for recurrance risk…no additional risk of chronic pain…again…where are these tissue repair is superior studies???

https://pubmed.ncbi.nlm.nih.gov/35451174/

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