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Rates, percentages, and trends in lap versus open
I came across a short SAGES presentation, from 2020, about ten year trends in laparoscopic hernia repair. With all of the articles and videos about laparoscopy a person gets the impression that laparoscopy dominates the hernia repair market. But, apparently, lap is only about 40% of the market, open is 60%.
Which begs the question of “where are the open repair problem stories?”. I think that the reason might be a matter of degree and paths to a solution. Open repair problems seem to be less significant to the patient than lap mesh problems so the people that have them don’t end up on forums like this one seeking solutions. There might be other reasons but I can’t think of them. To a normal patient, surgery is surgery. Get the diagnosis, get a referral, go to surgery, hope that you get healed. If lap mesh is 2/3 the volume of open surgery (probably mostly mesh – Lichtenstein or other) why are the stories on this forum mostly about lap mesh? Something doesn’t seem right.
The presenter notes that the CPT codes he used for the study don’t distinguish between TEP, TAPP, or robotic (still not calling robotic TAPP although that’s what it is), but he doesn’t say anything at all about the types of open repair. Another one of those blind spots. All mesh types are “mesh” and all open surgeries are “open” to a lap surgeon, apparently.
Anyway, another one of those things that makes you wonder. Why are there so many lap mesh complaints on this forum when lap mesh is not the predominant method of repair? The ratios don’t follow the overall volume of methods used.
“Ten Year Trends in Laparoscopic Hernia Repair: A NSQIP Database Review”
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30 Replies
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So open would or should be less problematic long term hopefully?
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We looked at why we remove mesh over a span of about 5 yrs. The majority of mesh removal was after prior open operations (83% total). However, over time, we noted that the need to remove mesh after prior laparoscopic/robotic surgery significantly increased in a stepwise fashion. So, your observations are valid: we are seeing more complications after lap/robotic surgery than we were seeing before.
The full article can be found here: https://pubmed.ncbi.nlm.nih.gov/30382481/
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It’s just one study, but seems to indicate that open removal of mesh slightly less complications than lap removal.
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I wish I could add this without bumping the thread.
Add Paco as an expand of the plug and patch.
https://herniatalk.com/forums/topic/my-explanted-mesh-photos/
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As far as I remember Baris did not have mesh removed at Shouldice. They left it and used it to help the repair he had there on one side. The mesh was put in by Dr Koch at Biohernia even though Baris wanted no mesh.
I’m not sure if he had it removed elsewhere though, I think he wanted to.
Hope I have this right!
Brilliant research and idea David M. You must have some patience! Also Good Intentions too.
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Someone named Forest. He doesn’t say anything about removal, but he came here pre lap surgery and 7 or 8 months later was having trouble sitting as of his last message.
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Someone named Timothy had pain after open mesh surgery,though his pain went below knee and may not have been related to the mesh. Doesn’t say that he had it removed.
https://herniatalk.com/forums/topic/chronic-pain-affecting-most-of-one-side/
Forgot to add Paul to the above list.
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Ok, here are the lists so far.
Had lap mesh removal…
Good Intentions
Chuck
AJM
Herminius
NGP (I think those are the initials)
Sensei
Edward
Jnomesh
James Doncaster
Esm
Mitchtom6
Josh V
Ian J
DmpainFor open mesh removal…
Lucas S
Baris-
This reply was modified 9 months, 3 weeks ago by David M.
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This reply was modified 9 months, 3 weeks ago by
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I guess you’re right, because in the link you gave, Jnomesh also said his mesh covered all three spots, including the femoral. That would have to be a lap mesh.
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I think that he was saying that Dr. Belyansky does remove mesh that had been placed via open surgery. He does both.
” had my mesh removed by Dr. Igor Belyankski-Although he removed open placed mesh his expertise is definitely in robotic/laparoscopic removal of mesh placed this way.”
Here is one his older posts where he describes the 3DMax. There are others with more detail. He used the term “hard as a rock” often, as I recall.
