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Rates, percentages, and trends in lap versus open
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Thanks William. I looked through some of the BHS pages and they are the typical “we do it best” marketing pages of almost all hernia repair facilities. They seem to be claiming credit for all of the “tension-free” mesh methods. Pretty proud of themselves.
But, without the numbers, it’s just more salesmanship. At this point, I barely look at work reported without the numbers. It’s just chest-beating and crowing without the long-term measurements of success, using the things like quality of life, chronic pain, and recurrence as measures. Their publications page is dated, the most recent is from 2009.
The patient stories page is full of the typical vague terms and words. One patient climbed Mt. Kilimanjaro. Woohoo? There are few dates on the patient blog site and there are only 146 reports. Sorry, but to me the BHS looks like a typical hernia repair mill.
This Topic is really about finding numbers that will allow a patient to eliminate the worst choices. Worst mesh product, worst procedure, even worst surgeons or clinics. The BHS site doesn’t have any numbers that help.
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Good Intentions you may be interested in this from the British Hernia Centre, it’s their view of why robotic causes pain
“When done well, by well-trained and experienced surgeons in appropriately selected cases, the results of keyhole inguinal hernia repair can be very good and where appropriate we use it ourselves.
The problem is that well-trained surgeons who are experienced in laparoscopic surgery and specialise in hernia repair are few and far between. The consequences of a poorly carried out keyhole repair can be serious.
The advantage put forward for laparoscopic surgery is that no large cut is made on the abdomen so in theory there is less post-operative pain and a faster return to normal activities. For example, with major bowel surgery, where large cuts have traditionally been made, the laparoscopic option is a good one.
But for inguinal hernia repair the incision for our described open local anaesthetic repair is small anyway, particularly in the hands of surgeons who specialise, so the difference in that regard is not at all significant.
Pain after Keyhole Surgery
In practice and depending upon how it is performed, you can get quite a lot of pain after a laparoscopic inguinal hernia repair, because the pain does not come from the skin cut anyway. The pain is more likely to be related to the fact that the deep tissues have been cut and pulled, and staples may have been used to fix the mesh.
Disadvantages of Keyhole Hernia Surgery
It is technically demanding for the surgeon.
What that really means is that its difficult to learn and difficult to do well. He has to practice a great deal and perform a large number to become really good at it.
Due to the nature of operating by using a 2D video image of the site rather than proper 3D visualisation there is the risk of major organ damage (blood vessel, bowel and bladder).
Keyhole repairs have to be done under general anaesthesia. That carries risks on its own and certainly not so good if you are elderly or have other medical conditions.”. -
From the link
“The peritoneal bulge is returned to where it belongs, but the repair is achieved by placing a piece of fine (inert and sterile) mesh at the opening in the tissue. This is firmly held in place and the outer incision closed. The whole operation takes minutes to perform.
Unlike other techniques, even those now using mesh, our approach does not require any stitching together of the muscle tissue at all, thus eliminating the tension induced by other methods.
The healing process starts to take place immediately whereby, (sensing the presence of the fine mesh) the muscle and tendon send out fibrous tissue which grows around and through the mesh, incorporating it in a way similar to the placing of the steelwork inside reinforced concrete. It is not a “patch” stuck on the outside, (as is relatively common with mesh repairs) but a total, tension-free reinforcement inside the abdominal wall itself. The results are also similar to the concrete analogy, in that the mechanical load is spread over the whole area, precisely at the area of weakness, rather than on high pressure points of stitching through the deep, sensitive tissue with older methods.”
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Yes it does point to a registry. It’s a must have … For patients at least.
Here’s the British hernia centres description of their open operation, they make it sound unique, I don’t know if it is it just worded to imply so…
https://www.hernia.org/tension-free-mesh-2/
Interestingly enough, and tying in with this thread, on the previous page the BHC say pain is more likely with robotic mesh repairs, they put this down to surgeons not being sufficiently trained or experienced enough in the practice amongst other things.
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And, of course, this circles back around to a registry. With a well-designed registry these numbers would fall right out. Which is, of course, a reason that the device companies would not want to have one. The less people know the better off they are.
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Not sure but with open can more be seen and did Watchful say it’s placed differently depending on open or lap.
It’s this sort of analysis that I can’t believe the medical profession/Industry don’t follow up… If one is obviously causing more issues than the other it should be noted and patient informed at the very least or the worst method dropped totally.
Ive just read a British hernia centre, hospital not group, saying their mesh is placed between something’s as though it’s unique..I’ll see if I can find it and let the brainier posters decipher it!
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In short – just trying to find another tool to use for a “process of elimination”. A patient might not be able to find the best procedure but they can avoid the worst.
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David M I think that is a whole separate discussion, about the cause. At this point many surgeons are dismissing the problem as unreal or just the result of people in today’s world being weaker than people in the past. The problem has to be recognised first, as Dr. Campanelli did in his Editorial, so that professional researchers at the medical device companies and universities have a reason to work on solutions, and/or so that consumers can avoid the bad products. As long as the denial continues not many people will put effort in to working on it.
The point of my post here is about the relationship between the volumes. If more product is sued you would expect more problems to be reported. The ratio of problems to product used gives the probability of problems for specific products. A similar comparison, which the professionals should have figured out and which the medical device companies probably already know, is “what is the ratio of problems to the specific device?”. For example, plugs have been identified as “not a first choice” or “evil”. But, according to Dr. Towfigh’s past remark, and a past forum post, linked below, plugs are a very high volume product. So, are the bad plug cases actually a small percentage of overall plug usage? Or not.
If you get on to the MAUDE database you can find a huge number of reports about specific devices but there is no context with the total volume of their usage. This is what the FDA should be doing, identifying the probability of problems with a product. If I knew that 20% of people with plugs had problems, and only 10% of people with Lichtenstein had problems that would help me make a decision, along with other information about the work needed to fix the problems. But I don’t know if a database exists that would allow someone to define those percentages. The numbers have to be out there. Somebody should be drawing those correlations.
https://herniatalk.com/forums/topic/plug-and-patch-hernia-repair/
I had created a Topic about the MAUDE database in the past but Google and the forum’s search engine can’t find it. Here is a link to the database.
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm
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There’s a tiny number of people on this forum. No meaningful conclusions can be drawn from this miniscule population.
The surprising thing to me is that so few people pop up here. You would think that a lot more would find their way here since there’s a very large number of hernia surgeries.
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It could be just luck, but assuming the higher pain rates for lap that we see on here are representative, do you have any theory as to why lap might cause more pain?
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