re-absorbable mesh recurrence rates

[newagehernia]

I think people underestimating the difficulty of access methods. If you have 2 hernias AND want some light suturing of the defect AND then a bio or resorbable mesh on top AND have it attached with glue or sutures, this is adding massive complexity in a limited viewable space. If you now want TEP so don´t enter the abdomen, who can do this? maybe this eTep and how long will it take the operation?
Maybe 2 people in the world will try it? Btw, this is the surgery I would like for bilateral hernias as it seems you have 3 layers of redundancy like you see with a NASA spacecraft where you need redundant systems because you are doing something new and can´t afford even a small chance of failure…but more things can go wrong the more complex or steps there are. What is the solution? A permanent plastic mesh weights like 2grams for 2 sides for the lightest ones. I sometimes wonder if 2grams of foreign material can cause so many symptoms. Maybe one day they will have a collagen matrix with your own stem cells grown on it like in a hair stem cell transplant for baldness that will be implanted, won´t be attacked, will be solid, and friendly to your body.

• This reply was modified 2 years, 9 months ago by  newagehernia.

[saro]

I read another post in which open resorbable mesh repairs were evaluated according to the two most popular methods, the Liectenstein or the Shouldice. This is because in the case of hernias larger than an egg, many suturing-prone surgeons apply a reinforcing mesh. If I remember correctly this happens when the hernia exceeds 5 cm, but I’m not sure. However, I do not find the suggestions of the doctors of the site if one is preferable (Liectenstein) or the other (Shouldice with mesh)

[Wim]

I remember that post, but why not let the patient choose? If it is 500$ extra for absorbable mesh, so what? Compared to total cost it is not that much extra for more safety.

• This reply was modified 2 years, 10 months ago by  Wim.

[Alephy]

I asked this very question in an old post, and was told that this would not be such a bad idea, but that the the financial cost would be much higher and therefore people don’t do it…

[Wim]

Why not combining tissue repair with re-absorbable meshes? Maaybe it is the combination of the two that makes the best?

[Alephy]

The way I see it, the ultimate mesh would foster healthy tissue regrowth, as opposed to scar tissue, and eventually disappear. Some meshes apparently have this property, with a bunch of unwanted side effected unfortunately…It seems no “device” can do better than our body, so we might as well accept that and try to make our body fix the problem the best it can….

Also, at the moment some situations I think warrant the use of mesh (like very complicated hernias etc)…

ps: Does anyone know what the situation is in the EU with regard to the new guidelines whereby a mesh can only be used if trial data is produced to its effectiveness?

[Good intentions]

Yes, I had a direct hernia and have not had any signs or symptoms of recurrence since having the Bard Soft Mesh removed three years ago. There is still a small piece of mesh remaining though, near the site of the hernia. It was too entangled with critical structures to risk removing. The stiffening and thickening of surrounding tissue that the mesh caused seems to stop any new hernia formation.

For anyone trying to understand the reasoning behind what’s happening, they need to keep in mind that a “market” has been firmly established in medical devices for hernia repair, with a very large revenue stream, flowing out to all of the device manufacturers. These studies in to new products are funded by device makers trying to gain market share or improve their products enough to maintain market share, or, possibly, to deflect from their responsibility and show that they are trying to solve a problem. But, as shown by the International Guidelines document, there is no focus on the best hernia repair for the patient that does not include a device, a mesh-like product. “International Guidelines for Groin Hernia Management” is actually a deceptive title. An honest title would be “International Guidelines for Mesh-Based Hernia Repair”. The group that put the Guidelines together, HerniaSurge, was funded by the mesh makers and they state clearly that non-mesh repairs would not be considered. It’s all about expanding the market for mesh.

All of this work is designed to maintain the billion dollar revenue stream. So, there might eventually be a “best” mesh device, but if pure tissue repairs are actually best for the patient, this type of work will never define that. The device makers would lose revenue and their stock prices would drop. Follow the money.

The people using the Danish hernia registry to quantify things like chronic pain and recurrence are the only ones that really seem to be showing how bad things are. If the medical industry eventually turns toward a long-term results focus instead of short-term their work might become more relevant.

Sorry to bring doom to the discussion again. The business side of things is really in firm control right now though. Marketing and advertising are their tools for influencing.

[Alephy]

I wonder, are these data specific for incisional/complex hernias? From the small reading I did it seems as though 20% recurrence rate in this case is understood to be expected…the Italian study even concluded positively in considering the Phasix mesh a valid alternative.
I guess my question is: could these meshes be an alternative for uncomplicated inguinal hernias too?

ps: I have also another question: are these (bio and not) absorbable meshes also placed laparoscopically? If so in this case a bigger mesh would be used, as opposed to an open repair?

[ajm222]

It also could be related to type of hernia. Dr. Belyansky suggested he really hasn’t seen recurrence among those who had an indirect hernia originally and had their mesh removed by him. But those who had direct hernias sometimes get another hernia within just a few months. Something about the anatomy. I do know one person who had both direct and indirect on the same side and had removal and they have not gotten another hernia so far after 3 years. Several other people I’ve spoken to remain hernia free after 2-3 years. It could also be related to the type of removal – open versus lapro. And I think good intentions may have had a direct hernia (?) and had his mesh removed several years ago with no new hernia. Who knows if that will change.

[drtowfigh]

One study shows 18% recurrence at 3 years with ? of patients following up: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=phasix+mesh&btnG=#d=gs_qabs&u=%23p%3DNZZFiJjtnWYJ

No results published from the other study, but the data was presented last year at our meetings and I believe the recurrence was also around 20%.

The consensus is that the recurrence de rates will continue to climb. There is no perfect mesh product. Also, scar tissue typically is not strong enough to prevent recurrence, but sometimes it may be.

[Alephy]

In fact, on the same line, is recurrence then a potential problem for those who had their mesh implants removed (because of chronic pain etc) i.e. are they at higher risk with time? I cannot quite understand some statements whereby when the mesh is removed the scar tissue left is strong enough to stop future hernias, but somehow the same does not apply to (a subset of?) re-absorbable meshes…

[Wim]

In Europe it was possible to register a grape fruit mesh as suitable for mesh implants…
It is in Dutch:
https://radar.avrotros.nl/uitzendingen/gemist/item/mandarijnennetje-als-implantaat-goedkeuring-implantaten-is-een-farce/

English: https://radar.avrotros.nl/uitzendingen/gemist/item/all-meshed-up-from-manderin-bag-to-medical-implant/

• This reply was modified 2 years, 10 months ago by  Wim.