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Mesh Removal as an official topic for meetings
Since mesh complications and removal are very well-known as problems in the field of hernia repair, would it not make sense to have mesh removal as its own topic at the professional meetings? I posted a topic recently where four surgeons each gave explicit video demonstrations of how to implant mesh. But I can’t real seeing a meeting topic solely about removing mesh. It is a “thing” and it is difficult and removal can cause more problems than the mesh itself if done certain ways. And the variety of methods used seems wide, with everything from routine triple neurectomy to no neurectomy, and open surgery to robotic laparoscopy, as possibilities.
There should be a forum where surgeons with expertise in mesh removal can show how to do it best. I know that my surgeon, Dr. Peter Billing, has been asked about his methods by other surgeons. I also know that I seem to be doing better than some of the stories I have seen from other mesh removal patients. His method seems worth sharing.
I also notice that “mesh” is either being buried or people have run out of ideas about it, in the next SAGES meeting. Only one instance of the word “mesh” in the 2019 SAGES conference program, link below. That is not going to help progress in the field, ignoring the problem because it’s difficult. So, if the 10 – 30% chronic pain is the new norm, then mesh removal should also be part of the new norm. It’s the right thing to do, until better products are developed. Mesh removal surgeons should not be the outcasts of the surgical community. Take the profession back from the device makers’ control.
Maybe a surgeon could make this recommendation. I don’t see how it would not be a topic of major interest. [USER=”935″]drtowfigh[/USER]
https://www.sages2019.org/wp-content/uploads/2019/03/SAGES-1pg-SAAG.pdf
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8 Replies
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Dear Chaunce.
I agree with you, especially since many hernias are repaired that are asymptomatic. It is wrong to take a patient with minimal symptoms and turn him/her into a patient with chronic pain.
Regards
Bill Brown MD is -
Mesh or not, it should not be considered acceptable or ‘the new norm’ for chronic pain to impact 10%-30% of patients for a routine surgery. I genuinely do not understand why chronic pain prevention is not given the highest priority in inguinal hernia repair.
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About one year ago there was an effort to increase the dialogue between the FDA and the affected parties. Not clear what ever came of it.
https://www.herniatalk.com/6583-dear-patient-advocates-seeking-feedback
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quote DrBrown:Dear Good Intentions.
Your comments and information in this forum are a start, but I agree it would be very helpful if the FDA would acknowledge the problem. Many surgeons that use mesh do not realize that their patients have serious problems with mesh, because the patient goes to another surgeon to have the mesh removed (i.e. Myself and Dr Towfigh)
I appreciate your effort to keep attention focused on Mesh.
Regards
Bill Brown MDThank you Dr. Brown. As you can see from the FDA’s own web site they are aware. But they seem to be deflecting any responsibility for action, even suggesting that the problems they list have all been removed from the market, by recalls. Even as the lawsuit ads on the mainstream media channels become more prevalent. It really looks like the device makers have got to them and are running the show. The FDA expects the device makers to recall their own products, seemingly not realizing that self-recall means self-blame which means liability. The FDA does not seem to understand their role.
From the FDA:
“Many complications related to hernia repair with surgical mesh that have been reported to the FDA have been associated with recalled mesh products that are no longer on the market. Pain, infection, recurrence, adhesion, obstruction, and perforation are the most common complications associated with recalled mesh. In the FDA’s analysis of medical adverse event reports to the FDA, recalled mesh products were the main cause of bowel perforation and obstruction complications.”
They put all of the responsibility on the surgeon, and the patient. Surgeons make fun of “Dr. Google” but Dr. Google seems to be necessary.
“The FDA wants to help patients make informed decisions about their health care and to facilitate a discussion between patients and their surgeons.”
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Agree we need more.
These are not closed door meetings, but open to whomever chooses to register and attend. It is quite expensive to broadcast the meetings themselves, whether live or on Youtube, and so only a handful of the larger, richer societies do so. Surgical conferences and meetings are on string budgets and surgeons no longer travel for meetings in the ways they used to in the past. The economy just does not allow for so much expense by the surgeon nor so much time away from a clinical practice.
It’s a multifactorial problem.
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Dear Good Intentions.
Your comments and information in this forum are a start, but I agree it would be very helpful if the FDA would acknowledge the problem. Many surgeons that use mesh do not realize that their patients have serious problems with mesh, because the patient goes to another surgeon to have the mesh removed (i.e. Myself and Dr Towfigh)
I appreciate your effort to keep attention focused on Mesh.
Regards
Bill Brown MD -
Thank you for the reply Dr. Towfigh.
Of course, I meant an open forum with presentations, at one or more of the national meetings, similar to the presentations about how to implant mesh. As the patient becomes more responsible for the decision about how to repair their hernia, the patient needs good information. The closed door meetings between surgeons and others don’t help the patient learn anything. They actually make the patient more suspicious that something is being hidden. In the long run, the closed door meetings might even be making the participants of the meetings more liable for future problems.
It would be so much better to just have an official acknowledgement of the problem, with some level of quantification, and some shared information about how to deal with it. My surgeon delayed and denied for almost a year and finally said that he was going to seek outside help. He should have had an answer immediately and recognized the symptoms. He was fully up to speed on how to implant mesh, training and certifying people in laparoscopic techniques, but apparently clueless about mesh removal. He was either pretending, or he really did not know what to do. Both are bad.
Unfortunately, there is a growing gap between what the doctor needs to do for their profession, and what the patient needs to do to heal and get back to a full life. I think that this also plays in to the burnout and depression among doctors that mentioned in my other topic. The doctors need patients to push back, for the health of all involved. Expose the bad side of hernia repair so that people can be ready to deal with the failures.
I think that in today’s world it is inevitable that mesh removal will eventually be fully exposed. Better to be ready for it and ahead of it. It would make a great 60 minutes story.
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Yes. We have talks about mesh removal at our meetings. We need more.
We just published our video manuscript on tips to safe laparoscopic and robotic mesh removal.
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