Please Watch 60 Minutes Sunday regading mesh in the human body

[UhOh!]

quote Good intentions:

Thank you Dr. Kang, that is a very nice compliment from a man of your expertise. I try to only write about things that I feel I understand, but am certainly learning as I go, and starting from almost nothing.

My thoughts about going back in time with the mesh repairs are based on what I thought were promising early results that drove people to consider the tension-free repair as superior. But your video is very timely in showing how that thought process might be wrong. It is an excellent educational presentation. Thank you for supplying it.

I can’t imagine that the big organizations behind the hernia repair industry would let people go back to non-mesh repairs. The large institutions resist change, if they are benefiting, no matter who or how many people get harmed. It will take time and constant pressure to get things to change, I think.

How expensive is hernia mesh? If patients are starting to insist on a non-mesh repairs, is it out of the realm of possibility for the same device/pharma companies to develop “new” and “special” sutures that cost the same (and therefore provide the same opportunity financially)?

I would imagine the pushback will come largely from doctors who don’t see the ROI in taking a long time to teach/learn to do something the right way vs taking a short time to teach/learn a “good enough” way. All of this helps make the case for why hernia repair should be the domain of specialists vs general surgeons.

[Good intentions]

Thank you Dr. Kang, that is a very nice compliment from a man of your expertise. I try to only write about things that I feel I understand, but am certainly learning as I go, and starting from almost nothing.

My thoughts about going back in time with the mesh repairs are based on what I thought were promising early results that drove people to consider the tension-free repair as superior. But your video is very timely in showing how that thought process might be wrong. It is an excellent educational presentation. Thank you for supplying it.

I can’t imagine that the big organizations behind the hernia repair industry would let people go back to non-mesh repairs. The large institutions resist change, if they are benefiting, no matter who or how many people get harmed. It will take time and constant pressure to get things to change, I think.

[UhOh!]

Dr. Kang: Very interesting and insightful, particularly the idea of looking at direct and indirect hernias as two separate conditions. Has anyone ever documented the failure rates of various repair techniques broken down by direct vs. indirect hernias? It sounds like mesh solved the wrong problem; that of differentiating one type of hernia from another preoperatively and choosing the repair technique accordingly (or perhaps it was a desire to “streamline” things and have one fewer procedure to teach surgeons in training).

Among others, this is a big part of why I would insist on imaging prior to seeking surgical repair if/when I decide to go that route. If different repair techniques are best suited to different types of hernias, I’d want to know the type before choosing a surgeon.

[drkang]

quote Good intentions:

One major shame of the whole situation, assuming the origin of the idea for this mesh is Lichtenstein’s work, is that Lichtenstein’s original work actually had value, and still does. The concept is valid and proven, but it has been exploited to where the good, and the potential good, is far overshadowed by the damage being done by the device makers’ devious methods to get market share.

Here is another link to the story for anyone that missed it. https://www.cbsnews.com/news/boston-…0-women-suing/

Hi Good Intentions,

I have almost always agreed with your writings and at times have earned new insight and knowledge. To that I want to express my respect and gratitude to you.
However, I disagree with your reference on Lichtenstein. I personally believe that Lichtenstein repair lead inguinal hernia repair in the wrong developmental direction. But that doesn’t mean Dr. Lichtenstein is responsible for it and thus cannot be criticized. That is because although it wasn’t intentional, Lichtenstein repair represented the thoughts of most doctors at the time.

Tissue repair, which was the gold standard of inguinal hernia repair at the time, had a very high recurrence rate and most doctors thought that the tension after surgery was the cause of such a high recurrence rate. The vast majority of doctors still believe so. Therefore, the concept of the tension-free Lichtenstein repair using mesh was a necessity. Using foreign material instead of one’s own tissue has been attempted from the past by some doctors as it was one of the easiest way to solve problems of tension.

I do acknowledge that excessive tension is partly responsible for high recurrence rate of tissue repair but I believe the core cause lies elsewhere. It is that only one surgical method was applied without separating the two subtypes of inguinal hernia: indirect inguinal hernia and direct inguinal hernia. The problem is, almost all tissue repair including Bassini repair and McVay repair are in fact surgical methods more suitable for direct inguinal hernia repair but have been identically applied for indirect inguinal hernia. These methods have tried to narrow the deep inguinal ring where indirect inguinal hernia comes out. But in my view, they were very insufficient and inappropriate methods for indirect inguinal hernia. This issue is likewise present in Shouldice repair and Desarda repair, which are being appraised as good methods of tissue repair.

(I attach you a link to a video of my lecture relating to this. It is a lecture on inguinal hernia that I gave when I was invited to the Surgical Grand Rounds held in the Department of Surgery in Seoul National University Bundang Hospital. It is a 33 minute long lecture in Korean but there are English subtitles. I hope it is of help to those interested in the overall aspects of inguinal hernia repair.)

Aside from this, there are a few other factors that I believe cause a high recurrence rate of the existing tissue repair but I do not wish to ramble on lengthily.

Therefore it is my perspective that instead of Lichtenstein repair, which had the objective to reduce tension using mesh at a time where a new surgical method was required to prevent high recurrence rate, it would have been much better to classify indirect inguinal hernia and direct inguinal hernia separately and develop ideal surgical methods for each. I believe it is still not too late. As the problems of mesh complication are increasingly magnified currently, we should go back to the start and find the ideal surgical method. Unfortunately however, I do not think there are many doctors that agree with me as of now. So there will have to be more time and effort to adjust the current situation.

In addition, I believe some recent theses that presume the recurrence rate of mesh inguinal repair to be close to 10% supports my claim that mesh inguinal hernia repair is not the best option to reduce the recurrence rate.

