New(er) mesh technique? (“All-in-one”)

Hernia Discussion Forums Hernia Discussion New(er) mesh technique? (“All-in-one”)

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    • #30168
      UhOh!
      Participant

      I was reading about this technique that seems to have been developed in the past decade in Italy:

      https://www.intechopen.com/chapters/60157

      Curious whether there has been any continued follow-up as to its success. It at least seems to try and address some of the specific pitfalls of other mesh applications, but things often look better on paper…

      If it has gained traction, has it begun appearing in the U.S. yet?

    • #30169
      Good intentions
      Participant

      Here is a link, below, to a recent paper from a different set of surgeons, using Dr. Guttadauro’s technique. It has a direct comparisons with conventional methods.

      One of the major flaws in defining the chronic pain problem has been the survey methods used. Reading these papers it’s hard to tell what they were asking their patients, and how they were quantifying the answers. The time frames are short also.

      I doubt that the method will make it to the States because there is no serious acknowledgment of the problem in the USA. It is discussed at the meetings but the actions proposed to address the problem are more about moving liability to the patient. Much discussion about “consent” but essentially none about solving the problem. The efforts are focused on how to live with the problem. Keep doing the same things that have been invested in.

      Sorry to be cynical again. At least there are people in other countries working on the problem. America is not at the forefront of medical research for the benefit of the patient.

      https://mail.ijsurgery.com/index.php/isj/article/view/7812/4874

      And here is a later version of Dr. Guttadauro’s paper, in downloadable form.

      https://www.researchgate.net/publication/326500185_All-in-One_Mesh_Hernioplasty_A_New_Procedure_for_Inguinal_Hernia_Repair

      • #30172
        UhOh!
        Participant

        As someone who markets innovations professionally (albeit software, not medical devices), all I can say is that if this is the case, this needs a different story. So, doctors here won’t acknowledge the problem… but there are other issues which they are more than willing to acknowledge. Like time it takes to train surgeons, or the need to stock different materials for different repairs. Saying “one piece, suited to any hernia, left or right, direct or indirect, with the same repair technique for all” will get attention even without the pain issue coming up. The question is whether this is a sound repair – the marketing is easy.

    • #30170
      Good intentions
      Participant

      And here is one from Egypt using his technique. Click the “PDF” button in the upper right and you can read the whole paper.

      https://journals.ekb.eg/article_149204.html

    • #30174
      Alephy
      Participant

      The technique is used in some hospitals in Italy as the surgeon who introduced it is Italian. I had the chance to speak to him, and he mentioned that he also uses absorbable meshes…it can very well be that the technique is also offered in other countries as well….

      I would also mention that he called me to explain what he does and how, which I found helpful and nice…

      In the end I did not go for surgery, but he is on my list should I decide to go for it…

    • #30177
      saro
      Participant

      I had read the description of the “perfect execution of the Liectenstein method”, now I have read this very accurate description of the Guttaduro method, but for someone like me, who does not fully understand anatomy, it is difficult to understand the differences. and the possible advantages of one method over the other. From most of the experts present here, it might be possible to explain the qualifications of this innovation, to understand why to choose One mesh rather than the Liectenstein. Regarding the pdf published by the ‘hound’ Good intentions that I greet, I must say that, if I remember correctly, in the liectenstein method we do not recommend tying the sack as a possible cause of chronic pain. In the Egyptian hospital instead it is described. It doesn’t seem very reliable to me. It seems more interesting to me to examine any other sources, which I will try in my turn. The basic question remains for the (non-medical) experts: what anatomically would make you prefer the One mesh method?

    • #30186
      UhOh!
      Participant

      I am in NOOOOOOO way an expert (or even that knowledgeable) in any way, shape or form. However, I can say what it was that made me take notice of this method (as described in the original Italian article):

      1. First mesh method I’ve seen specifically identify, acknowledge and address a suspected cause of chronic pain (mesh-nerve contact; folded mesh; migrating plugs). Both the shape of the mesh and the placement are designed to remedy these faults.

      2. Issues of recurrence (or, more likely, development of a different type on the same side) seem to typically be addressed with more mesh, but here we see what’s meant to be less, but better designed, mesh. Each part of the design also appears anatomically-specific.

      3. Seems to be more emphasis on also closing holes, not just patching over them.

      4. Use of absorbable (sutures) or partially absorbable (mesh) materials when/where possible.

      At least that’s how I understand this in contrast to other mesh methods, particularly the open ones.

