Hernia surgery types offered in Berlin

[Good intentions]

Hello Alephy. “3D” generally refers to mesh that has a curvature pre-formed in to it. I posted a link below as an example. It is supposed to “automatically” take the desired shape of the space it is meant to cover, supposedly giving better results. But like many new products, it is really just a guess.

A plug product would be “3D” in shape but would not be considered as “3D”.

https://www.bd.com/en-us/products-and-solutions/products/product-families/3dmax-mesh

[pinto]

Leading Berlin Medical Practice Exposed?
Dr. Pawlak reports his observation of medical practice in Berlin:
“I spent a few days in his excellent 3Chirurgen Practice in Spandau and learned about the indications, saw few happy follow-up patients and again practiced dynamic groin ultrasound.”
Thus Pawlak reports that the results left much to be desired. Or did Pawlak simply overlook a fine point about grammar.
(Even in the mesh world we might find some humor.)

[Alephy]

From my (ignorant) side, what caught my eye was all the different “surgeries” that were mentioned, some of which I never heard of….

BTW are 3d meshes all considered a no-go, or the problems were associated to only a particular type? This also I found confusing, as it seems on the web site that 3d mesh is considered as a viable mesh, but as pointed out by Good intentions, one of the few agreements on mesh is that the plug mesh should not be used…..

[Good intentions]

Here is more about the author of the report that you posted William. He has really been around. It is a good sign that he is open to a better understanding of what is going on. I hope that he is sincere.

Fascinating that he is part of the Herniasurge group and also participates in the charity work in under-developed regions of the world. Back when the Herniasurge pages were open to the public, you could read about the efforts to train surgeons in mesh repair techniques through those charity efforts.

“He has also volunteered with Operation Hernia and HerniaHelp, taking part in surgical charity missions in Ghana and Haiti.”

https://www.northdevonhealth.nhs.uk/services/general-surgery/upper-gi-surgery/meet-the-team/mr-maciej-pawlak/

[Good intentions]

Thanks for finding and posting that William. It is definitely worth reading. It gives the perspective of the new surgeon. Not trained in the pure tissue repair methods but is aware of them and wants to learn them.

It is also interesting that the page that Alephy posted is so pro-mesh, but Dr. Lorenz is known for pure tissue repairs and his name is at the top of the page. The Guidelines work that was done in 2009 is still very powerful.

This excerpt from the page you posted really caught my eye. If hernia repair surgeons start using a fully formed chain-of-logic approach with long-term results for the patient in mind, his philosophy makes perfect sense.

“During my training, I did not have a chance to learn the basics of pure tissue repair. When I started my career it was already the era of mesh repair. The evidence and multiple trials that had shown the superiority of mesh vs non-mesh repairs sanctioned those changes in surgical approach. Nevertheless, I wanted to explore the field of pure tissue repair to become familiar with the strengths and weaknesses of the groin region and its layers and to be able to tailor my approach if necessary. I believe that to become a true expert of hernia surgery, it is of utmost importance to know the anatomy of the abdominal wall and the proper management of tissue, as well as how to use fascia to support the repair. Most of all, that knowledge should be the backbone of honest, patient-oriented decision making while considering methods of hernia repair. Therefore, Shouldice, pure tissue repair, as the technique with best-proven outcomes, should be taught and used when the patient could benefit from it.”

[William Bryant]

https://www.europeanherniasociety.eu/european-hernia-society-travel-grant-visit-2019-berlin

Saying here Lorenz favours Desarda Shouldice

[Good intentions]

Hello Alephy. It looks like Dr. Lorenz and/or his staff, whoever put the page together, have just taken the latest thoughts being promoted in the hernia repair field, especially “tailored repair”, and come up with a list showing many possible tailored methods. But it all starts with the European Guidelines. Mesh is still the first choice, and the list just shows the huge selection of materials and how to use them. All for the same malady.

The page says that they follow the Guidelines, but then they describe the use two types of plug repair. Even though the Guidelines recommend against the use of plugs.

I think that it is just advertising, to show that they are up to speed with the mainstream words. “Tailored repair with mesh”. It’s doubtful that they use all of the methods that they showed.

From his page –

“All inguinal hernias have long been classified in our center using European guidelines. (EHS Classification = European Hernia Society Classification). Together with requirements, risk profiles, and the patient’s wishes, this classification serves as a guideline for decisions made during surgery.”

The scare words are still used, with exclamation marks. Basically, if there’s a bump, “you could die!” –

“Do you have to operate on an inguinal hernia?
Although most inguinal hernias are harmless, they nevertheless can lead to intestinal incarceration at any time, which presents a more threatening complication. This is not only extremely painful, but it also presents an emergency and must be operated on immediately! In contrast, small inguinal hernias with flat protrusions (ultrasound diagnosis) are rather harmless, particularly in younger patients with no pre-existing conditions or pain. In this case, a deferral with constant medical supervision (about 6 weeks) is possible for the purposes of „watchful waiting“.”

[Mike M]

My understanding is the Muschaweck repair is limited to small hernias and there might be other specifics too.