Paper: "Why we remove [hernia] mesh" by Dr Shirin Towfigh

[saro]

https://www.ecnmag.com/article/2016/08/how-design-surgical-mesh-can-impact-risk-chronic-pain-after-hernia-repair

[saro]

quote paco:

I think the future should be something like taylor made mesh with autologous stem cells culture in a cell matrix, stimulating the right type of fibers (through CRISPR or whatever). But it sounds like Sci-Fi.

But the nerve entrapment will remain a problem.

I’m not so expert, but I think the research of biological prosthesis, remodeling, which would have the characteristic of developing an autonomous response in the form of collagen .. I notice that they do not develop fibrosis, but I am too ignorant to understand if they can trap a nerve

[drtowfigh]

quote scaredtodeath:

Dr towfigh… also as more meshes were removed to systemic reactions as time went on was there any underlying Common ground as why those pts developed these reactions

Yes, and we are doing a deep dive on this. Will publish those results specifically on mesh reaction patients.

[drtowfigh]

quote UhOh!:

Does this have to do with the laparoscopic technique in and of itself, and how such meshes are implanted/affixed, or the fact that the mesh is placed inside the abdominal wall, as opposed to outside of it?

We didn’t see a correlation with type of mesh or type of mesh placement or operative technique.

[nonPalpableHernia]

quote Good intentions:

Shouldice seems to avoid these horror stories. Another good reason for a registry of hernia repairs. Not just mesh. Without the numbers there’s no way to tell what is best for the patient. It’s all anecdotes and marketing.

I think shouldice does not take patients that need major reconstructions or they may in fact use mesh in these cases. Their website does say they will use it if required. I do understand that mesh has really improved the lives of many. Some of the presentation of complex cases seem impossible without mesh. I’d just wonder if it is being used more in cases, where it does not need to.

[Good intentions]

Shouldice seems to avoid these horror stories. Another good reason for a registry of hernia repairs. Not just mesh. Without the numbers there’s no way to tell what is best for the patient. It’s all anecdotes and marketing.

[nonPalpableHernia]

quote drtowfigh:

[USER=”2608″]dog[/USER] it wasn’t possible technically possible before synthetic mesh so most lived with their hernias, no matter how disabling, and could not be offered a repair. People were maimed by other techniques and complications of open tissue hernia repair. Use of the darning technique caused fistula and erosions and chronically draining wounds. Surgeons were harvesting fascia from the thigh to treat abdominal wall hernias. This worked about half the time for the hernia, and the fascia harvesting left a disabling set of complications to the leg, including nerve injury. Deformity was more common. Testicle loss was more common. Scars were enormous.

It wasn’t a rosey picture before mesh.

That paints a scary picture of tissue repair, I imagine this has to do with abdominal reconstructions of a certain size. For sure there are many people for whom treatment looked like this before mesh.

[idoncov]

quote drtowfigh:

[USER=”2608″]dog[/USER] it wasn’t possible technically possible before synthetic mesh so most lived with their hernias, no matter how disabling, and could not be offered a repair. People were maimed by other techniques and complications of open tissue hernia repair. Use of the darning technique caused fistula and erosions and chronically draining wounds. Surgeons were harvesting fascia from the thigh to treat abdominal wall hernias. This worked about half the time for the hernia, and the fascia harvesting left a disabling set of complications to the leg, including nerve injury. Deformity was more common. Testicle loss was more common. Scars were enormous.

It wasn’t a rosey picture before mesh.

These are medical emergencies, rare complications. Mesh, however, is now used for every garden variety hernia. There are surgeons now who will use mesh as an absolutely last resort. Those are the ones I would suggest going to.

[scaredtodeath]

Dr towfigh… also as more meshes were removed to systemic reactions as time went on was there any underlying Common ground as why those pts developed these reactions

[UhOh!]

quote drtowfigh:

Also, in doing so, we were shocked to see a trend toward more patients requiring mesh removal after laparoscopic repairs and also more patients showing up with systemic mesh reactions.

We will followup wirh an outcomes paper soon.

Does this have to do with the laparoscopic technique in and of itself, and how such meshes are implanted/affixed, or the fact that the mesh is placed inside the abdominal wall, as opposed to outside of it?

