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Pros and Cons of Open vs Lapro
Can anyone please in general terms explain what the pros, and cons, are of open VS laproscopic techniques?
Such as one can more easily damage (which) nerves, but..
Or one doesn’t split the oblique, but…Just in general terms, is that possible?
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28 Replies
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I asked why not laproscopic they said had a higher recurrence rate
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One of the surgeons not on forum that were recommended girls answering phone said
They didn’t take Medicare, I asked who they would recommend they said whatever you do
Or use don’t get it laparoscopically -
@good-intentions Ha — yes!! That wayback machine is great. Fun to also look at the old amazon and apple sites, etc. Technical archeology.
Too bad about the images here… maybe there’s a setting in the backend that needs to be turned on…
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It doesn’t look possible. I was going to post the old herniasurge page with the
J&J logo (I copied it and saved the image) but there’s no option for attaching or pasting images.But I did find it on the “Wayback Machine”. Internet archive.
https://web.archive.org/web/20180809000128/http://herniasurge.com/
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Can we upload images?…
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@good-intentions Please no worries 🙂 All good!
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Cshelter, I apologize for taking over your Topic. If you start a new one I will stay out, and leave you alone. I learn new things though, each time somebody opens a new Topic and need to follow them out. I can’t edit my older posts.
@cshelter
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I just found what is essentially the updated version of that 2014 paper. Things are much more clear, pain is mentioned 26 times instead of just 2. Herniasurge still looms over the effort though.
Worth reading.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981671/
Here is the Herniasurge page, with their mesh logo. Those that might have seen earlier posts about Herniasurge will see that the sponsors are no longer highlighted. Johnson & Johnson used to get about 1/3 of the front page.
They are not there anymore. Pretty fascinating, in a macabre way. Funding apparently comes through the European Hernia Society now. But where does EHS get their money?It’s worth following what these guys are doing. They might be the most influential group on hernia repair in the world.
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I overwrote in my reply. Got a little bit carried away. I was struck by the lack of quantification (quantitation?) though, which is common in all of the discussions of “best” practice, when it comes to hernia repair, and the difficulty you will have in trying to “rank” methods, based on outcomes. Much opinion and feel but not much clear verification.
I went out to find something similar to what the people who followed up proposed. I think that a “decision-tree” is the thing. Engineering and science types might call this a flow-chart. Here is a paper about forming a “decision-tree” for hernia repair methods. Digging deeper though, of course, it leads back to the European Hernia Society, which leads to Herniasurge, which leads to Johnon & Johnson and Bard, and other device makers.
Again, you’ll find numbers when they support mesh, and words like “significantly lower” when things aren’t clear. And, despite the Guidelines recommending against it, Dr. Kockerling includes the plug systems in his tree. And if you search for the word “pain” it only appears two times. The paper was published just over 5 years ago. Dr. Kockerling was in the working group of the Guidelines effort.
Anyway, I think that something like this is along the lines of what you’re trying to do. It would be interesting to see what the tree looks like, if it was generated from a patient’s long-term quality of life viewpoint. Including “pain” and “pure tissue” as variables, instead of setting them aside.
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@alephy Agree. An accessible, digestible, general informational set, of which this is just a part, has hope to help some potentially avert situations you and others like me can personally describe…available where many people also are looking, possibly saving some from unneeded suffering — one of many seeds found that might open up an important dialog down the road. Positive things.
The tailored approach is a topic I plan to cover, and even thought that could make a great podcast topic, or article-format interview, with a surgeon. 🙂
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Age certainly plays a role, although being young vs old is often a stereotype (is 40/50 old/middle aged or even young?) and considering that we live longer and longer and so having a surgery at age 60 might mean dealing with the aftermath and possible complications for another 20 or more years…
what would be important to me is that this or that doctor, whatever the procedure, tell the patients BEFORE going in: if they take the nerve out as a planned action, the patient MUST know that they will do that! If not, it is a criminal action in my opinion -
It posted before I could provide the link.
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In the following video, one of the doctors asks the audience(at the 17:25 mark) of doctors how many “take” the illioinguinal nerve and the answer was 20%! Then he said that he also did in the older patients, but tried to preserve it in the younger. He then says that they don’t notice.
The presumptiveness is bothersome. What justification is there for this way of thinking? Is the nerve in an older person more fragile?
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I appreciate the thought, effort and objective of this thread.
