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Mosquito netting, and fabric comparisons. Dr. Bent Matthews SAGES webinar 2018
I came across an interesting SAGES webinar in which Dr. Brent Matthews of Carolinas Healthcare discusses mesh properties. His is the first of four presentations in the linked youtube video. I realized at the end of it that he seemed to be giving the message that the basic original knitted polypropylene mesh design was just as good as any of the new lightweight materials. And, also, that the expensive knitted materials are basically no better than plain old inexpensive mosquito netting, at least by the typical standard measures. There’s a table in the middle of the presentation that shows that.
I also realized that I have been using “knit” and “weave” incorrectly. Most of today’s meshes are knitted, with many tight knots and loops that open and close as the fabric moves. This could be part of the reason for the irritation that many people with mesh feel as they try to get back to normal after mesh implantation. As Dr. Bendavid described in his paper about SIN.
Another very encouraging thing I noticed is that Dr. Matthews called chronic pain the #1 risk factor in inguinal hernia repair. At about 11:50. As opposed to recurrence. And the lightweight mesh which was supposed to be the best, is the worst, in the study he showed.
I just watched it again, and I’m still struck by the fact that he seems to be showing that most of the mesh improvements over the last decade or more haven’t really been improvements. Minute 13 as an example. But they are being sold as “better”. Overall, a hopeful presentation in that somebody is recognizing chronic pain as most important, and saying it out loud, but disappointing in that there doesn’t seem to have been much progress made in understanding it or preventing it. Actually, considering all, the industry has been introducing materials that cause more chronic pain, and advocating more coverage with these worse materials.
But, still, even though Dr. Matthews seems on top of the situation, he uses Bard 3D Max for laparoscopic inguinal hernia repair. Despite the problems it seems to cause. The Q&A sidebar at about 47:55. And all of the surgeons discuss how they do things differently than the next guy. Nobody ever has a presentation where they show their own results from the hundreds of repairs they’ve done, even though all it would take is a survey of past patients. It seems like great progress could be made if somebody collected methods and materials, and correlated them with long-term results. I can’t imagine doing this type of work, yet not knowing if you’re really helping people in the long term.
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