[drtowfigh]

Not a fair statement, in my opinion.

Dr Felix was the first to introduce the TEP laparoscopic inguinal hernia repair. He was trained under Dr Nyhus, who performed a similar repair in open fashion.

Drs Felix & Daes wrote the initial paper in 2017, discussing the importance of defining the critical view for laparoscopic or robotic inguinal hernia repairs.
http://www.nugits.nhs.uk/wp-content/uploads/sites/14/2019/07/Lap-inguinal-checklist.pdf

Their work is so important, as it helps reduce poorly performed laparoscopic repairs, which is rampant. Just read my paper on review of the top 50 YouTube videos of these operations. Absolutely horribly done by most of them. https://link.springer.com/article/10.1007/s00464-020-08035-z

The critical view is not relevant to any open anterior approach operations for inguinal hernias.

Dr Felix is retired. He could just be basking in the beach. Instead he is using his expertise to continue to advance safe laparoscopic hernia care.

[drtowfigh]

Yes. This is all very interesting to watch. The hernia mesh companies are changing their strategies or holding off on new products developments as they are observing how this all plays out. My hope is that hernia product design and innovation will improve and not be hindered as a result of these litigations.

[drtowfigh]

Seems you’ve been to the right surgeons. You need a hernia surgeon who specializes in revisional surgery. Not a plastic surgeon. Not a surgeon who does primary hernia repairs. Revisional surgery is a different ballgame.

Follow the recommendations of the surgeons you already saw who offered you a plan of care.

[drtowfigh]

Completely agree. I have seen this product come and go in the US market for so many years, as each company keeps handing it around like a hot potato. I even posted about it on Twitter in response to a Tweet (since deleted) that asked if anyone would consider using this mesh given all the raving about it by the Company. This was my response: https://twitter.com/Herniadoc/status/1324928701671243777?s=20&t=kjIGzCkd5843jBFuR6KEbg

I got a DM from the Company at the time, admonishing me for being unprofessional in my post. Oh well.

I stand by my statement, btw.

The ProFlor never caught on in the US (and the company went bankrupt). And that’s a good thing. If the plug is too bulky, this is even worse. And any claims that an implant will maintain its springiness after implantation is melarkey. pic.twitter.com/INrwdL5WfL

— Dr. Shirin Towfigh (@Herniadoc) November 7, 2020

[drtowfigh]

No there will not be. Have a Happy Thanksgiving!

[drtowfigh]

Here is the link to watch this. https://youtu.be/TpiGa3zMxGc

This and all prior episodes can be viewed on http://www.youtube.com/@herniadoc

[drtowfigh]

Just click on the link for each HerniaTalk LIVE session and join at the time of the session. You can also join via Facebook LIVE from my FB page (@Dr.Towfigh). I include the link with each HerniaTalk LIVE post.

[drtowfigh]

Good for rejecting neurectomy during elective hernia repair. Your logic is correct.

[drtowfigh]

This is the current situation at Europe and also with pelvic mesh in US. We predict FDA will do same in US.

[drtowfigh]

Thanks, @OnlyKurt. Will add that to our next version.

[drtowfigh]

Couple of comments:

– Dr Victor Radu is the most talented surgeon I know in Romania. Not sure who your surgeon was.
– Lateral hernias are a different situation than midline hernias. The muscles are weaker. Hernia repair outcomes are worse. I’m curious how your repair was secured. Eg, we have moved away from pinning sutures into the bone. A TAR was likely performed because the defect was too wide to close without a TAR. Do you know how wide the defect was?
– Lateral/flank repairs will feel tighter than the opposite side. Fortunately you had lightweight mesh and it was placed retromuscular. That’s the best option.

I’d review the operative report to see the technical issue that may be contributing to pain. Perhaps some sutures can be removed. Mesh removal will be difficult and likely result in worse outcomes. Physical therapy and even neurotoxin injections may help.

The surgeons mentioned focus best on groin and I doubt they would be able to help you.

[drtowfigh]

HerniaSurge provided their updates at this week’s European Hernia Society meeting in Manchester. Go to my Twitter account, as I am live tweeting from the meeting, to read more. The official publication is coming up soon.

[drtowfigh]

@notanewbeeok Not sure why there is unflattering discussion about Dr. Sbayi as if there is some conspiracy in his decision to change jobs.

I know there is interest in seeing him in consultation by many patients. I announced that in November I will update you all about his new office information or contacts. As it is not yet November… I have no news to share.

[drtowfigh]

Cord lipoma refers to fatty tissue adjacent to a spermatic cord in males. This is often the cause of the bulging seen with hernias. The fat comes from the insides (retroperitoneally) and is really the herniation of preperitoneal fat. It is rarely just a lipoma unattached to anything, like one sees on an arm, leg, or back. The name is really a misnomer. In rare occasions the lipoma is a real lipoma or liposarcoma (malignant tumor) and not a hernia.

[drtowfigh]

HerniaSurge is an impromptu group of experts led by the European surgeons. They are working in their next updated guidelines.

Read more about that here: https://www.linkedin.com/posts/european-hernia-society_inguinalhernia-euroherniasnews-herniaguidelines-activity-6970116740076732416-3hGD?utm_source=share&utm_medium=member_ios

Should have their publications by the end of this year.

[drtowfigh]

It is not a contraindication. But that history is important to share with your surgeon, as there are risks, especially with laparoscopic surgery, in the face of prior infection and scarring from diverticulitis.

• This reply was modified 2 years, 2 months ago by  drtowfigh.

[drtowfigh]

Thanks to all who joined LIVE and who submitted their questions. We had a lively discussion about the pros/cons of watchful waiting, when it is not appropriate, and how inguinoscrotal hernias change the algorithm for hernia care.

If you missed it LIVE, you can watch it here: https://youtu.be/TfnKHwVVE8I

[drtowfigh]

Hi, everyone. Thanks for all your questions. I believe we were able to answer almost all of them! We had over 40 questions. What a session.

If you missed it LIVE, here is the link to it on my YouTube channel: https://youtu.be/akkp0fApJDI

[drtowfigh]

If you missed this LIVE, you can watch it in full on my YouTube channel here: https://youtu.be/3lHjSFwVZ90

[drtowfigh]

1. On 8/15/22 I wrote “Also I reached out to Dr. Sbayi. Hopefully by November he can provide you with new contact information where he can see his patients.” No mention of October. And I kept my promise.

2. Surgeons change practices all the time. They are often employees and are limited by their employers (e.g., the hospital) as to whether they can a) alert patients of their move and b) alert patients of their new position. Most employers (e.g., hospital) consider the patients as theirs, not the surgeons’, as the surgeon is only an employee. To shed a negative light on a surgeon who is doing his job and seeking a better opportunity to treat his patients is without evidence and borders on disingenuity.

3. A lot has changed since 50-70, including access to online information and the business of healthcare. Most patients did not travel for care and went to their local doctor based on word of mouth. There is nothing illegal about advertising or marketing. As with any business, it is upon the consumer to do their due diligence.