1)Is one or the other methods recommended based on size of the hernia? If so, at what size, generally, would one method gain preference? (my hernia on the right side is about the size of the top half of a tennis ball.)
2)I’ve read on this forum that thinner folks who engage in sports to some degree are more prone to have problems after laparoscopic. How much importance should be given to weight in making a determination? Is there a bmi dividing line?
3) How does age affect outcomes with regard to pain and recurrence for the mesh-open, tissue open, and laparoscopic methods?
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I think any such list should always start from the medical problem first eg direct vs indirect IH, recurrence vs incisional, age weight etc. One of the few things I got loud and clear is that the hernia treatment requires a tailored approach to be successful. I personally think that the problem is to find a doctor that does that which would mean getting out of the numbers churning mill, which requires money as health insurances might not support you. That patients should be kept in the dark or even worse be lied is something that is not far from criminal…also having myself a scientific background to see people publish papers on small biased samples or even without any accessible and verifiable data makes me shiver….
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@good-intentions I would respectfully counter that academic argument can go on forever, without consensus. For the practical purposes of providing laypeople who are looking at surgery with points that they can potentially bring up with their doctor, and open up these valuable discussions in greater detail, and become their own advocate, this can be the roadmap of points to consider or ask about that otherwise may never have entered into a conversation — which can only be an asset. As in my case, I had almost none of these point top of mind — or even in mind. That lead to a lack of dialogue I could initiate. Which largely led to my situation now. In practical terms, this list would have benefited me immeasurably and that’s said as an understatement. And I again thank @drtowfigh for taking the time to assemble her thoughts and provide her take on the question.
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What you’re proposing should be in this, below, already. If it is, but does not represent reality, that’s the hurdle that needs to be overcome. Something is skewing the effort.
https://www.sages.org/publications/sages-manuals/sages-manual-hernia-repair/
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Without numbers, the percentages or odds of certain things happening, AND the type of damage that each causes, debilitating versus uncomfortable, for example, a case could be made to use any of the methods, using a list like Dr. Towfigh’s. Lower, higher, majority, more, less, etc. don’t have much meaning without quantification. 51% is more than 49%. 51% is a majority. The list is a great start but needs filling in to be useful to a patient.
You might actually be helping those that want more of the “bad” methods. For example, Johnson & Johnson has their “International” Hernia Mesh Registry which they delay publication of every year, but cherry pick data from in the meantime to support their products. e.g. The only mesh product that the “International” Guidelines recommend against, the plug, is promoted by Ethicon (a J&J company) using IHMR cheery-picked data, in their professional marketing literature. J&J supported the group that put the Guidelines together, financially. So you have a J&J supported effort that defines plugs as bad, but at the same time you have J&J supported data saying that they are good and should be used. If J&J (Ethicon) was an honest company they would take the Guideline data as evidence for discontinuing plugs. But they have done the opposite.
I use J&J as an example often because what they do is so obvious and documented. Contradictory efforts and data everywhere you look. But my main point is that without objective conflict-free measurements, real numbers, your effort can be manipulated to support the method that makes the most money. Not what you intended.
And, if you’re not very thorough and careful things can get overlooked, maybe because you’ve seen them so often. No offense Dr. Towfigh, but despite almost all of the chronic pain stories on the forum being of the laparsocopic mesh implantation type, you did not mention pain of any kind in your “Cons” section for lap mesh. Many people have also questioned the recurrence rate numbers. Is “Highest” recurrence rate, 5% vs. 4% or 10 vs. 4? Which method has the “highest” chronic pain rate?
And, one more thing – “open” and “mesh” are just way too broadly defined. You just posted in a different Topic about PTFE mesh shrinking 40% and “others” 10 – 25%. That needs to be part of the list, I think, if the list will really be useful in making a decision. Shouldice is open without mesh and they have data that does not match the list, as I understand things.
I hate to be a downer, but I think that you have to be careful not to lead people down the wrong path, as well-intentioned as your effort might be. What you’e proposing is a huge effort to do correctly. And the “pros” have done it, several times over the years, with their SAGES Hernia Repair manual.
Good luck, but be careful.
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This reply was modified 4 years, 2 months ago by Good intentions.
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This reply was modified 4 years, 2 months ago by
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@drtowfigh Can I ask for permission please to make an infographic based around this, or otherwise note it on my FB page? As either anonymous data, or credited, if you would have a preference? Wonderfully concise information. Thanks again.
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@drtowfigh So appreciate your response. Thank you so much.
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