    • #30192
      Alephy
      Participant

      This is why I got interested in the technique too, i.e. the mesh shape as well as the tissue repair part
      are combined in a unique way…

      It kind of reminds me of this other technique somehow

      https://maplespub.com/article/Minimizing-Retained-Foreign-Body-in-Hernia-Repair-Using-a-Novel-Technique-Reinforced-Biologic-Augmented-Repair-ReBAR

      ps: I tried to get some feedback from some Italian fora on the outcome in terms of pain and foreign body feeling in the medium term, but could not find much info, which makes me think that the technique is still offered in only few hospitals; it could also mean that the patients are satisfied and do not go online asking for help though…

      • #30245
        Wim
        Participant

        In the article they compare the weight of the sutures compared to mesh implants. It is not the weight but the surface of foreign material that matters.

      • #30246
        Alephy
        Participant

        @Wim From what I saw in videos etc the mesh they use seems very small. As mentioned before the mesh shape and not the size are touted to make the difference here…

    • #30193
      UhOh!
      Participant

      If I had to guess, I would guess that its popularity will depend on the desire of the inventing surgeon to evangelize it (and patent the mesh design) and, more importantly, interest from a device maker in licensing the design and manufacturing that specific mesh design.

      The problem with popularizing new/rediscovered tissue repairs (like Kang Repair) is that it’s on the surgeon and the surgeon alone to popularize it. That’s not always easy; it takes more than academic publications. But, if there’s something new that can be manufactured and sold, then you have all the resources of some of the largest marketing budgets in the world making sure everyone knows about it.

    • #30194
      Alephy
      Participant

      I think in this case the mesh materials (even when fully re-absorbable) are probably manufactured by somebody else or are the usual ones in the market; the shape is what makes the difference in this particular method: can you patent the shape? maybe you can, I am not sure…..

      When I have time I will look up few of the major hospitals in Italy, to check if the method has been adopted more broadly since last time I checked…in any case at least two major hospitals in Milan offer it regularly (which would fit me:)

    • #30244
      William Bryant
      Participant

      Alephy, would you have this mesh repair rather than natural tissue?

      • #30247
        Alephy
        Participant

        @william-bryant At the moment I would rather avoid surgery if I can. I should mention that 20+ years ago I had hernia surgery for an hernia few cm above the belly button which was repaired with sutures (it was small and the surgeon decided not to use mesh), so it is not that I am absolutely against surgery per se.
        The inguinal area is tricky and prone to problems, and as I have still minimal symptoms I am still considering available options (I mean, once every 4 weeks or so:). The moment I get back on the mat training martial arts will be the one where I am pushed against the wall for a decision, unless I end up being able to train still despite the “problem”, in which case I will happily read the forum here and stay put:)

    • #30260
      William Bryant
      Participant

      Thanks Alephy. I feel similar but the longer you leave a hernia, the bigger it can become and the more of an operation needed. I’m delaying surgery and would prefer tissue if I had to have an operation but living with it at the moment.

      What symptoms do you get with your hernia?

    • #30261
      Alephy
      Participant

      I have a feeling of weakness at times and minor pain if I train hard…at the beginning I had minor pain more often than not but that I have not had for a long time now (minor i.e. nothing at rest, not severe enough to stop me doing things or distract me, and has not affected my sexual life either) …some surgeons here would say it got bigger and therefore less painful, I honestly don’t know: I think it is not “big”, as I still can only see it when I stretch the skin…

      BTW I am not sure that a “bigger” hernia means necessarily a bigger operation (unless we are talking extreme cases), certainly if you end up with mesh this is not the case. For a tissue only repair, I understood that more than the hernia size what matters is the tissue quality, but I might be wrong

    • #30262
      William Bryant
      Participant

      I don’t have pain, thankfully, but it itches, I can’t find why, would like to know what, if anything, that means. It is also slightly tender to touch and bulge is visible.

    • #30263
      Alephy
      Participant

      Well there are plenty of nerves in the inguinal area, and so any increase in pressure or movement might trigger some of them….just out of curiosity: is the itching present at all times? is it severe? Is it at the skin (surface) level, or deeper? I bet some doctor on the forum might chime in when given more details…

    • #30264
      William Bryant
      Participant

      The itching comes and go’s, in all senses. Sometimes it’s constant and drives me mad. Othertimes it stops.

      Sometimes it’s right where the bulge is. Other times higher than bulge.
      Other times lower.

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