What is the real risk of mesh repair -forum bias

Hernia Discussion Forums Hernia Discussion What is the real risk of mesh repair -forum bias

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    • #31005
      Chuck
      Participant

      lets face it this is a tissue repair forum…if you read here you will assume that mesh compliations are inevitable…it will wrap your organs crash into your bladder…tie up your nerves…GI says 15 % com[plication rate…at 800k surgeries per year thats 120k complication patients per year…could a methodology survibe that level of complications? Dr Felix claims 1 mesh complication in 10k surgeries…a doc i consulted said he performe 2k surgeries with zero complications. As we consider our options Are we giving mesh a fair shake here? As watchful says lap tep does not destroy much tissue…whereas shouldice is very invasive..Desarda too…The guys at carolina medical center..say the studies they conducted showed lap mesh beats shouldice for pain..i posted a study showing 36 % chronic pain with shouldice. Is our prejudice against mesh driven by the overall numbers…if 800k tissue repairs were performed…wouldnt there be nightmare stories that might shift everyone chasing kang desarda and shouldice back to the mesh side? AS i try to decide whether i should remove my mesh…i want to understand its real risks..and that is difficult to ascertain here..any commentary appreciated on the real risks…

    • #31008
      Good intentions
      Participant

      I do not think that you should have your mesh removed Chuck. Many people do just fine with mesh for many years. Apparently, you do not have problems that you can tie directly to mesh, therefore, keep the mesh. It’s working for you.

      In my profession I read numerous scientific research papers for whatever I am working on. So I am used to collecting information and picking through it for the strong conclusions and seeing the errors in the weak conclusions. Almost all of my posts have a research paper supporting whatever point I am trying to make. I started posting here because I was having problems and I felt that I had been fooled. Over the years that I have been posting I have been surprised by the lack of good solid arguments for using mesh as the first choice for a hernia repair. In the beginning I expected to be convinced that I was just one of the very few unlucky ones. But my research showed that the problem is much bigger than described.

      The vast majority of papers supporting the use of mesh are supported by weak data, from the perspective of the long-term welfare of the patient, and the problems in fixing the patients that do have problems.

      But you already have mesh implants and are are apparently fine. Your concerns are about whether your original decision was correct. But that is in the past, you made the decision and it can’t really be undone. Just take the time to heal and get strong again and see where you’re at. If you have problems you known where to come back to for a solution.

      Somebody just posted a comment from a surgeon who had had his own hernia repair, that a person is never the same after surgery. That is true no matter what hernia repair technique a person chooses.

    • #31009
      drtowfigh
      Keymaster

      I totally agree with Good Intentions.

      Despite all the literature inconsistencies, there is one consistent recommendation: if you had a mesh repair and you have no problems with it, there is absolutely no indication nor recommendation to remove the mesh. Fortunately, most patients fall into this category.

    • #31011
      William Bryant
      Participant

      There’s no doubt that when it works, mesh is very good. There’s a poster, Scarlettville, who wanted non mesh abroad, on here but because covid led to cancellations he opted for expediency and mesh here. So far and as far as we know, all is well. Maybe Scarlettville will update us.

      I think there was another.

      However there must be a reason mesh surgery has been changed from medium risk to high risk in Australia. And similarly in Scotland there is agitation for banning it.

      Years ago I had surgery, unrelated, on the form of complications it said death, 1 in something. I still went ahead, reluctantly. I did mention it to the anaesthetist and she said we havent had a death for years.

      It’s all a numbers game I suppose. And a gamble. And risk taking.

      Many people end up “anti mesh” because the issues with it seem to be downplayed, not acknowledged. Even to the point a surgeon told me that people only think they have pain and issues, all in their heads.

      How long ago was the mesh put in Chuck? And could the urinary issues be unrelated?

    • #31014
      MarkT
      Participant

      Chuck, several of your posts here seem irresponsible.

      You continue to parrot a claim regarding very high chronic pain rates that requires evidence.

      In another thread, you claimed that “nearly everyone who has a tissue repair will concede to getting pain or weakeness on occasion in some cases years after the repair” and “lots of reports of chronic pain with shouldice”. I asked for evidence to back up those two claims, both of which I believe to be bogus.

      In this thread, you said that you posted a study allegedly reporting a 36% chronic pain rate with Shouldice…and I also question the validity of that claim. Could you repost that study here or link to the thread where you originally posted it?

      I highly doubt that 36% claim is legitimate in the first place, but I would bet just about anything that figure (if it exists) is not from patients of Shouldice Hospital…so if your study is from some random doc(s) who performs a small fraction of the number and frequency of Shouldice repairs that a Shouldice Hospital surgeon does, you are badly misrepresenting the situation.

      If you don’t support what you claim, you are doing a disservice to the people reading this forum who are trying to make the best decision for themselves.

    • #31015
      William Bryant
      Participant

      This is the report I believe Mark T

      https://pubmed.ncbi.nlm.nih.gov/15243743/

      • #31017
        MarkT
        Participant

        Yes, I found it too.

        I also pulled a copy of the study (rather than rely on abstract/conclusion) to learn more about the claim of 36% chronic pain with Shouldice (vs. 31% with Lichtenstein and 15% with TAPP).

