Proactive mesh removal – Dr Towfigh can you weigh in?

[Chuck]

Dr. twofigh will frequently push lap tep as the best modality…but then you read that she has found evidence of inflammation foreign body response and significant tissue damage in every mesh she has removed. Then she says the mesh can be infected by colonoscopy,,,a tooth abcess or other illness…on top of this the mesh is moving and degrading and folding throughout its lifetime getting tangled in nervs and organs. in a moment of sheer idoicy i selected a mesh repair..but i am only 7 months in…wouldnt it make senes to get it removed now…to prevent these horrific complications down the line. Does anyone here have a real sense of how often these complications occur? It seems like its a slam dunk that they will at some point given all that i have read. i know its a difficult surgery…but in a cost benefit world…which way would folks here lean…hoping for a vibrant debate…this board can get very sleepy at times.

[William Bryant]

Because it is major surgery with risks, personally I’d only have removal if the problems were significant. And yes I’d have it done earlier rather than later.

There are some people who’s issues get better in time. So I’d ask a doctor if mine would too.

Some people are ok with mesh. Indirectly i ‘know’ 3 with mesh. 1 is okay, 1 is reasonable but on pain relief, 1 not good at all.

[drtowfigh]

There is absolutely no indication for proactive mesh removal.

Yes, laparoscopic repair with mesh has been shown in every modern study to be superior to all other hernia repairs in terms of risk for chronic pain, acute pain, and hernia recurrence. This is based on population studies. It does not mean that lap repair is the best choice for each individual person.

Do I recommend laparoscopic repair for everyone? No. I tailor to each patient’s needs.

All foreign bodies will result in a foreign body reaction. This is a finding on pathology and not a clinical finding. That means, just because the patholgist will see foreign body reaction doesn’t mean you will have any symptoms or reaction. In fact, my research proved exact opposite. The finding on pathology had nothing to do to predict the clinical state of the patient. So, that’s not a reason to remove mesh.

It is not expected for mesh to move or fold over time. It also does not commonly entangle with organs or nerves. In some patients, mesh may degrade. That is again a tissue pathology diagnosis and not something you can see with you eyes or feel in your body.

Mesh can get infected by a tooth abscess or other cause of bacteria in your blood system. but the rate is super low. I see one unlucky patient where this happens every 5-10 years.

[Watchful]

Isn’t it pretty common for nerves and/or the spermatic cord to adhere to the mesh scar tissue?

[Good intentions]

Dr. Towfigh, your statements would be much much more impactful if you would supply a link to one or more of these modern studies. The internet is full of people making unsupported statements. The references to refereed journal publications make the case much more powerfully. That’s why refereed journals exist, to separate the facts from the opinions.

“Yes, laparoscopic repair with mesh has been shown in every modern study to be superior to all other hernia repairs in terms of risk for chronic pain, acute pain, and hernia recurrence. This is based on population studies. It does not mean that lap repair is the best choice for each individual person.”

[Good intentions]

Here is a recent paper comparing open mesh to lap mesh. The findings are that open mesh gives better results.

https://www.sciencedirect.com/science/article/abs/pii/S0022480419301623

Excerpt –

“Methods
A retrospective single-institution analysis of 1299 inguinal hernia repairs performed at the VA North Texas Health Care System between 2005 and 2017 was undertaken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed.”

“Conclusions
Outcomes in the OHR cohort were, in general, superior compared with both the LHR and RHR. However, these strategies should be viewed as complementary. The best approach to an inguinal hernia repair rests on the specific expertise of the surgeon.”

[Good intentions]

Here is one that finds the opposite, but offers no comments about chronic pain. Plus it is a small study, 130 patients.

https://www.surgeryscience.com/articles/677/5-2-22-876.pdf

[Chuck]

Good Intentions –i have not been able to corroborate Dr towfighs statements…and she never cites references…she just repeats the contention on every podcast…and its part of the reason i selected lap teo mesh from a surgeon who claimed to have don 5000 of them…needless to say it was a huge mistake a life ender…my main symptoms are urinary pain and burning..hesitancy,,,perineum pain which appears to get worse with stress…i wonder if slamming two huge pieces of mesh into the pelvic floor…is causing it to spasm…do you agree with the goood doctors claims that mesh infection is rare….and that mesh migration and folding is rare…maybe bercause thats all we read about we think its common when its not…i know you will probably not give your position on this…but on the issue of proactive mesh removal…do you believe that the removal surgery is so traumatic…that mesh removal should be a last resort??? i have since spoken with three guys who had seemless removals using Dr belyansky…yunis also implies that the removal process can be safely and routinely accomplished…it sure would be nice to get this crap out of me and possibly avoid having it get all tangeled up in the spermatic chord..whish seems like happens in nearly every case. Any thoughts on how common this is appreciated…

[Good intentions]

Where does Dr. Campanelli get his information? He seems to understand the need for better studies. If the existing data is bad then the best a person can do is to say that they do not know. Choosing a side and supporting it with bad data is not right. There is nothing wrong with not knowing, but claiming knowledge that doesn’t exist leads people to bad decisions. People are coming to this forum to find the facts.

https://link.springer.com/article/10.1007/s10029-022-02576-z

It seems reasonable to assumed that the editor-in-chief of Hernia would have good sources for his information.

From the article –

“Each year, millions of patients undergo this surgery and therefore constitute a population potentially exposed to the risk of complications that, while not high in percentage terms, can nevertheless together form a critical mass.

In the past, the most negative long-term effect was recurrence, the incidence rate of which seems to have fallen significantly since prostheses came on the scene. This latter observation, however, remains to be assessed in light of the doubts we have often expressed about the effectiveness and reliability of reported follow ups.

However, while recurrences no longer seem to be the concern that it once was, a different but equally undesirable outcome has now emerged prominently in specialist scientific debate: chronic postoperative pain.”

[Author]

Posts