[Alephy]

This really made me laugh 😆 thumbs up for a free health system like in Canada

Ps: if one did an A/B testing between the old and the new forum, which would be the winner?🤔

[Alephy]

No I am still watching it and staying put. I just found the cold therapy interesting and wondered if it could be of value for those in severe pain after a failed hernia surgery, whether with mesh or without…

[Alephy]

I personally find it pretty weird that a patient doctor communication/exchange should happen on a public forum…

[Alephy]

My doubt with high volume surgeons is that sometimes they only supervise the surgery, maybe jumping from one room to the other…I am talking about a hospital like environment. In this respect I would go for a low volume specialist as opposed to a bigger center. I got my first hernia repaired 20 years ago: I was supposed to have a surgeon the department chief, but it was an assistant who did it in the end. She reckoned the hernia was small enough that mesh was not needed. I believe the chief surgeon would have seen it differently probably. So sometime lower rank is better as it translates to more attention to the patient (the repair still holds, and apart for the first few weeks of careful movements I never had any problems)

[Alephy]

You mean a travel insurance? Or a medical one for abroad in case of accidents? As far as I know no medical insurance will pay for a pre existing condition unless it is a compulsory one as dictated by the specific country of residence, and in that case they would probably object to a procedure done in South Korea…🤔

[Alephy]

Nice video! @drtowfigh I was wondering, you mentioned you operated on professional basketball players: can I ask if you used mesh for some of those cases?

You also mentioned biological meshes for those patients allergic to synthetic meshes: are the bio meshes getting better? Was there a conclusive study on the recurrence rate for those?

Thanks again!

[Alephy]

I watched the video but I am puzzled at what message was conveyed in the end. Variability in medicine seems to include radiologist incompetence or lack of proper training…same statement about some surgeons, allegedly non experts. Then some facts are reported about why mesh is the preferred choice, and here one is faced with the variability in the quality of many publications (patients are not doctors but some patients are statisticians). One thing is clear though: it is no wonder patients are at best confused and at worst very disappointed 🤔

[Alephy]

Yes the meta analyses are affected by the quality of the included papers, it is a real problem…I almost understand why some surgeons rely on their own direct experience more than the guidelines 🤔

[Alephy]

As for the (number of) meshes, it’s a good example of divide and conquer… the more the better for the manufacturers

[Alephy]

Exactly ie could they go back to their lifestyle? It would also be interesting in general to have a measure of the physical fitness of the patients and whether or not PR was prescribed and done before and after the surgery: the more tailored information is available the more informed the decision making process can be I guess?🤔

[Alephy]

Also when inflammation is present, the amount of it correlates to the size of the source of the inflammation ie the mesh? I am assuming all things equal, as if one is allergic to a substance things can go quickly south with just a small amount…

[Alephy]

Some researchers seem to think that scar tissue forms around static foreign bodies. In particular I remember the discussion in a paper for a 3d mesh for inguinal hernia where the mesh is implanted but otherwise free to move within a certain space. It was found that no scar tissue formed around the mesh, which I assume meant there was less inflammation as well…

[Alephy]

My impression is that the medical/surgery field is not as scientifically rigorous as other fields are eg you cannot be a physicist without a deep knowledge of statistics.

[Alephy]

Interesting post…as far as I know the role of fascia has only recently started being fully understood, which also means most of the surgeons might still not understand it. In some martial arts it has a pivotal role in transmitting force from one part of the body to another, and they actively train to remove “knots” that are seen as an impediment in the transmission. I think any surgery modifying the fascia layer is likely to have an impact one way or another. Personally I think when watchful waiting it is equally important to train the core muscles as well as the fascia, or at least I try to…

[Alephy]

I have also wondered about this, given I have allergies and urticaria…I have also read that it is difficult to test against an allergy to the mesh material, and that the result may not tell you what will happen once the mesh is inside the body…@drtowfigh I think also mentioned once that these cases may or not warrant a pure tissue repair, but it is based on further analysis

[Alephy]

@Watchful indeed this is what made me angry when I found out that most doctors, including hernia specialists, will tell you false or inaccurate information!
Btw I don’t think this site was created with a focus on high volume surgeons and their patients, and many patients do not have the option to go to the best specialists either…it is ironic that part of the mesh argument was to make the surgery simpler therefore making the procedure also less problematic. I still believe that if the hernia numbers were not so big we wouldn’t be in this messy substandard situation….

[Alephy]

I would go for tep with an absorbable mesh, because I am not so worried about the possibility of a recurrence. The hope is also that an absorbable mesh might pose a lesser risk in the long term, and in case of problems it will be absorbed eventually, reducing the need for a complex mesh removal surgery…

[Alephy]

I seem to remember that while for an indirect inguinal hernia one can talk of an opening, for a direct one the tissues give way and get deformed, so there is no real hole. By the way I searched for the paper and it seems to have been published in 1933!?

[Alephy]

I think @drtowfigh once mentioned the benefit of exercising the core in reducing the chance of the hernia getting larger, possibly also reducing pain/discomfort. I advocate exercising when one does watchful waiting. As for hernias healing by themselves, that would probably require the tissue that gave way reshape itself regaining its original strength, maybe in the future with genetic engineering this will be possible, who knows.

Ps: whoever got a successful surgery in this forum will likely recommend that one gets their hernias fixed surgically asap…

[Alephy]

I guess we are all different…I wonder whether the hernia type plays a role when it comes to core exercises 🤔