        Unfortunately, all we know about the repairs are “[t]he patients were operated on by three surgeons experienced in both conventional and laparoscopic techniques (>100 TAPP, Lichtenstein and Shouldice interventions each)”.

        What is not clear in that wording is whether all three surgeons have done at least 100 of each technique or whether each surgeon has simply done more than 100 repairs altogether. Regardless, even giving them the benefit of the doubt, that experience pales in comparison to Shouldice Hospital surgeons who average 50+ Shouldice repairs *per month*.

        It is also worth noting that another study referenced in that one cites low recurrence rates from several other studies for Shouldice repairs (0.5-2.8%), but importantly that Shouldice is not as effective when performed by inexperienced surgeons, and that modified Shouldice techniques being used makes comparison across studies very problematic.

        If Shouldice Hospital patients are not reporting 36% chronic pain rates, then the question becomes whether that figure reported in this study from other surgeons is really an indictment of the repair method or whether it is more attributable to other factors?

        It is becoming more accepted that the surgeon (i.e. their skill, experience, frequency of repair, etc.) is a key variable, across repair types, when evaluating patient outcomes; however, too many studies don’t seem to address this well. For example, I recall reading another comparative study that merely stated that the surgeons had ‘good knowledge’ of each repair type. What does that mean? How does that compare to a highly experienced hernia specialist who does *way* more of them then the average non-specialist?

        For me, until we get WAY better data than what currently exists (i.e. data that clearly accounts for relevant surgeon, patient, and hernia characteristics), the sensible course of action is to seek out a surgeon with a relatively high level of expertise and experience, regardless of the repair type chosen.

        While I am a fan of the Shouldice repair, given what I have read and given my own experiences, I would still choose a mesh repair with an expert hernia specialist over a Shouldice (or modified Shouldice) repair from someone who doesn’t really do very many of them. The flip side is true as well…why would I NOT go to Shouldice Hospital for their repair vs. going to some general lap surgeon who does a small handful of repairs in comparison, all else being equal?

    • #31016
      William Bryant
      Participant

      This one claims more people had “pain” after Shouldice but when you read it, it states mild discomfort.

      Think better mild discomfort than mesh wreckage.

      Not sure the numbers matter too much as it’s still the case that it’s easier to sort out a tissue repair after than it is a mesh repair after.

      • #31018
        MarkT
        Participant

        Yes, that gets into one of the many reasons that abstracts and conclusions are useful, but often are poor substitutes for actually reading a study, which is to see how variables are defined/operationalized.

        “Chronic pain” can be defined in many ways, across different timelines, be measured differently. It is indeed responsible to look at different levels of pain…whether it occurs at rest, during day-to-day activities, or during high-demand physical activity like certain sports, etc…and to consider longer timeframes than are typically seen, given that soooo many of us will be living with our repairs for *decades*.

        Of course, these types of studies are expensive, difficult, and time-consuming…but they need to be done to generate really good data.

    • #31019
      William Bryant
      Participant

      Hello Mark,

      Didnt you have Shouldice repair/s?

      Shouldice is still on my list. As you know I’m finding it hard to decide between shouldice and Desarda and Dr Kang.

      I’m not keen on risking mesh. As the complications to my simple mind seem worse than tissue.

    • #31020
      Good intentions
      Participant

      From above – “the sensible course of action is to seek out a surgeon with a relatively high level of expertise and experience, regardless of the repair type chosen.”

      My surgeon was one of those. He was actually part of a group that trained people in laparoscopic techniques. His organization was where you would go to get training. Dr. Billing, who removed the mesh, found that the mesh on the left side was properly placed according to the “state-of-the-art” at the time. The mesh on the right, where the direct hernia was, had folded over and I remember distinct times when I think I felt it move in the days soon after the mesh placement. The feeling of pain and discomfort was broad and diffuse and encompassed all areas in contact with the mesh, both left and right.

      The canard that it is the surgeon’s skill level that determines chronic pain rates doesn’t seem to hold water. It seems to be an opinion, without support, that is spread wide throughout the hernia repair industry. It is convenient though, as a deflection from inherent problems with mesh. Blame the surgeon, not the material. Does it really make sense that a surgeon in training would be released to perform independently even though, supposedly, they needed to “practice” on many more patients before their “failure (chronic pain)” rate decreased? “Keep trying, your patients will stop suffering after 40 – 50 more procedures.”.

      And, as usual, I have to mention the issue of “what if you have chronic pain?”. Complications from a pure tissue repair are much simpler to deal with than mesh complications.

      Your arguments are almost identical to mine before I chose mesh. I could not believe that the medical profession would allow the travesty to continue, that “they” must have realized and identified the source of the problems. But things today are almost identical to 2014.

      I think that Dr. Kang’s comments about how most surgeons only practice what they are taught in school is probably on target. My conspiracy minded side says that the mesh makers have big influence over the medical schools.

    • #31021
      Good intentions
      Participant

      Just to add, my point is really about how I think that mesh might, probably, in my opinion, have the same rate of chronic pain in the hands of an inexperienced surgeon as in the hands of a newly trained surgeon. My experience convinced me that the mesh itself is the source of the pain, not the way it was implanted. And, as they have moved to larger and larger pieces over the years to avoid recurrence, the inflammation becomes more severe due to the wide coverage area. So, in short, their efforts to eliminate recurrence have led to an increase in chronic pain. The theory fits the trend.

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