David M
Forum Replies Created
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I think the 4 and 5 ratings should actually be 4 or more and 5 or more. This should mean that the 5 number is a subset of the 4.
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Open score of 4 – 15.1% (if I’m reading that right)
TEP score of 4 – 14.9%
Tapp score of 4 – 18.4%Open score of 5 – 10.1%
Tep score of 5 – 9.2%
Tapp score of 5 – 14.7 %Open low volume surgeons – 54.4%
Tep low volume surgeons – 23.7%
Tapp low volume surgeons – 29.7 %Low volume surgeon defined as less than 26 per year
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I was talking about re operation with Lichtenstein after an open 2 or 4 layer failure. I realize standard practice currently is to do the opposite side from what was done originally, but that’s assuming levels of scarring with Lichtenstein mesh or the more layered tissue repairs. Maybe it wouldnt be as bad if the original was just transversalis fascia repair. Also, not everyone can do the general anesthesia, in which case you’d want a lesser scarred site to reenter.
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The higher degree of recurrence by skipping the 3rd and 4th layers actually seems probable, despite there being no indication one way or the other in the limited study.
However, the question I would ask given the closeness of the study is whether there a pick your poison question involved I may be totally off base, but it would seem like scarring would be less with the 2-layer than the 4-layer. So, let’s say a 2-layer has a 10% chance of recurrence and a 4 has a 5% chance, but the re operation with mesh on a 2 layer is much easier with less scar tissue. Which is the better initial operation then?
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Glad to hear you’re doing better!
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Ok, so here are a few thoughts for Dr Towfigh concerning the comments about 2-layer Shouldice on the recent program.
First of all, the name. I don’t think what the Joneses are doing should be called a 2-layer Shouldice, because the differences are too great. I’m not sure, though, that there is better thing to call the one mentioned in the above mentioned paper. To make that point, let me quote the surgeon from the following biohernia 4-layer demonstration,starting at the 21:40 mark.
He says after finishing the first two layers: “And that’s the most important part of the Shouldice operation, the double breasting of the transversalis fascia, which you can see, has cured the hernia.”
He repeats:”And that’s the most important part of the Shouldice repair. So that’s the double breasted posterior wall….feel that Peter. The transversalis fascia feels like it would feel in you.
“The premise of the Shouldice operation is that the transversalis fascia is the most important structure holding hernias back…preventing hernias from recurring”
From there he goes on to sew the third and fourth layers and finish up.
My point here is that, for the particular operation in the 1994 study, if they’ve done the actual main part of the Shouldice operation similar to what was done in this video and they stop at 2 layers instead of four, the name 2 layer Shouldice, in this particular case, isnt deceptive. To use your car analogy, a car with a four piston engine is still a car as much as a car with a 6 piston engine, even though it might not be as fast.
Ok, more importantly than the name, though, does it work? And just because nobody expanded the study, that’s not a sufficient reason to believe it doesn’t. The results from the study, however limited, suggests that it very well might.
Granted, an expanded study might could be “guessed” to prove otherwise. That actually seems to be one conclusion to draw here, that hernia experts could see without testing further that despite whatever this study said, it must be wrong.
But another possibility might have to do with the timing of factors of hernia surgery progrssion, inertia and conservatism within the industry, coupled with the fact that this study came out in 1994, well past the advent of mesh, such that few people would be willing to actually think about it. There aren’t that many of you guys specializing in hernias, so something that seems like such a throwback question could have been overlooked.
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I think I saw the one on “technique”. The main part of which was the fault of the keyhole mesh for lap repairs of inguinal hernia. That part was very informative. I think you also mentioned the Shouldice naming problem there.
However, can I point out a possible point that maybe it is similarly smart for Dr kang to call his indirect something different than a Marcy, if in fact his repair does differ from the actual Marcy? Not that I understand whether that is true or not.
I am now looking forward to watching your latest video if more of this is covered.
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William,
Thanks for pointing this out. Elsewhere on the forum, it says that Simon Bailey was trained by the Joneses, who seem to do their two layer in a different way than the 4 layer Shouldice first two layers of double breasting.I’m not a medical professional, but I have my doubts about the technique that the Joneses employ in their Youtube video. I’ll try to find a way to explain what makes me wonder about it’s relative value.
