Mesh Removal

[Herniahelper]

I feel this testimonial is very timely and important. There is a lot of ‘gloom and doom’ out there surrounding hernia complications. A small group of very talented surgeons have been pioneering efforts to remediate these and their published data seems to suggest that the majority “get better.” But what does that really mean? There is so little information available to patients that a positive outcome from one particular doctor or procedure is actually a huge data point. The procedure you had (minimally invasive primary tissue repair) is somewhat new. Jogging after six weeks also sounds miraculous.

Granted every case is different and peoples individual mileage will vary. I can echo many of your observations regarding traveling the country looking for the right doctor. Each has an approach that is very different. Some of these doctors are even booked over 6 months out.

Your case stands out.

Just like surgeons share these cases with each other at meetings all over the world it would be great if we as patients had a better resource to share our experiences. Many of the old support sites/groups are now defunct as their creators moved on with their lives. I suspect many patients with good outcomes return to a normal life so we don’t hear from what I hope is the happy majority.

If you can, continuing to share how your recovery goes would be really helpful.

It sounds like you may be able to return to a full active life which is really quite inspiring.

[drtowfigh]

There are many studies comparing different mesh products and techniques. There is no best mesh. There is no ideal mesh. Whereas one patient may do very well with one type of mesh, another would not. For example, perhaps an obese patient will do better with a heavier weight mesh, a thin patient may do better with a lighter weight mesh or no mesh, a patient with a wide-based hernia may do better with a sandwich type designed mesh. A direct hernia may be best treated with a heavier weight mesh, but what if you are thin and have a direct hernia or a wide-based hernia? The permutations are plenty. There is no formula to plug in to tell you which patient will have the best outcome with which technique. Each surgeon has a different outcome with each technique and each patient has a different outcome with the same technique. That is where the art comes from.

Many mesh companies profit nicely from selling implants, especially since mesh repair is considered gold standard in the US. Surgeons don’t have contracts with mesh companies. In fact, in many situations, the type of mesh carried is an economic decision.

Medicine, as you may have figured out by now, is not a profits-first business. Patient needs supersede profit margins. Unlike most businesses, patients’ lives come first. So, e.g., if the patient requires a certain treatment, implant, procedure, etc., and they can’t pay for it, or their insurance doesn’t cover it, or the insurance pays too little to make the procedure profitable, that is often not a reason to prevent the patient from having a life-saving, life-altering, or to withhold health care. It is part of the reason why the US healthcare is bankrupt: improvements in technology and availability of new technology precludes the doctors to take advantage of the new technology and provide the best care to their patient, even though it is often at higher cost. Same with pharmaceuticals. The real winners are the industries that provide this technology. For sure, it is not the doctor. They intend to provide the best care for their patient.

Perhaps this is too much information.

[Good intentions]

Thank you for the reply. I did not mean material gains. I meant contracts with the mesh companies. It might not even be the surgeon who has the contract.

I have heard the statement about losing money on mesh implantation. It doesn’t make sense. That’s not how businesses are run, costs are adjusted to break even at least, in a non-profit organization.

I really appreciate your contributions, but your comments are the general platitudes, with no useful detail, that leave everyone wondering. No offense intended. For example, why are there so many different types of mesh, from so many different companies? If the procedure is as easy and as safe as suggested, what purpose would be there be to have all of these different products? Somebody is making money here. A person could argue that there must be flaws in the materials and methods because medical device companies see a need for new products. There must be, they don’t do research for fun. How do we patients get the information behind the reason for the new products.

We all go in to the specialist’s office expecting that they will be up to speed on the state-of-the-art. Then we’re supposed to tell them what we want. But we don’t have the information we need to make an informed decision.

“There are a lot of quality of life studies performed on patients with and without mesh implantation”. Where are the quality of life studies comparing the different materiasl and methods of implantation? “With and without mesh” is not really the question, it’s “what is the best mesh and method to give the best quality of life”.

[drtowfigh]

Good Intentions,

Just to clarify: surgeons do not implant mesh for material gains. There is no gain in implanting mesh. Surgeons don’t get paid extra to place mesh in patients. Institutions/facilities lose money each time a mesh is implanted in a patient, as there is no extra payment for that procedure.

There are a lot of quality of life studies performed on patients with and without mesh implantation. It is a fallacy to believe that non-mesh patients in general, as a population, have significantly improved quality of life. That has never been proven.

However, population studies and trials are different than individual experience. For sure there are individual patients that have complications after hernia repair with mesh. Of that population, some of the complications may be directly related to the mesh itself. We are struggling to determine the mesh-related risk on an individual basis before it is implanted in a patient. There are a few studies looking into it.

[Good intentions]

quote vtjbrent:

I had my mesh successfully removed 6 weeks ago. Bilateral mesh was completely taken out during the same surgery..

Thank you for sharing this. Your situation mirrors mine in many ways. I had Bard Soft Mesh implanted laparoscopically about 2 1/2 years ago. It never settled in like it was described that it would, I had to devise my own methods of getting my abdomen in to a condition that I could tolerate, and I wake up every day thinking about having it removed. I used to be very athletic – running, biking, and playing soccer. Now I focus on working out in the gym to just the right degree to allow me to be somewhat comfortable during normal activities like sitting at a desk or walking around. I’m too physically healthy to obviously need surgery, but the distraction degrades all other aspects of my life.

Please post back with the results of the healing from the surgery, if you can. It looks like it’s been nine weeks since you had the surgery. It would be fantastic if Dr. Towfigh could describe what she found, although from what I’ve learned, there was probably nothing unusual. Your mesh was probably exactly as it was intended to be, for recurrence avoidance purposes. But not quality of life.

To the Herniator – your reply almost perfectly exemplified the problem with the mesh implantation industry. A focus on avoiding recurrence, and a safe procedure. vtjbrent’s point was all about a degraded quality of life, but you replied with an answer about safety.

Anybody considering mesh implantation to fix a hernia should make the surgeon prove that they have satisfied and happy patients. There is no reason at all that the surgeons shouldn’t know by now what works and what doesn’t, for quality of life after the implantation. But nobody seems to be trying to determine that. The mesh companies are all selling their weave patterns and materials and shapes but with no quality of life correlations. After thousands, or hundreds of thousands of implantations, those comparisons should be possible. Many surgeons and organizations seem to be captured by the mesh company they work with though, and are making financial decisions first, with the patient second I think.

[Momof4]

vtjbrent,
I sent you a personal message through the message center asking a few questions about mesh removal and your stay in CA. I look forward to your reply. Thanks!

[Herniator]

I’m pleased that you are better – but mesh overall is very safe as well as recommended
http://mailchi.mp/23a275fbe343/j114lk1gnu