Of known hernia repair methods, over time – which is best for a typical patient?

[Good intentions]

I’ve realized that almost every presentation, discussion, or research paper that deals with hernia repair avoids the most fundamental question – what is best for the patient?

They all pick a small sub-topic of the bigger question. Which method gives fewer recurrences? Which method gets the patient back to work soonest? Fixation or no fixation? Open or MIS? Biologic or synthetic?

But if you consider the surgeon as a physician (some people separate surgeons from physicians, considering them more as mechanics doing what physicians recommend), the surgeon has recited and committed to the Hippocratic oath. Which, in essence, says to do what is best for the patient.

If a rational objective surgeon thought about the next 20 years of their patients life, and they had the ability and means to perform a pure tissue operation or any of the mesh procedures, which would they choose if they did not have the burden of the administration or the eyes of their colleagues on them? If they truly were doing what was best for the rest of their patients’ lives, what would they choose?

I’ve been watching these presentations and reading articles and research papers over the years and I see a group of people avoiding what they are really doing. Much time, effort, and looking away to justify the continued use of mesh products even though they have seen the incredible damage that is done when patients have chronic pain, and/or need to have the mesh removed.

I think that every surgeon should take the time to think about the pros and cons of all of the potential repair methods, considering the next 20 years or more of their patients’ lives. Not the extra days saved, or the insurance company reimbursements, or the size of the scar. But the real-world effect on the rest of the life of the people that they are supposed to be helping. Are they really helping or are they doing something else? What is really best for the individual patient?

This thought came to me as I was trying to understand what was so frustrating about watching the presentations from SAGES 2019. I realized that not only was the issue not being addressed, but it was actively being dismissed and covered up. More justification of mesh usage as “it’s just what we do”. By people that certainly know better. It’s just not right.

• This topic was modified 2 years, 4 months ago by Good intentions.

[JamesDoncaster]

My view on this is pretty simple.

1. I have read many Many MANY stories of people that have had a mesh operation and subsequently had life-altering, debilitating pain. This happens, even in cases in which the mesh-based repair was performed perfectly.

2. I have not read a single story in which a person had a tissue repair and subsequently had life-altering, debilitating pain.

Given the above, if the hernia is not too large, the 1st (and hopefully only) repair ought to be a tissue repair. If the tissue repair does not hold, one can always try a mesh-based repair at that point. Using mesh as the first option is, in my view, cavalier and irresponsible.

[DrBrown]

@good-intentions

I agree with James.
I have not used mesh to repair an inguinal hernia in 20 years and I have been very happy with the results.
Regards.
Bill Brown MD

[Author]

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