Inguinal Hernia Mesh removal stats

[pinto]

@alephy, I agree with you and I also agree there are some inherent problems with mesh. One is the communication part (though not with every “mesh” doctor) that the doctor is so sure of his/her practice and the viability of mesh that they funnel you onto the process of getting an operation without nary a word about the risk and so on. Some mesh doctors can’t tell you on their own what mesh they use. I got it. And just for clarification, I recognize that much scrutiny here of mesh is well deserved, but the natural counterpoint assumed are non-mesh methods, which seems to end up exalting them undeservedly. This is a “see-saw” effect that if unchecked may lead to unfortunate medical decisions. Thank you for your post clarifying your own view on matters and your much valued participation.

[Alephy]

@pinto I can understand your point about a University hospital. The question is: was the patient informed before surgery that it would have been handled by other surgeons, with the occasional supervision of the chief surgeon? The article criticising what had happened described the way the “many surgeries” were handled as not acceptable and I agree with this: the criticisms were on the procedure and process, as well as the “volume concept” and I think they stand.

I think you are right that this case was settled out of court.
I also agree there is a bias against mesh, but this is probably due to the many more mesh surgeries than pure tissue ones….
However, I also think that as you said some cases warrant indeed the use of mesh.

Last but not least, the criticisms against doctors come from their (the vast majority of them) conveying wrong information to the patients e.g. that the mesh is inactive, that the patient will be able to go back to full contact sports in few weeks, that the % of chronic pain is smaller than 1% and that it all depends on the surgeon technique etc: it is this behaviour that causes the mistrust!

[pinto]

Further to my comment: My purpose is to show that some people, if not many here, treat doctors rather unfairly. Specifically they are ultra strict with mesh practitioners yet so soft with non-mesh ones. Incredibly lopsided. That unfairness results from bias.

Let me remind people here: in some extreme situations mesh is the only option. So if you eradicate the “mesh industry” then you deny some people the chance for life itself. If you cannot be dispassionate about things mesh, then surely you cannot be objective about matters non-mesh.

Besides possibly ending up with unscrupulous non-mesh doctors yourselves, you compound matters because your rose-colored glasses lead other patients astray. I agree that mesh requires close scrutiny but so for any other method. I surely hope we can join together by which to gain a clearer picture of all things hernia. Thank you for your attention.

[pinto]

Yes, hello, @good-intentions. Good to see you active, for we can all benefit. Speaking of conflating something, please re-read your posts for an example. 🙂 As to the matter directly, you misspeak when you make these two false claims:
“Dr. Ramshaw is just an example of how a person seeking [1] a simple hernia repair can end up with [2] a doctor who has become part of the system of pushing patients through as quickly as possible.”
Was it a simple hernia because if I read it correctly, the patient had ten prior surgeries for the same ailment. Ten! Ramshaw goes on to say that consequently the scar tissue was so immense that it obviously was an important factor. This was no simple case for surely you must agree.

Secondly wasn’t Ramshaw at a university hospital thus a teaching hospital, as well as being a chief surgeon? Translation: teaching hospitals teach, so any patient will necessarily have the chance of having a less experienced surgeon do their surgery; and Ramshaw had a supervisory role over other surgeons (i.e., “trainees”) requiring him to bounce around the various ORs. Whose fault is it for this scattering of his attention–his or the hospital’s? Neither, according to your posts. The fault lies with the “industry” of mesh medical practice, for you claim that Ramshaw “became a cog in the machine.” Was the “machine” or “system” that of the mesh industry’s or the reality of today’s teaching hospital? Your case for the former is on weak grounds.