Niebuhr H and Köckerling F. Surgical risk factors for recurrence in inguinal hernia repair –a review of the literature. Innov Surg Sci 2017;2(2):53-59,

Murphy BL, Ubl DS, Zhang J, Habermann EB, Farley DR, Paley K.Trends of inguinal hernia repairs performed for recurrence in the United States. Surgery. 2018 Feb;163(2):343-350.

Zwaans, Willem A., R., MD; Verhagen, Tim, MD; Wouters, Luuk, MD; Loos, Maarten J., A., MD, PhD; Roumen, Rudi M., H., MD, PhD; Scheltinga, Marc R., M., MD, PhD. Groin Pain Characteristics and Recurrence Rates: Three-year Results of a Randomized Controlled Trial Comparing Self-gripping Progrip Mesh and Sutured Polypropylene Mesh for Open Inguinal Hernia Repair. Annals of Surgery: June 2018 – Volume 267 – Issue 6 – p 1028–1033

Non-mesh Inguinal Hernia Repair ‘Kang Repair’ – YouTube
https://www.youtube.com
Surgical Grand Rounds Lecture at the Department of Surgery, Seoul National University Bundang Hospital (December 13, 2017)

[Chaunce1234]

Related, a big documentary called “The Bleeding Edge” is about to come out on the $400 billion medical device industry with vaginal mesh as a primary topic. It’s not clear if it will include references to hernia mesh…

https://www.hollywoodreporter.com/review/bleeding-edge-1105081

[Momof4]

Agree that the problem is being over simplified. There is certainly nothing simple about living with a polypropelene implant that you have a reaction to!! Also, it is not simple to find a physician who understands your problem and can offer help! I hope and pray there is a resolution to this Mesh Mess in the near future.

[Good intentions]

Thank you Momo. My comment about the engineer was more about how 60 minutes asked him to comment on a very complex science problem, the potential degradation of polypropylene in the body, when that is not an area that a plastics engineer would have expertise. Then they made it worse by oversimplifying it down to “oxygen eats plastic”, which is,of course, a gross oversimplification. But that’s how TV shows work, they need a catch phrase. The plastics expert should have said “that’s not my area of expertise”. His comments about identifying that the material was counterfeit were on target though. But plastic has been used in the body for many years, for a multitude of purposes.

It’s actually a big problem with much of what’s happening in the overall mesh travesty. People are oversimplifying, when they should be defining the fine details.

[Momof4]

I thought the piece started off strong, but ended up putting too much focus on the counterfeit polypropelene and not the fact that it seems any polypropelene is bad for the human body. Not everyone has Boston Scientific mesh, yet people still have severe systemic reactions to polypropelene! I’m glad the subject was discussed on 60 Minutes so it will prompt people to think that maybe there is some validity to the complaints by patients who have been harmed by polypropelene. It is REAL for so many!! I would love to see a follow up piece that focused more on the consequences for those who have had a reaction to polypropelene and also to include hernia patients, both men and women.

Good Intentions, not sure why you said the weak point was portraying an engineer as a polymer expert. My son studies Material Science Engineering and there are engineers that are experts in Polymers. I guess most people just think of Mechanical Engineers, Electrical Engineers or Civil Engineers. He probably was a true expert in polymers and he did seem very well informed on the subject. More experts need to speak up in defense of the patients that have been harmed by polypropelene! The problems are not in our heads!! Also, thank you, Good Intentions, for the well researched advice that you offer on this forum. I’m sure it has helped so many.

[Good intentions]

Thank you Khernia, for bringing that to everyone’s attention. I actually got texts from family members when it came on, to watch it.

It was much better than I thought it might be. Very on-target, with the corporate greed and criminality, and the incompetence of the FDA. There are weak points, though, for example, having an engineer portrayed as an expert in polymer science. But, still, the story is clear. An unproven product, and counterfeit materials, pushed to market, to make money, at the expense of patients. People from Boston Scientific should go to jail.

One major shame of the whole situation, assuming the origin of the idea for this mesh is Lichtenstein’s work, is that Lichtenstein’s original work actually had value, and still does. The concept is valid and proven, but it has been exploited to where the good, and the potential good, is far overshadowed by the damage being done by the device makers’ devious methods to get market share.

Here is another link to the story for anyone that missed it. https://www.cbsnews.com/news/boston-scientific-gynecological-mesh-the-medical-device-that-has-100000-women-suing/

[Khernia11]

Wow, this story breaks my heart. The greed of Boston Scientific is beyond comprehension. They are still selling the Chinese polypropylene mesh to put into women today!?! This is an outrage!!

Some key call outs from the episode tonight regarding polypropylene mesh implanted in the human body which applies to all polypropylene mesh, including hernia mesh:

Surgeon Dr. Michael Margolis who has removed over 350 mesh implants says “The mesh causes a chronic inflammatory reaction.” The mesh shrinks.

Chevron Philips became concerned of the medical use of polypropylene in the human body and in 2004 issued a warning that “polypropylene should not be used in human body!!” When pressed for sales they said we are simply not interested in this business anymore !! Why didn’t the pharmaceutical and medical communities listen?! Why is this still recommended today? This has to change!!

Leading Plastic engineer Dwayne Pritty, a fellow of the American chemical Society says “ I can’t in my wildest imagination imagine anybody that’s knowledgeable in the science of plastics ever deciding it was appropriate to use polypropylene in the human body. It is well known that it’s oxidatively unstable” They explained that the mesh has antioxidant additives but will break down rapidly once they wear out. “Oxygen eats plastic” Then come your systematic reactions…

I hope this helps other people decline mesh and insist on a pure tissue fix. With this demand, it will then get more surgeons to learn the skill set Required. Eventually this will bring back pure tissue techniques As a primary fix and these polypropylene mesh implants will be a thing of the past.