• Update of the international HerniaSurge guidelines for groin hernia management

  Posted by Good intentions on October 31, 2023 at 8:12 am

  No dramatic changes. They’ve extended the update cycle, they won’t even assess the impact of the new guidelines until two years have passed. Looks like new material about chronic pain and pain treatment centers has been added. Basically, the surgeon should pass the patient on to the next revenue center if they have pain. Some minor waffling, changing the word “all” to “majority” for adults who should get mesh. Nothing surprising.

  Pay attention to the Evidence column after each statement. A huge list of references yet the majority of the evidence for the recommendations, the Statements, is still weak. Still a minefield.

  I still see some denialism, even after all of this time. Maybe it’s a liability issue, they can’t admit that hernia mesh is a problem. Just can’t say the words. The Summary attempts to lay the blame for fear of mesh on “adverse events in other surgical fields”. All of these authors and all of this work and this still goes on. Kind of weird.

  https://academic.oup.com/bjsopen/article/7/5/zrad080/7325871?login=false

  Update of the international HerniaSurge guidelines for groin hernia management
  Cesare Stabilini, Nadine van Veenendaal, Eske Aasvang, Ferdinando Agresta, Theo Aufenacker, Frederik Berrevoet, Ine Burgmans, David Chen, Andrew de Beaux, Barbora East … Show more
  BJS Open, Volume 7, Issue 5, October 2023, zrad080, https://doi.org/10.1093/bjsopen/zrad080
  Published: 20 October 2023

  “…
  Summary

  The HerniaSurge recommendation to use mesh in all adult patients was altered to the use of mesh in the majority of patients (consensus 88 per cent). Although there is high evidence that mesh repair is superior to non-mesh, there are cases in which a non-mesh repair can be suggested. Due to concerns regarding the use of permanent mesh, related to adverse events in other surgical fields, some patients search for surgeons who are prepared to offer tissue or non-mesh repairs. There are some clinical scenarios where the use of permanent mesh is contraindicated, for example in some infected operative fields. There are parts of the world where mesh is not available or affordable. There is some discussion concerning the value of non-mesh hernia repairs in young male patients with an L1–2 hernia. The evidence for this is very low and does not allow for a recommendation. Shouldice is the best non-mesh repair, although the experts agreed that it has a learning curve that should not be underestimated. In countries where mesh material is available it is infrequently used, and further training is needed but is not always readily available.
  …”

  “…
  It is important to reiterate that the literature demonstrates the benefit and safety of mesh prostheses. However, the following complications of mesh repair, whether due to prosthetic or surgical technique, have been observed and should be taken into consideration when advising patients’ treatment options. Mesh, especially small pore meshes and three-dimensional mesh gadgets, have been found to shrink, migrate, or erode into adjacent structures, serving as a common mechanism for chronic post-inguinal hernia repair pain8–11. Dysejaculation and pain associated with sexual activity have been reported as a complication of mesh inguinal hernia repair, although other studies have demonstrated an improvement in sexual function and fertility with hernia repair10,12. Mesh repair, especially with preperitoneal mesh placement, confers the potential for rare visceral complications because of the proximity to adjacent organs including the colon, small intestine and bladder13,14. Preperitoneal mesh repair can complicate the performance of future radical prostatectomy, especially in the non-minimally invasive era of open prostate surgery15,16. Finally, the potential for true mesh allergy seen in autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/Schoenfeld syndrome must be considered, although such cases are extremely rare relative to the global volume of mesh-based inguinal hernia repair17,18. Recognizing that these potential complications are infrequent, they can cause concern to such an extent that patients and surgeons in a shared decision process decide a non-mesh repair would be preferable.
  …”

  Good intentions replied 1 year, 5 months ago 1 Member · 0 Replies
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