However, your advice is a good one: avoid such medical enterprises in which the patient gets reduced service due to its large-scale or perhaps more pertinently, the teaching hospital. I strongly agree. On the other hand, I wish you be a bit more reflective about your posts. 🙂

@Alephy, I agree with the tenor of your post but please note that you didn’t quite use all the evidence. Yes, one doctor opined against Ramshaw as you rightfully point out. However you apparently overlooked another doctor (Clarke) who joined the fray in support of Ramshaw by saying that that other doctor was “mean-spirited” and lacked empathy for Ramshaw’s situation. https://www.generalsurgerynews.com/Article/PrintArticle?articleID=63154

Noteworthy is the unsaid: No further commentary was made in the journal about Ramshaw. I believe that most surgeons understood that Ramshaw, for good or ill, was in a situation beyond his control (but not due to the mesh industry :). It is very likely that the unfortunate patient received millions in an out-of-court settlement; thus Ramshaw can be so forthright about the case. If no settlement, then it would have been very unlikely Ramshaw would have admitted his mistake publicly. Moreover, he probably received some exoneration by the likely internal review that the medical case was extremely difficult and one made more so by his supervisory role at the hospital (therefore by his job not by personal choice).

[Alephy]

I read the second article where another doctor openly criticises Dr. Ramshaw, and I totally agree with the comments therein! I do not understand how the description of what happened could not be the subject of a lawsuit, and one that would be very easy to win!

Going back to the volume tenet, and the idea that the medical corporations push for more surgeries, how do they do it exactly? Because if money is the tool, then that is called bribing/corruption in my book, and I will most definitely not pity the “victim surgeons”, whether with a burn out or not! I cannot think what my anger would be if I learnt that my surgery went south because my surgeon jumped from one OR to another: I have a feeling I would have serious problems controlling it (in fact I would be furious), so the part where such doctor would apologise would also go very south….

[Good intentions]

Hello pinto. Greed was not mentioned anywhere. And “mesh” was not the point about Dr. Ramshaw being a businessman before a doctor. I think that you have conflated business with greed. Dr. Ramshaw is just an example of how a person seeking a simple hernia repair can end up with a doctor who has become part of the system of pushing patients through as quickly as possible. He is one of many. His article describes how it happens.

Dr. Ramshaw lowered his standard of care for each individual patient whose procedure he was overseeing, so that he could see as many as possible within a certain period of time. He described that in his article. He became a cog in the machine. In the article he described this explicitly.

The point about mesh was that Dr. Ramshaw is a mesh proponent and mesh-makers would love to have him on their side defending the use of mesh, as an expert witness, now that he has left individual patient care behind. Dr. Ramshaw has even talked about the profession of “expert witness” and how it can be lucrative. I linked the article below. The result of his being co-opted by the industrial business model of healthcare today is that he is no longer a true doctor. He has moved on to other ways to make money, and defending mesh will probably be part of that. It’s just part of the bigger story. The arc of a physician’s career.

My post wasn’t about Dr. Ramshaw. I just used him as an example. The subject of physician burnout is an important topic today. Many are not allowed to care for patients in the way that they know is best.

https://www.generalsurgerynews.com/In-the-News/Article/07-21/Tips-on-Being-an-Expert-Witness/64041

[pinto]

If I may say so, every medical practice charged for a fee is a business. Hardly is it apparent that Ramshaw’s error came from greed; nor that it was mesh. Indeed he had yet to apply mesh at the time for this patient, one who had ten previous operations for the same ailment. So I am at a loss to see how Ramshaw can epitomize the ill of mesh medical practice. He did strangely write seemingly to lessen his responsibility despite admitting it. His double talk is quite unprofessional in my view, but attributing his medical error to greed or to the use of mesh is without foundation.

[Good intentions]

I often use the word “industry” when I talk about the hernia repair field, because it really is a business, with pressure to get customers and keep revenue coming in. Dr. Ramshaw wrote an article about he got caught up in the mechanism of the industry and a patient of his had part of their leg amputated after a hernia repair, because of his error. He had transformed from a physician in to a businessman, no longer a true doctor, and one of his patients paid a huge cost.

