[Alephy]

This question has an interesting side.
When consulting for a knee problem I had exactly the same experience you are describing, until I found a doctor who was once a professional footballer. He being a sports doctor discussed my problem with focus on my angle ie going back to martial arts. I believe he was in as a former professional to help others continue doing what they love, without any other bs intentions. He cared because he had been there himself… find someone who is or was an active sportsman

[Alephy]

Again I don’t see anything wrong with the post. On the other hand you seem make your point by accusing others of being racist and uneducated. Perhaps you should request that the forum take actions and even ban us, I would actually be ok with it as I am not sure I find any value anymore in the discussions that take place here … go ahead and do it

[Alephy]

He explained his point in the post, and unless we should change the name of the code itself I am not sure that he can be blamed of any hidden meaning: he also clearly explained that that was not his intention…I didn’t find this post offensive

Ps: I found offensive some of the posts in this forum suggesting that the covid vaccines are deadly, that yes

[Alephy]

I honestly don’t see anything wrong with the topic of this post, or the discussion that followed. However I am reading among the lines of some of the answers strong feelings against any possible criticism of non mesh repairs and the surgeons that offer them, and the more so if you were actually one of their patients.
I understand that this forum is more and more a place to voice anger at the mesh industry, I am not really sure it got started with this idea in the first place though…

[Alephy]

Any new medical procedure should be validated by peers ie doctors or researchers in the field, not by the patients…as should any claim attesting the superiority of this or that surgical procedure! As for the numbers reported eg recurrence rate, without an independent registry it is difficult to make a judgment.

[Alephy]

I will let others comment on the medical aspects, but one main difference is that as far as I know the Kang repair is only performed in Korea at the hospital where it was developed, while the Muschaweck one is performed by several other surgeons, both in Germany and in the Uk.

[Alephy]

This was a very interesting talk!
@drtowfigh what is your first line of care with patients with allergies and/ or urticaria? I happen to have both and while not debilitating but only annoying I would consider myself not a candidate for mesh repair or any implant in general…

[Alephy]

Chronic pain in general is not fully understood so it is not surprising that the same can be said for SD.
All known risks should be mentioned to the patient IMHO …ideally the surgeon would also mention the plan B if things go south but this is probably asking too much in the inguinal hernia battle field…

[Alephy]

I am not sure there is an answer that applies to everyone…
I personally also think that it depends on your lifestyle ie being fit with a strong abdominal core will go a long way in keeping you off surgery.

[Alephy]

I think that is the crux of the problem ie whether their claim that healthy tissue forms around this mesh is correct, as opposed to scar tissue which is commonly found in virtually all the other meshes?

Ps: maybe we should have two sections in this forum: one for personal stories and experiences (which will be probably very wild) and another one focused on doctor opinions, papers, research as well as useful info when looking for a doctor

[Alephy]

One thing perhaps worth noticing is that these plugs were tested on animals (I think pigs), which were then explanted and showed healthy tissue built around (they even published the pictures). They maintain that the shape is the critical aspect together with the lack of fixation.

[Alephy]

I came across this type of mesh few years ago as the surgeon is Italian.
From my understanding the surprising observation was that around this mesh healthy tissue grows, as opposed to the scar tissue in the other meshes?
I guess if confirmed this would mean less inflammation as a whole.
The other thing is that the plug is not attached but free to move within the space, which they claim makes it less “present” to the patient. These are the key points that they were trying to convey back then when I asked about this mesh…
Personally I would love to see a paper where patients are also divided based on their physical activity level pre and post surgery. On the same token I would be curious to see some stats for watchful waiting with also the fitness level of the patient factored in 🤔

[Alephy]

I think one question you should ask yourself is if you can still do all you used to do, or all that you want to do, with the understanding that the hernia is maybe now preventing you from doing it…

Many doctors will tell you that watchful waiting is not recommended anymore; however Dr. Towfigh has endorsed it (when symptoms free).

Other than that, you can do physical activity with an hernia, weight lifting etc…

[Alephy]

@good-intentions thanks for the link…if I understood correctly there is an ongoing effort to reduce the risk of infection, both for absorbable as well as non absorbable meshes, which is a good thing.

I had the impression though that the main criticism against absorbable meshes was that the recurrence rate was too high, and/or it caused too much inflammation (see Dr. Towfigh’s comment on the video above):
I still don’t see the evidence for this…

[Alephy]

What are natural tissue repairs? I have heard of tissue repairs, but not the natural type ones 🙂 you get vegi sutures?:)

[Alephy]

Quite frankly, the long term performance of the various meshes in the market is not well assessed either…

Again, I have not seen any study that reports high rates of recurrence for the synthetic absorbable meshes after e.g. 3 years….I have heard Dr. Towfigh mention that in her opinion after few years they may start failing, but I could not find the paper this was based on…

There seems to be a diffused belief/assumption that people with a hernia cannot regenerate healthy tissue, and that whatever tissue is generated will fail without the support of the mesh: as in many other examples where the doctors got it wrong, it would be good to have this supported by data….

The absorbable meshes have entered the market since many years by now, I honestly do not understand why they are not offered more broadly….also considering the severity of mesh complications, a mesh that disappears seems something to consider, there might still be chronic pain but it would improve with time also in the most severe cases without the mesh being there….

[Alephy]

@good-intentions

Yes, with Dr. Heniford.

Here is the link to the video

https://www.youtube.com/watch?v=_wdB-QfJDKc

and the relevant bit is after 43:30 more or less….it seems as though Dr. Heniford is in favour of absorbable meshes, whereas Dr. Towfigh has reservations…

It is mentioned in the video above that synthetic absorbable meshes are highly inflammatory: but then again so are the non absorbable ones, with the caveat that the absorbable ones go away, and so in case of problems one would have an easier life I guess?

As for the substances in the blood stream, I think I misunderstood the point, the inflammation side is related to the mesh being a foreign body, not to the material itself necessarily…

Basically I still do not understand why absorbable meshes are not offered more than the non absorbable ones, other than that they may be more expensive….and I never saw conclusive study that showed problems with them (I even asked here few times)

[Alephy]

I think they can handle so many surgeries because they let their assistants do most of the work and only supervise when needed….is it bad? Maybe… I had a hernia right above the navel that was operated 20 or so years ago: the chief surgeon was supposed to operate on me but in the end the assistant did it. She felt the hernia was very small and opted not to use a mesh ( at that time I did not even know what it is and was not told this could be used in my surgery). I have had discomfort for a month, started back on swimming after about 6 weeks, have never had any problem ever since. A mesh surgeon wanted to convince me in recent time that this would eventually fail and require mesh….I ignored his opinion

[Alephy]

It would be interesting to know whether surgery is deemed to improve things across eg age, fitness level, IH type, time between diagnosis and surgery vs some type of physio…

[Alephy]

It is also my experience ie if I stop training when eg ill I will then feel the hernia at times vs no symptoms if I exercise regularly… personally the way I see is after a certain age one should always exercise whether you have an hernia or not.