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Why there is no foolproof method?
If I can say this, inguinal hernia has been with mankind since time immemorial. Almost everyone on the road has one kind or another kind of this hernia. It is EOE/AA in the sense of men and women. In our family, my father had it, my kid had it, my brother had it and I had it. My father passed away without surgery but rest of us got surgery done. My kid got it at very young age.
YET we have no fool proof method of imaging it, or any scan. The best is the touch by surgeon who can tell if I have one and need surgery or not. I met two surgeons. One said I have 6/10 and the other said 5/10 (10 being worst that can cause vomiting, strangulation etc). Why do not we have a fix-it-fizzle method to detect a hernia? On a related note, Dr. Towfigh, is not this a great research topic to do some work? I have a Ph.D. in biomedical engineering and am interested to work on it if anyone wants to collaborate. Let me know.
Second, why do not we have a quick fix for this problem? We have mesh, shouldice, no-mesh, Desarda and so on methods but there is no single one that can cure all. Desarda seems good but I have heard stories hernia comes back in some patients. I chose not to go with Desarda since hernia seems to be in our family genes and Desards can make it come back (weak pelvic floor?). I myself do not have any problems after almost 6 months of surgery.
My other question – Since most mesh problems are coming after 6 months or so should I be ready to get some or am I ok? I went to a great surgeon who is hernia specialist in the North East and he did a great job. Never heard complaints about the surgeon or from his patients. Can my mesh still cause problems in future?
Thanks for reading.
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3 Replies
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Why there is no foolproof method?
And- Thanks for WasInTN for the original post- we look for collaborations with patients and others outside of healthcare who can add diverse perspectives in our attempts to improve outcomes and address complex questions and problems.
Thanks again,
Bruce -
Why there is no foolproof method?
Thanks for the heads up on this post, Shirin. The reason we have not been able to do a better job of figuring out who will get a hernia, whether a hernia will cause a problem within someone’s lifetime and what is the best treatment option for each patient (lap vs open, mesh vs no mesh, etc.) is because those are complex biologic issues/problems and until now, in healthcare, we have only been using reductionist scientific methods to understand our biologic world. In reductionist science, we try to prove or disprove a hypothesis. This is a fallacy in attempting to understand a complex system- there is no one right answer. In complex systems science, the scientific method does not attempt to prove or disprove, but to improve outcomes over time through a better and better understanding of whatever process is being measured. The tools used include continuous quality improvement principles (actually should be termed continuous value improvement because costs have to be measured as well) and non-linear statistical analysis (like factor analysis, which produces weighted correlations). Ultimately, it is the same thing as the information science that is being applied in other industries, but I think is desperately needed in healthcare. The process of improvement involves collecting data that matters to the outcomes of a definable patient process (in this case, inguinal hernia) and to collect outcome measures that define value. Then as data accumulates, the non-linear analyses can lead to predictive analytics that get better and better at predicting: who will get a hernia?, whose hernia will become incarcerated?, who will do better (or worse) with a mesh (or non-mesh) repair? We have started to do this and it will be the future of our healthcare system- just very messy at first and we still have a lot of people in healthcare firmly rooted (and benefiting from) the reductionist principles for research and for the design of our organizations. I hope this helps- thanks again.
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Why there is no foolproof method?
This would be a great one for Dr Ramshaw to answer. His lifelong research interest is this problem.
He will tell you that it’s because hernias and our individual bodies are complex systems. A mesh repair in one patient will act differently in another patient even if performed exactly the same. Until we can approach it with this in mind and determine the best modality depending on the specifics of each patient (cancer treatment is finally moving in that direction), then the problems you present will remain.
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