Here is a link to the story and also a response to the story. So, my point was to be aware of what type of organization a person chooses for their hernia repair. The big ones will lean toward bureaucracy and displaced responsibility, where no one is really responsible for whatever happens. The doctors are just performing procedures, as quickly and cost-effectively as possible. Get ’em in and get ’em out.

As far as I can tell Dr. Ramshaw has given up surgery and is now a consultant and expert witness. Ironically, I would bet that he is used most often by the mesh companies in mesh lawsuits, since he has the air of an expert and has flatly denied that mesh is the cause of chronic pain in the past. He is a mesh promoter.

It’s a sad story for everyone involved, a good surgeon lost to the field, and the industry just keeps chugging along, impervious to the damage done.

https://www.generalsurgerynews.com/Opinion/Article/10-20/My-Worst-Surgical-Error/60834

https://www.generalsurgerynews.com/Letters-to-the-Editor/Article/02-21/Surgical-Errors/62536

[William Bryant]

Good Intentions, what is Dr Ramshaws story?

[Johnso]

Ian:

On Hernia Talk Live #85: “Hernia Surgery and the COVID Pandemic” Dr. Towfigh mentioned she will be making her paper on Mesh Implant Illness and mesh removal available on her website after it is published. I assume she is referring to her Beverly Hills Hernia Center website. Hopefully she will provide a link on this forum when the paper is available and it is available in time to help with your hernia mesh removal decision.

You can skip ahead and listen from 15:45 to 17:20 to hear what she said. Here is a link:

https://www.youtube.com/watch?v=-rTGQ62gu-8

johnso

• This reply was modified 2 years, 10 months ago by  Johnso.

[Ian J]

I think mine was called polymesh I’m not certain about that though.

Can anyone provide an idea of cost for the removal? I know it’s how long is a piece of string but so far I can’t seem to get any indication of what I would be looking at.

Thanks

[Good intentions]

I asked Dr. Billing if he could do both sides at the same time and he said “I just can’t last that long”. An example of taking the time and effort to do things the best way possible versus trying to fit what can be done in to a time slot, I think. Plus, it’s not good to be under general anesthesia for extended periods of time.

Another thing I thought about was to be aware of the difference between a surgeon at a large practice versus one at a small practice. The surgeon at a large practice will probably have time constraints, trying to do as much as they can within the time allowed, fitting the work to the time. The individual or small practice surgeon will have more freedom, making the time fit the work. And, in the same vein, surgeons at large practices sometimes use interns or surgeons-in-training to do the work, under their guidance. Dr. Ramshaw’s story comes to mind.

It would be good for you to find out what type of mesh was used in your implantation. There is a very large variety. It will give you an idea of how straightforward the removal might be. Get the surgery notes, they should still be available. Even in 2015 there is still a wide variety of possible materials and methods that might have been used. Area of dissection, size of mesh implant, shape of implant, fixation, etc.

[ajm222]

I only had mesh (Progrip) on one side – my right. I had an indirect inguinal hernia. I don’t know if all surgeons have the same belief about doing only one side at a time. I had thought I’d heard of some doing both together but not really sure. I’m guessing some will definitely do that. And mine was removed by Igor Belyansky in Maryland. Mine was robotically placed in February of 2018 and robotically removed in February of last year (2021). My symptoms were weird and mostly discomfort and regular moderate soreness from my groin and even up my whole right side on some level. I didn’t have any nerve issues or auto-immune issues. I just never felt right after the surgery and bothered me constantly.

[Ian J]

That is exactly the kind of detailed answer I’ve been looking for, thank you so much.
Can I ask what you had removed? Was yours both sides inguinal mesh? Is it correct they only will one remove one side at a time?

Thanks again for your comprehensive reply.

• This reply was modified 2 years, 11 months ago by  Ian J.