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GI, Thanks for that report. It sounds like the right side had more worrisome adhesions, but the left side still had a lot of inflammation (and contraction).
It’s hard to imagine why someone would choose lap hernia surgery unless there is a significant chance that not getting one would harm one’s health.
Also, thanks to Herminius for sharing your report.
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GI, would you be willing to post your pathology report? I remember it being said at some point that your peritoneum, your muscle and the mesh had all fused together. This may have come from Chuck, so could have been his interpretation.
It almost sounds like getting the mesh off the muscle may be easier than getting it off the vessels that it covers. Is the damage to the muscles and peritoneum temporary?
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“Bill”
Lots of interesting stuff here. I believe you really talked to Grishkan, as you had indicated you would in a post that was pulled. There is a lot to ponder here, though. Somewhat ironically, just this morning I got thinking about the 2 layer Shouldice, something that Grishkan was supposedly known for, and found a description of his version in the archives. It seemed backwards, as it did not involve the double breasting of the transversalis fascia, which is supposed to be the major part of the shouldice. Here he sounds more traditional.
I’m surprised that:
1) He did not know of Kang
2) believes that mesh repairs have a higher recurrence rate
3)Says stainless steel sutures will break. That doesnt seem impossible,but I havent heard that.His premise on Desarda is logical, but is it actually supported that it has a high fail rate, or is he just projecting based on its India origins.
The polybuterate sutures point is worthy of attention.
Did you ask him without any prompts about specific surgeons which surgeon he would go to with him picking Lorenz and Koch out of the blue, or did you just ask from a narrowed pool who he would pick?
Thanks you for sharing this post. (Hopefully, it can be trusted?)
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Someone named Forest. He doesn’t say anything about removal, but he came here pre lap surgery and 7 or 8 months later was having trouble sitting as of his last message.
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Someone named Timothy had pain after open mesh surgery,though his pain went below knee and may not have been related to the mesh. Doesn’t say that he had it removed.
https://herniatalk.com/forums/topic/chronic-pain-affecting-most-of-one-side/
Forgot to add Paul to the above list.
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Ok, here are the lists so far.
Had lap mesh removal…
Good Intentions
Chuck
AJM
Herminius
NGP (I think those are the initials)
Sensei
Edward
Jnomesh
James Doncaster
Esm
Mitchtom6
Josh V
Ian J
DmpainFor open mesh removal…
Lucas S
Baris-
This reply was modified 1 year, 5 months ago by David M.
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This reply was modified 1 year, 5 months ago by
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I guess you’re right, because in the link you gave, Jnomesh also said his mesh covered all three spots, including the femoral. That would have to be a lap mesh.
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GI, Jnomesh does say in the post I linked just above that his mesh was open placed.
Be sure and bring back any open removals, as well, so we are not distorting the numbers.
I found someone named paul who had lap removal.
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Two more lap surgery removals- mitchtom6 and Josh V.
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Above post should say explantation numbers, not explanation.
I found this older thread about mesh removal doctors. Having gone through part of it, there are two (counting the original poster seekng removal) for Lichtenstein removal and two who had lap removal.
Jnomesh and Lucas S were the two for Lichtenstein, and James Doncaster and Esm were lap removals. Some of the others I havent determined yet.
https://herniatalk.com/forums/topic/best-surgeons-for-mesh-removal/
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This reply was modified 1 year, 5 months ago by David M.
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This reply was modified 1 year, 5 months ago by
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Sure, no one is saying that there aren’t some problems of pain with Lichtenstein, but youre pulling in people from other fields of representation.
Baris, of course, belongs in this pool of posters with pain complications from mesh. But certainly in recent memory, the lap pain numbers here have far outnumbered the Lichtenstein pain.
A better view of this would be the relative explanation numbers, Lictenstein vs lap, from a surgeon who does removals. Barring that information or some other well thought out statistical pool, the mounting number of lap removals here is still concerning.