Redesigning hernia mesh with the patient and outcomes in mind

[Good intentions]

My post had a link in it. Maybe why it was unapproved. Here it is without it.

And here is another paper which addresses the definition of “chronic pain”. Easy to shrink the numbers down if you choose an extreme definition, like “debilitating”. Disingenuous.

It’s pay-per-view but the abstract is pretty good. They also mention the wide range of mesh types. >160.

https://www.ncbi.nlm.nih.gov/pubmed/26567717
[h=1]Chronic pain after open inguinal hernia repair.[/h] Nikkol C., Lepner U. [h=3]Abstract[/h]
Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient’s quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. [h=4]KEYWORDS:[/h]
Inguinal hernia; Lichtenstein hernioplasty; chronic pain; lightweight mesh; pore size; self-gripping mesh

[Good intentions]

And here is another paper which addresses the definition of “chronic pain”. Easy to shrink the numbers down if you choose an extreme definition, like “debilitating”. Disingenuous.

It’s pay-per-view but the abstract is pretty good. They also mention the wide range of mesh types. >160.

https://www.ncbi.nlm.nih.gov/pubmed/26567717
[h=1]Chronic pain after open inguinal hernia repair.[/h] Nikkolo C¹, Lepner U¹. [h=3]Author information[/h] [h=3]Abstract[/h]
Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient’s quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. [h=4]KEYWORDS:[/h]
Inguinal hernia; Lichtenstein hernioplasty; chronic pain; lightweight mesh; pore size; self-gripping mesh

[Good intentions]

Dang. Unapproved. Anyway, here is an interesting response to Dr. Kavics presentation on the same topic.

Look up the definition of debilitate.

https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543

[Good intentions]

Here is an article about the response to Dr. Kavic’s presentation. Dr. Voeller defends the use of mesh and chooses the low chronic pain numbers of 4-6%, plus adds “debilitating” to the description. Implying that the bar for defining success is debilitation. If the patient who came in to fix a small problem with their hernia, get it “taken care of”, ends up non-“debilitated” that is a success, apparently. Somehow, surviving surgery and being still able to function, with or without enjoyment of life, is the criteria for success. This is why the patient has to be very careful.

https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543

““The number of people with chronic debilitating pain is around [4%] to 6% so I don’t think this qualifies as an epidemic,” said Guy Voeller, MD, a professor of surgery at the University of Tennessee Health Science Center, in Memphis. ”

https://dictionary.cambridge.org/us/dictionary/english/debilitate [h=2]debilitate[/h] verb [ T ]
UK ​ /dɪˈbɪl.ɪ.teɪt/ US ​ /dɪˈbɪl.ə.teɪt/ formal
​
to make someone or something physically weak:

Chemotherapy exhausted and debilitated him.
Synonyms
drain
enfeebleformal

[Good intentions]

Chaunce1234, your list is very similar to one that Dr. Kavic, Professor Emeritus at Northeast Ohio Medical University and editor of the Journal of the Society of Laparoendscopic Surgeons, produced back in 2016, in his review paper.

Of course, he said “mesh”, but a more proper word might be device or prosthetic. The word “mesh” brings up an image of a net-like material, but that might not be necessary.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/

“Most would agree that the ideal mesh characteristics for repair of inguinal hernia include the following and not include symptoms resulting from use of mesh itself:

1. Not be modified by tissue fluids,
2. Be chemically inert,
3. Not excite an inflammatory or foreign body reaction,
4. Be noncarcinogenic,
5. Not produce an allergic or hypersensitivity reaction,
6. Resist mechanical strain,
7. Be capable of being fabricated in the form required,
8. Be capable of being sterilized,
9. Resist infection,
10. Provide a barrier to adhesions,
11. Respond in vivo like autologous tissue.¹⁷

A 12th characteristic might be that the mesh be easily removed whenever a problem such as pain or infection develops.”

[Good intentions]

I know somebody that works in venture capital and they said that all of the device makers are waiting to see where the litigation ends up. Their research budgets are small, they’ll just make the money that they can while they can.

[dog]

I think that is the only product can be approved for mesh repair….Until there ..must be mandatory no mesh surgery..mandatory lose weight if necessary to perform the surgery..I think it is good idea to start a petition?