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New mesh use review article in General Surgery News – worth reading
Here is a new review article about the use of mesh for hernia repair today. Anyone interested should read through it more than once. It covers a lot, rambles around a bit, and many of the flawed arguments for continuing to use mesh instead of pure tissue repair are recycled, but the article does show that pure tissue repairs are coming back.
I read the article and see recognition that the lawsuits are not going away, that there are real reasons for them (many patients suffering), and that this is driving change. The title is misleading but it should get more surgeons to read it. Which is good.
The impetus for change seems to be the lawsuits. The legal system really does work but it shouldn’t take threats to cause improvement. That is one sad realization that comes from the article. It’s not the welfare of the patient driving change. It’s the lawsuits.
And the final statement is about making mesh work, not about developing the best hernia repair methods. It’s ingrained in the thought processes – find ways to continue to use mesh. Many, maybe all, of the surgeons quoted have deep investments of time and effort in to building mesh implantation practices. Pure tissue repairs will cut in to that business. It’s just the way things are today.
Replace the word mesh with “hernia repair” and the statement sounds a lot better.
“Ultimately, Dr. Poulose said, “the current medical-legal climate is bringing up a necessary conversation in a convoluted way, but if these discussions help us make mesh, technique, post-market surveillance and patient selection more optimal, something positive can result.” “
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4 Replies
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Not to get too focused on the lawsuits but Dr. Pulouse’s comment is timely. There is a large wave of suits about to break on the courts and it seems wise to be ready. The more exposure the better, for the patients,and the surgeons.
The suits have been delayed due to the COVID-19 pandemic but are about to start passing through the systems.
“Ultimately, Dr. Poulose said, “the current medical-legal climate is bringing up a necessary conversation in a convoluted way, but if these discussions help us make mesh, technique, post-market surveillance and patient selection more optimal, something positive can result.” “
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Here is a collection of hernia focused articles from GSN. The format is difficult to use, some of the articles can be found on the main site using the search function there.
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I just don’t understand Dr. Towfigh. I search for reasons and write them down, hoping (dreaming) that some young surgeons or students will see the travesty of using mesh for any and all hernia repairs of any type when there are safer methods available, and choose to take a different path. I try to describe things in a way that seems rational, because what’s happening does not seem rational. Money seems simple and rational.
But my comment was about the total cost, not just the remuneration for a single procedure. The investment in equipment, training, risk of extraneous costs, risk to reputation, risk of using the change as evidence in lawsuits, etc. The costs of running a business after it has been established. Change costs money.
These lawsuits are the best thing that can happen for future hernia repair patients. And surgeons. Because not much is happening at the professional guidance level besides talking. I think that mesh has become incorporated in to the hernia repair field body and will be very difficult to remove. The lawsuits are analogous to a mesh patient’s chronic pain. A strange parallel but appropriate, I think. The lawsuit pain will continue until the mesh is removed.
You wrote an article a short while back titled “Hernia Mesh and Why We Remove It”. The next in a series could be “Hernia Mesh and Why We Use It”. That would be an interesting read if it was backed by good solid data with real precise numbers. Why do surgeons use mesh? Is mesh really appropriate for any and all hernia repairs? Should mesh be used to cover all future hernia sites?
Are all meshes the same? Are there safer repair methods that don’t involve mesh?It’s a decades old problem but it is heartening to see some change even if it is small and inadequate. Thanks for continuing to support at least one small place to discuss the issues.
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Not sure what you mean by “mesh implantation practices” and how you feel that pure tissue repairs somehow provide less remuneration to surgeons. It doesn’t. If anything, reimbursement for laparoscopic/robotic repairs which almost always involve mesh, is less for surgeons.
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