[UhOh!]

quote drtowfigh:

[USER=”2608″]dog[/USER] it wasn’t possible technically possible before synthetic mesh so most lived with their hernias, no matter how disabling, and could not be offered a repair. People were maimed by other techniques and complications of open tissue hernia repair. Use of the darning technique caused fistula and erosions and chronically draining wounds. Surgeons were harvesting fascia from the thigh to treat abdominal wall hernias. This worked about half the time for the hernia, and the fascia harvesting left a disabling set of complications to the leg, including nerve injury. Deformity was more common. Testicle loss was more common. Scars were enormous.

It wasn’t a rosey picture before mesh.

Not to mention, from a purely practical standpoint, it could easily be a decade or more before there could be a sufficient number of surgeons trained in tissue repairs. First, the small number of surgeons proficient in such techniques would have to train other teaching surgeons. Then, those surgeons would have to begin training fellows and residents, who could then begin training the next batch of fellows and residents. Overall, it would require a significant lead time, no?

[drtowfigh]

[USER=”2608″]dog[/USER] it wasn’t possible technically possible before synthetic mesh so most lived with their hernias, no matter how disabling, and could not be offered a repair. People were maimed by other techniques and complications of open tissue hernia repair. Use of the darning technique caused fistula and erosions and chronically draining wounds. Surgeons were harvesting fascia from the thigh to treat abdominal wall hernias. This worked about half the time for the hernia, and the fascia harvesting left a disabling set of complications to the leg, including nerve injury. Deformity was more common. Testicle loss was more common. Scars were enormous.

It wasn’t a rosey picture before mesh.

[drtowfigh]

[USER=”2721″]paco[/USER] great idea. Now have to make it so it’s cost effective. After breast surgery, hernia surgery is the poorest reimbursed field in general surgery.

[Ben999]

Honestly, it seems like skilled surgeons performing anatomical reconstruction does the job a lot better than any mesh will…

[paco]

I think the future should be something like taylor made mesh with autologous stem cells culture in a cell matrix, stimulating the right type of fibers (through CRISPR or whatever). But it sounds like Sci-Fi.

But the nerve entrapment will remain a problem.

[dog]

quote drtowfigh:

Thanks for the message. I like to deal with issues scientifically and with an open mind.

I do not support abstinence from mesh repair at this time. That’s technically not possible. We do need better technology and some companies have a mission to develop them.

Dear
drtowfigh … Just wondering how technically was it possible before mesh was invented ? ..Term.” groin pain ” complication after hernia repair has become almost common from the time of that great invention…

[drtowfigh]

Thanks for the message. I like to deal with issues scientifically and with an open mind.

I do not support abstinence from mesh repair at this time. That’s technically not possible. We do need better technology and some companies have a mission to develop them.

[dog]

quote drtowfigh:

It’s been a busy month or so…

Correct, this paper was not intended to be paper about postoperative outcomes, rather of preoperative workup and indications for mesh removal. One goal was to share our experience with the relative incidences of the various indications for mesh removal, with insight into whether specific types of repairs, mesh, techniques, or other clinical factors stand out among them. Also, in doing so, we were shocked to see a trend toward more patients requiring mesh removal after laparoscopic repairs and also more patients showing up with systemic mesh reactions.

We will followup wirh an outcomes paper soon.

Thank you dear dr drtowfigh for coming the right side of the battle..Would you consider to start petition to stop using mesh in the hernia repair..we all will support you! ..Myself i have a thousands followers :} Get media attention …..

[drtowfigh]

Yes. I wrote a Chapter in our book that specifically addresses autoimmune diseases and mesh use.

The book is the SAGES Manual of Groin Pain. You can click on its link on our homepage to buy online.

[paco]

[USER=”935″]drtowfigh[/USER]

Thanks, I will share this paper with the surgeon who removed my mesh recently, who in fact is a devotee of Dra Towfigh.

Another contribution of my surgeon Dr Prof Moreno Egea about a case of autoimmune disease and scleroderma due mesh reaction, with removal, who also quotes Dra Towfigh. Spanish, English (abstracts):

http://www.sohah.org/wp-content/uploads/rehah/v6i3/08_NC_Hernia_Moreno.pdf