Large studies- thousands of patients -tissue repairs don’t hold

Hernia Discussion Forums Hernia Discussion Large studies- thousands of patients -tissue repairs don’t hold

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    • #32881
      Chuck
      Participant

      As i continue to analyze my moronic decision to pursue lap surgery….I was reminded that Todd Harris sited numerous large studies showing that tissue repairs had a high failure rate 20 percent he said….Voeller also contended that when it came to recurrance it was no contest mesh crushed tissue repairs…he said this was particularly true after 5 years…where tissue repairs failed and mesh didnt. Then there were the Towfigh interviews…where she repeadtedly said lap mesh was the gold standard for recurrance and chronic pain and that there were lots of problems with tissu repairs….we dont even teach them anymore. I dont know why i bought all this BS but i did….thinking these people were real authorities…while the studies were cited…they were never speficially identified…though scumbag Voeller did cite a few, But now i wonder just who were they studying….hardly anyone does tissue repairs anymore. And we know most of the docs that do….and they all contend they have low recurrance rates….so just where are those large studies coming from…is this more lies and deception?? i suspect so…and i am very depressed i fell for it.

    • #32883
      Watchful
      Participant

      Recurrence was indeed pretty high with tissue repairs in the old days. Performing these well requires strong skills which many surgeons didn’t have. Highly skilled tissue repair surgeons performing good techniques (Shouldice, etc.) achieve very low recurrence rates.

    • #32884
      Mike M
      Participant

      Mesh seems like the “easy way out” for a problem that should have multiple viable solutions for patients.

      How many of these “no mesh” failures are attributed to the following?

      #1. Poor surgical skill, ability, and/or training?

      #2. Bad technique i.e. “Corrupted Bassini”, too many modifications to the standard Shouldice technique, etc.

      #3. 35% BMI Obese+ Patients which were most likely becoming more common in the US and EU as mesh was becoming the “gold standard”

      #4. Lack of revenue / funding to support a solid, viable no mesh tissue repair alternative to mesh once mesh became all the rage.

      If these expert no mesh tissue repair specialists at the Shouldice Clinic, Dr. Kang, etc. had a 20% reoccurrence you wouldn’t hear a story here or there. There would be seemingly unimaginable outrage from vocal opponents of no mesh tissue repairs with their stories splattered everywhere. I am not talking about “Oh I get a twing every 3 days in this particular spot” or “Oh I had some tension then it faded after a year blah blah”.

      You can see the dramatic contrast in quality of surgeons from PeterC posts to MarkT’s experience. There is no comparison. Same with mine and Dr. Kang.

      I am cautiously optimistic the Dr. Krpata with the Cleveland Clinic will continue to research and develop viable methods of no mesh open tissue repairs like Dr. Kang.

      My advice is if a doctor tells you there is only one viable option or another regardless of the circumstances, patient preference, health, etc. run like hell. That doctor has stopped being open minded to viable and successful open tissue no mesh alternatives that are being used today and *working* successfully (some for decades). I never would choose a champion that does not want to or have the mental facilities to learn, develop, and continue to mastery their specialty.

    • #32895
      Chuck
      Participant

      Guys the only problem with what your are saying is that Harris and Voeller and Towfigh did not say studies from 20 years ago….they said studies…in some cases recent studies…some cited by Voeller….so it leads me to ask whether they are just lying…a good possibility….or there really are studies showing current tissue repairs to be faulty. Who knows…some one the FB pages are saying their tissue repairs failed after a year…not from Kang or Shouldice clinic. I dont understand how Mark T has no issues with all that steel wire inside of him. But i have meshed up friends with no isssues

    • #32896
      Watchful
      Participant

      Chuck,

      There aren’t many surgeons that have a large volume of inguinal tissue repairs these days. We’re talking about the Shouldice Hospital, Dr. Kang, Dr. Thomas, maybe Dr. Grischkan (not sure what percent he does without mesh), and a few German surgeons. I don’t think there are any independent recent studies of their results.

      The steel wire is very fine and thin. These aren’t rebar rods. It is true that a pretty hard wall is created from all these stitched layers, but this is true when prolene is used as well, and my understanding is that it’s not as bad as a hardened mesh.

    • #32915
      drtowfigh
      Keymaster

      The best long term data is from national databases in Europe. This article nicely summarized them.

      https://www.degruyter.com/document/doi/10.1515/iss-2016-0206/html?lang=en

    • #32919
      Watchful
      Participant

      Thanks for the link, Dr. Towfigh. These results aren’t consistent with results claimed by top tissue repair providers such as the Shouldice Hospital, German tissue repair experts, Dr. Kang, and Dr. Thomas.

    • #32920
      Good intentions
      Participant

      The paper by Dr. Kockerling is interesting. It is essentially a series of short paragraphs addressing the many problems associated with hernia repair and the many potential causes that have been hypothesized over time. It looks like he defined certain subject areas then tried to write about each. Some of them don’t really seem to go anywhere.

      Here is an example that starts in an interesting way but ends up vaguely. Anyone who has searched the literature for some thread of reason will recognize the dead end that ends up in. Lots of data…what does it mean?

      “In a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration, some 2612 patients responded (response rate 80.9%), of whom 1250 had undergone a Lichtenstein, 630 a Shouldice, and 732 a Marcy repair [70]. Chronic pain had been experienced within the previous month by 22.9% of the patients who responded. There was an overall decrease in pain with time, from 29.7% at 6–12 months to 18.1% at 37–48 months after surgery, with no overall differences between the three types of repair. Pain was more common in patients younger than 40 years [70].”

    • #32922
      Watchful
      Participant

      I thought the interesting thing is that the chronic pain numbers reported in this paper are an order of magnitude worse than what I’ve been told by surgeons (for both tissue repair and mesh), and the recurrence rates are much higher as well.

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