Mesh removal training – a new field of study

[Good intentions]

I wrote in a separate topic that mesh problems would be much better understood if mesh removal was a true area of research. Today I found this article about “skills accreditation” in mesh removal, I assume through on-the-job training since there are no official training centers, apparently.

If it’s happening in pelvic mesh it will probably follow in hernia repair mesh. Unfortunately, that doesn’t mean the problems will stop, just that people can get some of their life back before they die. Better than no hope.

https://www.bmj.com/content/372/bmj.n452.full

Excerpt –

“Surgeons who will work at new specialist mesh centres throughout England hope to establish their competence through credentialing in the field of pelvic mesh removal surgery, in the absence of a recognised training programme.””

Here is a link to one of the references in the abstract. Both of these are very recent, published in 2020/2021.

https://www.bmj.com/content/370/bmj.m3099

Excerpt –

“On 8 July the Conservative peer Julia Cumberlege published her much anticipated Independent Medicines and Medical Devices Safety Review, looking into the response of England’s healthcare system to patients’ reports of harm from drugs and medical devices. Commissioned in 2018, the review was conducted through the lens of three medical treatments: hormone pregnancy tests (mainly the drug Primodos), alleged to cause serious birth defects; the anti-epileptic sodium valproate, which can cause birth defects and developmental delays; and pelvic mesh, a surgical material (technically a medical device) implanted in thousands of women to treat organ prolapse and urinary incontinence. Mesh is now the subject of intense global scrutiny after reports of serious long term effects from material that has twisted, moved, disintegrated, or caused severe allergic reactions.”

• This topic was modified 1 year, 8 months ago by Good intentions.

[drtowfigh]

The US has multiple hernia surgery training centers. Many, such as my own, are imbedded within accredited laparoscopic surgery training center.

Official accreditation for a hernia-only training center has been discussed but is not yet reality. Nevertheless, we do have a couple of US training centers for hernias only.

• This reply was modified 1 year, 8 months ago by drtowfigh.

[Alephy]

Reading “..Mesh is now the subject of intense global scrutiny after reports of serious long term effects from material that has twisted, moved, disintegrated, or caused severe allergic reactions.” makes me wonder: if the pelvic mesh caused allergic reactions, shouldn’t one conclude that the same problem would be potentially present for a hernia repair? (I understood the different meshes are made of the same material?)

In any case the fact that a surgeon can put a mesh in but not know how to take it out as something is supposed to be permanent, is in itself a major flaw of thinking (personally I don’t consider a hernia surgeon who cannot take the mesh out a hernia expert)…

[Good intentions]

Thank you for the reply Dr. Towfigh. I think that you might have misunderstood the point of my post. It’s about mesh removal, not mesh implantation.

Surgeons are trained in how to implant mesh, but, apparently, mesh removal is not an “official” subject. It seems that learning about it is something that surgeons have to choose to do on their own. I think that the subject is in the same vein as the fact that there is no “mesh removal” code for reimbursement purposes. It’s something that people, apparently, don’t want to acknowledge as a problem.

I would guess that any surgeon who has done a few mesh removals would say that there are definite well-defined techniques for entering the abdomen, identifying structures, and peeling away the mesh, just like there are for mesh implantations. As the article I linked suggests, there is a need for standards of care for pelvic mesh removal but they do not exist. I think that the same is true for hernia mesh removal.

We’ll know that things are changing for the better when there is a SAGES session about mesh removal at one of the big meetings or when it’s included in their Education programs.

• This reply was modified 1 year, 8 months ago by Good intentions.

[Good intentions]

I searched “mesh” on the SAGES Educational video site, then browsed through the pages. I found a few videos about mesh removal, also called mesh “excision”.

The SAGES site is slow to load a new page and does not restart at the top of the page after the new page loads, so click the page number then wait, then move the cursor up to the top of the page. Or just put the next page number at the end of the url.

https://www.sages.org/video/?fwp_video_search=mesh

I have not watched each video so can’t say how relevant they might be. There are some good shots of migrated mesh though, just in the first images.

I’ll post two links per post so that my posts don’t look like spam. Posting just to fill out the Topic.

[Good intentions]

It’s also called “explantation”.

https://www.sages.org/video/materials-sciences-explanted-mesh/

https://www.sages.org/video/the-meshtissue-interface-and-its-implications-in-hernia-repair/

[Good intentions]

Humor does help, I suppose.

https://www.sages.org/video/ouch-my-groin-tips-for-safe-excision-of-inguinal-mesh/

I chose this one just because it seems to show a large piece of explanted mesh.

https://www.sages.org/video/synthetic-mesh-for-everyone-one-size-fits-all-all-levels-of-contamination-are-fine/

[Good intentions]

Laparoscopic removal

https://www.sages.org/video/laparoscopic-removal-of-inguinal-hernia-mesh-placed-during-a-robotic-tapp-hernia-repair-in-a-patient-with-chronic-pain/

Losing a testicle, I assume (lysis of spermatic cord), to solve mesh-related chronic pain.

https://www.sages.org/video/v016-robotic-spermatic-cord-lysis-treatment-post-operative-chronic-testicular-pain-laparoscopic-tep-inguinal-hernia-repair-mesh/

[Good intentions]

More laparoscopic removal.

https://www.sages.org/video/laparoscopic-removal-of-infected-incisional-hernia-mesh/

Making the “best” of a bad situation.

https://www.sages.org/video/reoperation-for-recurrence-with-pain-being-a-significant-complaint/

[Good intentions]

Here’s a recent and interesting article suggesting that mesh problems need to be monitored for at least 15 years to truly understand the source of the problems. An old name, Dr. Robert Bendavid, was involved before his death, along with some other well-known names like Koch, Petersen, and Grischkan.

It’s from researchgate.net so finding readable portions takes some work. Published in Hernia , a pay-per-view publication.

You can use CTRL + to blow up this preview.

https://www.researchgate.net/publication/348843686_Shouldice_standard_2020_review_of_the_current_literature_and_results_of_an_international_consensus_meeting

Here is an image from the article.

https://www.researchgate.net/figure/Rise-of-case-percentage-over-time-since-implantation-upper-with-numbers-of-excisions_fig1_344344465

And an excerpt.

“Purpose: Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. Methods: Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. ”

….

“Conclusions: Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks.”

[Good intentions]

Here is the Hernia website abstract with the payment link.

https://link.springer.com/article/10.1007/s10029-020-02297-1

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