“I really don’t want to worry you but wanted to chime in that I had the 3D maxx mesh implanted 6 years ago and had issues from day one. They weren’t debilitating but occasional flare ups were.
about 10 months ago I did experienced debilitating pain and after much exhausting journey found out that the mesh had folded. The only surgeon to see this on a cat scan was dr. Igor Belyanski in MD. I ended up having to have the mesh removed.”right laproscopic inguinal hernia surgery with numbness and pain on right leg
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GI, Jnomesh does say in the post I linked just above that his mesh was open placed.
Be sure and bring back any open removals, as well, so we are not distorting the numbers.
I found someone named paul who had lap removal.
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Jnomesh was actually one of the first 3DMax patients on the forum, as I recall. He often described how his removal surgeon found it balled up and hard inside him.
I came across another lap mesh patient. Ian J. A new mesh, a product called Polymesh. He was on the forum about a year ago but stopped responding after Chuck asked him to “chat”. Not sure why.
https://herniatalk.com/members/ianj/
I searched for Jnomesh and came across another lap mesh patient looking for solutions. dmpain. Honestly, they are so common that you almost don’t notice them. On for a few posts, gone, back for a few more later.
https://herniatalk.com/members/jnomesh/
Long-term pain: bounced between sports hernia and complications from hernia repair
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Two more lap surgery removals- mitchtom6 and Josh V.
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Above post should say explantation numbers, not explanation.
I found this older thread about mesh removal doctors. Having gone through part of it, there are two (counting the original poster seekng removal) for Lichtenstein removal and two who had lap removal.
Jnomesh and Lucas S were the two for Lichtenstein, and James Doncaster and Esm were lap removals. Some of the others I havent determined yet.
https://herniatalk.com/forums/topic/best-surgeons-for-mesh-removal/
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This reply was modified 9 months, 3 weeks ago by David M.
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This reply was modified 9 months, 3 weeks ago by
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Sure, no one is saying that there aren’t some problems of pain with Lichtenstein, but youre pulling in people from other fields of representation.
Baris, of course, belongs in this pool of posters with pain complications from mesh. But certainly in recent memory, the lap pain numbers here have far outnumbered the Lichtenstein pain.
A better view of this would be the relative explanation numbers, Lictenstein vs lap, from a surgeon who does removals. Barring that information or some other well thought out statistical pool, the mounting number of lap removals here is still concerning.
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We’ve had open mesh cases complaining about pain, such as Baris who ended up having his removed at Shouldice I believe.
A big part of Dr. Brown’s practice was treating chronic pain patients after Lichtenstein procedures. He used to post here before his retirement.
The first surgeon I approached regarding my hernia had chronic pain himself from Lichtenstein and needed a neurectomy.
A colleague of mine still has occasional pain 20 years after his Lichtenstein.
Studies show pretty high rates of chronic pain for Lichtenstein. It’s far from a safe procedure in that regard.
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Add Sensei and Edward to the lap pain group.
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Watchful, there are two different ways to look at the small numbers here.
First, yes, you would think there would be more people coming to seek help with their meshes-gone-wrong and that may suggest that the actual number of bad cases is relatively small.
On the other hand, without knowing what the actual combined totals’ percentage is, can we begin to get a picture of the way the pain is divided relative to type representation. I think maybe so.
I cant remember a single person on here who had open mesh and came to complain about the pain, but I can think of five off hand that had lap mesh removal due to pain. Chuck, GI, AJM, N**, and Herminius come to mind and I think there are more. If you fill a big hopper with 400000 black balls and 600000 white balls, representing the proportions of lap and open mesh surgeries according to the above chart, what are the chances that the first five balls drawn would all be black? The answer for .4 to the fifth is about 1%.
The proportion of lap surgery snafus here is therefore not that easily ignored. Is this not true?
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Oh yes I agree, I just found it interesting, and, a big, coincidence they should say robotic causes pain.
I wouldn’t personally consider them as apart from not wanting mesh I’ve read they can charge up to 12k.
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