The Gospel of Mesh

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    • #33323
      Good intentions
      Participant

      I just came across this “retweet” on Dr. Towfigh’s Twitter page. This is the state of hernia repair with mesh today.

      Edit – actually it looks like Dr. Knauer retweeted. I don’t understand how Twitter works. It’s confusing.

      Even though the “10 Commandments” should be well thought out before disseminating across the world, there are some inconsistencies. How does a surgeon do what Dr. Felix suggests via an open method?

      Also clear that even though he calls them the Commandments of Inguinal Hernia Repair they are really just directions on laparoscopic mesh implantation. He is 100% a mesh marketer.

      How has the hernia repair field has become so narrow-minded? Promoting lap mesh repair so vigorously while professional researchers are still defining its flaws. What is his goal? He seems more interested in fame and adulation than advancing the state of hernia repair. It’s disturbing.

    • #33328
      drtowfigh
      Keymaster

      Not a fair statement, in my opinion.

      Dr Felix was the first to introduce the TEP laparoscopic inguinal hernia repair. He was trained under Dr Nyhus, who performed a similar repair in open fashion.

      Drs Felix & Daes wrote the initial paper in 2017, discussing the importance of defining the critical view for laparoscopic or robotic inguinal hernia repairs.
      http://www.nugits.nhs.uk/wp-content/uploads/sites/14/2019/07/Lap-inguinal-checklist.pdf

      Their work is so important, as it helps reduce poorly performed laparoscopic repairs, which is rampant. Just read my paper on review of the top 50 YouTube videos of these operations. Absolutely horribly done by most of them. https://link.springer.com/article/10.1007/s00464-020-08035-z

      The critical view is not relevant to any open anterior approach operations for inguinal hernias.

      Dr Felix is retired. He could just be basking in the beach. Instead he is using his expertise to continue to advance safe laparoscopic hernia care.

    • #33329
      drtowfigh
      Keymaster

      Not a fair statement, in my opinion.

      Dr Felix was the first to introduce the TEP laparoscopic inguinal hernia repair. He was trained under Dr Nyhus, who performed a similar repair in open fashion.

      Drs Felix & Daes wrote the initial paper in 2017, discussing the importance of defining the critical view for laparoscopic or robotic inguinal hernia repairs.
      http://www.nugits.nhs.uk/wp-content/uploads/sites/14/2019/07/Lap-inguinal-checklist.pdf

      Their work is so important, as it helps reduce poorly performed laparoscopic repairs, which is rampant. Just read my paper on review of the top 50 YouTube videos of these operations. Absolutely horribly done by most of them. https://link.springer.com/article/10.1007/s00464-020-08035-z

      The critical view is not relevant to any open anterior approach operations for inguinal hernias.

      Dr Felix is retired. He could just be basking in the beach. Instead he is using his expertise to continue to advance safe laparoscopic hernia care.

    • #33330
      Good intentions
      Participant

      A true physician does not downplay the pain that their work causes and has caused like Dr. Felix does in his presentations. Too many surgeons seem to be so focused on spreading the neat new techniques and technologies that they are willfully ignoring the fact that mesh is over-used and has real problems associated with its use. There is no study out there that has suggested that improper mesh placement is the cause of chronic pain. To the contrary, efforts to find the cause besides the mesh itself have all failed. And, also contrary to the the recurrence myth that is being spread, recent studies are showing that laparoscopic mesh placement has a significantly higher recurrence rate than what is being propagated. I posted a paper about it recently, I will relink it below.

      It would be great if somebody could truly show a clear path to reducing the risk of chronic pain and recurrence. But people like Dr. Felix are out there suggesting that patients who complain of pain and discomfort are just weak, as he does in his “Let’s be honest…” presentation. To paraphrase Dr. Felix – “let’s be honest, mesh is not the great panacea that it is being promoted as”. It just isn’t.

      The mesh makers are still selling the products that the Guidelines recommend against. The Guidelines “update” seems to be delayed for some reason, even though professionals in the field have published papers to help create better Guidelines.

      I am sure that you are aware that nothing of significance at all has happened in the five years since the Guidelines have been published, except advancements in ways to get more mesh in to more patients. And besides Atrium getting sued for their fish-oil coated mesh, and Bard getting sued for their polypropylene mesh plugs. Chronic pain was identified as the number one problem in the hernia repair field just a few short years ago. Right about the time that Dr. Felix started his 10 Commandments tour. Chronic pain and mesh removal is now normalized as part of mesh implantation, with new pain center businesses created to handle the new business. It’s insane.

      The state of teaching hernia repair – Dr. Felix

    • #33331
      Good intentions
      Participant

      I might have confused recurrence with chronic pain rate in one of my comments above. Here is a recent reference to a paper confirming the high chronic pain rate for TEP.

      The focus on recurrence begs the question of “why did the patient see the physician in the first place?” To have their pain removed. That’s why Dr. Felix’s presentations are so frustrating to see. He completely ignores the Hippocratic oath. He will become known as the Father of Chronic Pain, I think, not the Father of Lap Mesh Placement.

      Doctors seem so caught up in the bright lights of technology that they’ve forgotten why they became doctors.

      New paper evaluating glue versus tacks fixation in LAP TEP – 13% pain rate

    • #33334
      Good intentions
      Participant

      Here is the essence of what bothers me about Dr. Felix.

      Dr. Campanelli, among many others, a surgeon who was involved in the creation of the hernia repair Guidelines, that promote the use of mesh, has acknowledged that chronic pain from hernia repair is real and the problem needs to be addressed in a professional manner.

      At the same time, Dr. Felix is traveling the world, telling medical students and surgeons that the chronic pain problem is not significant and should be ignored.

      One doctor is saying that the pain needs to be dealt with, the other is actively saying don’t worry about the pain.

      What kind of physician, or even person, tells his students to ignore a patient’s pain? That is not a doctor. It is a businessman.

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