[ajm222]

oh, and most mesh removal surgeons generally advertise that about 75-80% of patients who go through removal with an experienced surgeon see improvement, about 15-20% stay the same, and about 5% are worse off. not sure about how many people can honestly say they are ‘back to normal’ after removal (that’s probably not as common), but most are glad they did it and are better off than they were with the mesh. the % improvement is very individual. i am personally better off, but not 100%. but happy i had it removed, and i believe i still will see further improvement hopefully over time as it’s been less than a year for me. i work a normal work schedule and run 3-4 miles 5 days a week and do tons of yard and house work regularly.

• This reply was modified 2 years, 11 months ago by  ajm222.

[ajm222]

if your mesh was placed laparoscopically, you definitely want it removed robotically. there actually isn’t much tissue removed at all. the trick is the dissection of the mesh from the tissue it has adhered to. it is not an extremely dangerous procedure when done in the hands of the few mesh removal experts who have done hundreds of these. that said, it’s higher risk than the original surgery, and it’s a whole different animal. basic recovery isn’t all that different from the original surgery. but I think full recovery takes longer. i had mine removed in an outpatient surgery and was moving around pretty good the next day. then for several days i felt a lot of discomfort, but it was mostly from the robot I think more than anything. after a week or two, just like with the initial surgery, I was up and about and working. but the original surgery isn’t doing as much dissecting and cutting etc, so the full healing process is quicker. i think after removal, your body will be healing on some level for quite a bit longer. but you’ll still be able to be active soon after surgery.

• This reply was modified 2 years, 11 months ago by  ajm222.

[Ian J]

Thanks so much for both replies.

Is it extremely invasive or minimally invasive? All I keep hearing is it a massive operation that is extremely dangerous, is this true? I’ve seen pictures of removals where there is an extremely large amount of tissue removed with the mesh is this normal? Also what is the recovery period please?
Also mine was originally done laproscopically so the mesh is behind the abdominal wall. From what I’ve read this seems to matter I believe, with how the operation is performed. I’m guessing it would be done via robot?

Thanks

• This reply was modified 2 years, 11 months ago by  Ian J.

[Good intentions]

I think that mesh removal is the industry’s “dirty secret”. People don’t want to talk about it because the natural follow-up questions are about why and how much the problem occurs, and if there are alternatives to mesh. The mesh industry will not even create a standardized mesh repair registry to track the quality of the implantations. They don’t want to know.

When choosing a surgeon for mesh removal make sure that you find one who will take the time to tease out the various nerves and vessels that have become entwined with the mesh. Neurectomy is often used during mesh removal, supposedly as a way to remove the source of pain, but I suspect that it is also faster. Quicker to cut the nerve than to properly dissect it from the mesh. In other words, if the surgeon says that they can have all of the mesh out in just an hour or two, that’s probably bad. My surgeon took 2-3 hours on each side.

Of course, all mesh can be removed. The question, as you’re asking, is what is the quality of life after mesh removal. Unfortunately, in today’s world, forums like this one are the only way to learn about that. There is no registry for mesh removal, with names of surgeons and results of their efforts. There is no industry support for such an effort, because it will just shine a light on a problem that they don’t want exposed.

The lawsuits are still working their way through the courts. As the financial costs to the industry become more clear there could be an effort to reduce mesh complications, But it will probably not help at all with mesh removal. Ironically, as I just posted about, the efforts of the robotics industry will probably do more for mesh removal than anything the mesh makers do.

Sorry for soap-boxing in your Topic. There are several Topics on the forum about mesh removal. Dr. Peter Billing of Kirkland, WA might still remove mesh (he removed mine), and Dr. Andrew Wright of UW Medicine, if you are in the northwest. Both are good possibilities, I think.

https://www.transformweightloss.com/meet-our-team/

https://www.uwmedicine.org/bios/andrew-wright

[William Bryant]

I haven’t had mesh but some people who post on here have and as far as I can tell the majority with problems who have had mesh removed are glad they did. The people who say they are still in pain or just as badly off after removal are a small minority. Choose a surgeon who has done a lot of removals and is experienced and hopefully your quality of life will greatly improve.