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New chronic pain paper – surprisingly glib and non-specific. Says mesh is fine.
I just came across a recent paper which is apparently being discussed by the hernia repair community, supporting “mesh” as just as good, or just as bad, as a non-mesh repair. I can only get the abstract, without paying, but it seems to be a meta-study of chronic pain studies. In other words, an attempt to pull something meaningful from many previous studies that weren’t very useful as individual studies.
The disappointing part of this study is how the authors combined all of the numerous types of mesh medical device, apparently, in to one big blob of “mesh”. Overall, the paper seems somewhat self-serving, and seems to have been initiated to serve an agenda. It seems to have little real value besides making people feel comfortable about using mesh. Two of the authors appear to be paid consultants for Bard, and Merck. Andresen uses Bard’s Onflex system.
“Andresen reports personal fees from Bard outside the submitted work.
Rosenberg reports personal fees from Bard and Merck outside the submitted work.”
The other sad part, which should also have been part of the conclusion, is that what they are also saying is that anyone who has hernia repair has a 10-12% chance of chronic pain no matter what method they choose. There is no hope, all of the methods are similarly bad. So, like many other mesh-users, the “good” news is touted – “mesh is no worse than any other method” – but the bad news is ignored – “10-12% of our patients will have chronic pain”.
https://www.surgjournal.com/article/S0039-6060(17)30890-5/pdf [h=3]Background[/h] Chronic pain affects 10%–12% of patients after inguinal hernia repairs
[h=3]Conclusion[/h] Mesh may be used without fear of causing a greater rate of chronic pain. -
9 Replies
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quote seeker:It is not my intention to belittle your experience with mesh. In fact, I waited two years and tried to avoid having it implanted myself. I came to this forum and read thouroughly and sought the advise of the best surgeons mentioned on it. I had some scary painful experiences with my hernia pre surgery and had to make a decision. My posting was to explain that sometimes hard choices must be made. I spoke with two friends who had mesh implanted 10 years + and were doing well. I appreciate yours and others efforts to alert future patients of what can go wrong. But there are many good outcomes from hernia surgeries with mesh and I feel that must be acknowledged too.It would be interesting to know the type of mesh and technique used by your friends successfully, but I realize that the question is not always asked, nor is the answer known
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Originally posted by seeker View Post
” ultimately, I trusted my surgeon.”Trust but Check ..Blindly trusting surgeons it is like trusting to Fox guarding the Chickens :}
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It is not my intention to belittle your experience with mesh. In fact, I waited two years and tried to avoid having it implanted myself. I came to this forum and read thouroughly and sought the advise of the best surgeons mentioned on it. I had some scary painful experiences with my hernia pre surgery and had to make a decision. My posting was to explain that sometimes hard choices must be made. I spoke with two friends who had mesh implanted 10 years + and were doing well. I appreciate yours and others efforts to alert future patients of what can go wrong. But there are many good outcomes from hernia surgeries with mesh and I feel that must be acknowledged too.
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quote seeker:But ultimately, I trusted my surgeon.
So did I, and it was a mistake. Then I trusted another one three years later to remove the mesh the first one I trusted implanted. My trust in the first surgeon was flawed.
Good luck I had Bard Soft Mesh implanted via the TEP method and it was never comfortable, often painful, ultimately removed. Do you have the details of your so-far-successful repair? Without the details it just gets lost in the “mesh” pile. Even the surgeons don’t really know which method or material works best. Nobody is tracking results, beyond just a few months.
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I’m not sure. But Dr Ramshaw, Dr Towfigh, Dr Goodyear and Dr Jacobs all highly recommended mesh for a femoral hernia. They are all top hernia surgeons. They could explain best the answer to your wonderings.
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quote seeker:I understand that for many cases – hernia repairs can be reliably done without mesh. But there are many cases where mesh is required. I had a femoral hernia and was informed that I could have a non mesh repair but that it would likely not hold as well as a mesh repair for that area of the body and that a second non mesh repair needed within 5+ years would likely effect the many pelvic nerves in that area and cause pain. I went to a top surgeon to have what I felt would be the safest mesh repair I could have. He was sincerely interested in my long term health from this surgery and I felt that with his guidance I made the best decision – which involved mesh. I’m not wild about having mesh in me – but so far I am doing fine – two years out. I often think about the many people who have surgeries after auto accidents or even from hernias that require immediate attention. You are left to whatever the local hospital em surgeon decides for you. To find a reputable surgeon you trust after doing your homework proves to be the best option. You can over analyze to the point that you build up too much fear to do anything. My surgery has made my life and health so much better. I find these studies interesting having opted for mesh. But ultimately, I trusted my surgeon.
I am wondering how they did it before mesh was invented ? :}
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I consider this basic mesh-non-mesh discussion more interesting (About the onestep method. The authors boast of saving the cremaster muscle. But the method requires total anesthesia. The authors boast a fall in inguinal side effects with the Onestep method compared to Liechtenstein, but support their thesis with a questionnaire that leaves me doubtful. Although the questions were the same for patients operated with both methods, it emerged that some patients with onestep complained of sexual disorders before surgery, resolved with the intervention (:rolleyes:). :eek:)
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I understand that for many cases – hernia repairs can be reliably done without mesh. But there are many cases where mesh is required. I had a femoral hernia and was informed that I could have a non mesh repair but that it would likely not hold as well as a mesh repair for that area of the body and that a second non mesh repair needed within 5+ years would likely effect the many pelvic nerves in that area and cause pain. I went to a top surgeon to have what I felt would be the safest mesh repair I could have. He was sincerely interested in my long term health from this surgery and I felt that with his guidance I made the best decision – which involved mesh. I’m not wild about having mesh in me – but so far I am doing fine – two years out. I often think about the many people who have surgeries after auto accidents or even from hernias that require immediate attention. You are left to whatever the local hospital em surgeon decides for you. To find a reputable surgeon you trust after doing your homework proves to be the best option. You can over analyze to the point that you build up too much fear to do anything. My surgery has made my life and health so much better. I find these studies interesting having opted for mesh. But ultimately, I trusted my surgeon.
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Great post good intentions.
tje thing that drives me nuts is that the shouldice hospital reports a less than 1% recurrence rate and a less then 1% chronic pain. So the evidence is out there that a speciality hospital can achieve amazing results using a non mesh repair. Yes I know that the shouldice hospital uses certain criteria to turn away certain people so they may be technically ensuring a better result but still.
what these people are really saying by this study is that outside of a speciality place like the shouldice hospital there are compatible pain results between the two methods which again is silly.
and obviously the other thing that isn’t Apples to Apples are all the other things mesh can do-infections, autoimmune disorders, adherence to bowel and bowel obstruction, meshoma, migration., adherence to the bladde and other nerves.
its just not about equalness of the pain % but the type of pain and the fact that if it is a problem with the mesh the fact that mesh removal is a whole other nightmare of the equation. You just don’t have to worry about all of these other problems with a pure tissue repair.
so yeah it seems this study is nonsense and looks to neatly sweep the mesh problems under the rug by simply saying mesh is neither worse or better than non mesh repairs-not thst simple.
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