Inguinal hernia questions
07/22/2020 at 11:24 pm #27678
Despite having being on fora for quite some time, I am still puzzled by these questions:
Chronic pain rate? I have heard/read 15%, but then some of these will get better after a year, while others will get into this group in the medium to long term…and does this mean that 85% are “pain free” after few weeks? From what I have read it is more of having minor pain; I wonder what is the percentage of the truly pain free/go back to my life…(I guess I will not get an answer to this one)
In the videos posted here it is mentioned that chronic pain happens with mesh as well as without; on the other hand I think Dr. Brown mentioned that chronic pain was virtually unknown before mesh arrived. So which is which? papers? studies? facts?
Some also say that re-absorbable meshes do not work, the recurrence rate is high: can someone point me to recent studies about this?
It has been mentioned that polipropilene is associated to higher risk of cancer and other diseases: what do doctors think and why they still stick to it if they do?
07/23/2020 at 7:21 am #27681
I forgot another one: us it true that direct hernias are less manageable with a pure tissue repair? I never saw any paper on it…
07/24/2020 at 10:50 pm #27693drtowfighKeymaster
– 12-15% chronic pain after inguinal hernia repair, regardless of technique (mesh vs no mesh) at 3 Months after surgery. Any pain is considered chronic after 3 month is no matter how minor or major. This value drops to single digits at 12 months.
– Yes, thank means 85% are pain free within less than 3 months.
– not true that chronic pain was unknown. It has been reported and was in the 15-25% range. People undergoing tissue repair were routinely hospitalized in the US for up to week. It was considered a painful operation. Recurrence was the biggest issue back then. And pain was not really studied as an outcome until more modern times when recurrence dramatically reduced with the mesh repair (Lichtenstein and Nyhus repairs).
– no study has shown acceptable recurrence rates with absorbable meshes. Many studies stopped following patients after 1-2 years, when the recurrences started showing up.
– there are no studies linking use of polypropylene with cancer risk. This statement has been extrapolated from a paper which showed cancer in an area where there was a mesh infection with fistula. We know that certain chronic inflammatory conditions of the skin can cause cancer. This includes the base of some bad burns. But to claim that all inflammation causes cancer and polypropylene causes inflammation so polypropylene causes cancer is a misrepresentation. Based on that logic, all patients with arthritis (inflammation) have cancer. And of course we know there is no such correlation either.
07/30/2020 at 11:46 pm #27718
Thanks for your answers!
I am wondering why people had to stay a week in hospital back then when mesh was not around, given these days even with a tissue only repair one is sent home the same day or the day after….
Absorbable meshes: no long term study would mean it is not known then, as opposed to being a studied and verified as a fact? Again I hear contradictory claims in both directions…
Leaving aside the recurrence rate war, are mesh patients more at risk of developing complications after years from the surgery, and if so does this still enter into the 15% of complications?
Thanks a lot again for your help!
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