drtowfigh
Forum Replies Created
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[USER=”2844″]ssonic99[/USER] your symptoms sound like a hernia. Dr Tomas should be able to help evaluate you for that.
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Johns Hopkins has some good pain doctors. Also, Dr Dellon’s office has a good colleague that can help.
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The protocols have been published in books and online that you can access and I believe the mri protocol has been uploaded on this site, which you can search.
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Thanks for your post. And welcome to our forum.
When hernias keep recurring, we have to forensically analyze the cause(s): was it a technique issue, too little mesh, wrong suture, etc? Is there a risk factor for recurrence that we are not addressing (eg, straining, coughing, obesity, nicotine use, connective tissue disorder)?
Recurrences can occur. I think it’s time now to figure out why and a hernia specialist that loves the analysis part of their job is the best next step.
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The evidence is for asymptomatic or minimally symptomatic inguinal hernias. It is strong in showing that watchful waiting is safe.
Indication for hernia repair is not based on size, but primarily based on symptoms.
I recommend that that if a hernia is getting larger, then one should consider repair, as it’s an easier operation with better outcomes. But that doesn’t mean I’m saving a life by recommending that. It’s a discussion to have with the patient and their needs.
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You should have Dr Tomas re-evaluate you. Ultrasound or MRI preferred.
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There were a lot of issues. But they moved from Marlex, which is a brand of mesh made in Austin, to a cheaper dissimilar product that only had 2 of 9 components shared with Marlex.
Bad analogy alert: I equate it to moving from pure cocaine to highly contaminated crack cocaine.
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I believe Dr Felix had laparoscopic inguinal hernia repair with mesh.
Also note that he was trained in the 1960s, where he saw the shortcomings of tissue based repairs and how patients did better from mesh repair. That’s a unique perspective that shouldn’t be discounted.
My personal feeling is that today’s mesh is not the same as the original mesh in their manufacturing. I believe that companies have changed the contents of mesh and no longer buy from the same manufacturer. As a result, we are seeing way more mesh-related complications that are not explained by surgical technique alone. I think the inflection point occurred somewhere in the late 90s/early 2000 when mesh companies surged in their products to market.
The 60 minutes exposé on Boston Scientific’s transvaginal mesh basically proves my point. I believe the same actions are being taken by the hernia mesh companies. I wish someone (60 minutes?) would try to prove (or disprove) my theory.
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[USER=”2843″]Autumngirl[/USER] ice packs and other anti inflammatories work best. Narcotics aren’t as effective.
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Really depends on the seriousness of the symptoms
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They weren’t in close proximity. And most chose watchful waiting. Laparoscopic repair with mesh was choice of operative option. And they felt choice of surgeon was more important than choice of technique.
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If the op report didn’t say much more than it was checked, then the area was just looked at. Anything more would require takedown of the peritoneum, etc.
Give it some time. If the pain does not resolve or improve, then you should get formally checked for a hernia recurrence on that side.
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Method: Audience survey via text-in polling. So basically anonymous.
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Most studies show surgeons are less likely to choose surgical options (for anything, not just hernia) than the average person. We know risks occur and are often willing to delay risk potentials.
If surgeons are promoting early or urgent elective inguinal hernia repairs, that’s not supported by level 1 evidence.
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Interesting answers, right?
The data shows risk of watchful waiting to be 0.18%/yr and most of us (should) include that as part of our consent to the patient. Or, it’s safe to wait.
We also know that that the risk of complications, including chronic pain is lowest with laparoscopic repair with mesh done by an expert surgeon. That includes comparators of open with mesh and without mesh.
We also know that surgeon skill is directly related to outcome, including recurrence and chronic pain.
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Lot of causes for leg pain. Umbilical hernia or mesh not causes.
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Let’s not forget that non-mesh repair also causes chronic pain. It’s just the pain cannot be attributed to the mesh.
Thats not including the pain associated with recurrence.
This week alone, I’m repairing two patients with recurrence because they didn’t want mesh and their repairs would have done better with mesh, and now they require mesh.
There is is no perfect answer. We should tailor the repair to the needs of each patient.
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[USER=”1391″]UhOh![/USER] youre very correct. The fact that a surgeon even has a website nowadays is unique. Most don’t.
[USER=”2029″]Good intentions[/USER] thats a very cynical viewpoint. I don’t believe it to be true. -
In an ideal world, that would work.
The reality is that industry needs expert surgeons to provide them with their expertise as they develop new products. Such a collaboration should not be hindered. Also, surgeons enjoy the collaboration, as they have an opportunity to help influence the direction of their specialty.
Plus, it’s expensive to develop guidelines.
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[USER=”2831″]bekahjan[/USER] the ultrasound can not injure or damage or worsen anything