Good intentions

Dr. Towfigh would have the real world experience and history of many examinations and the results from mesh explantation. She would have seen the patients before and after. Most of the doctors you are talking to will not have that experience and will only know what they have been trained – that mesh materials ar inert in the body.

What type of…[Read more]

Somehow I left Ethicon’s page off of the list. It looks like they have come back under the wing of Johnson & Johnson now. The names seem to be used interchangeably.

Their portfolio contains all of the established designs and materials. Flat, plugs, two layer systems, etc.…[Read more]

Dr. Bendavid’s work showed that the shape or thickness of the tissue did not stop the ingrowth of nerves and blood vessels. The discussion in those papers of the benefits of the Proflor design overlook, or ignore, the fact that there is a flat sheet of mesh attached to the 3D structure. They also overlook, or ignore, the fact that fixation is…[Read more]

Finally, the primary author of the papers used to support the benefits of the device is the inventor of the device.

Conflicts of interest don’t get much more clear than that.

https://core.ac.uk/download/pdf/53302875.pdf

GA = Giuseppe Amato

Conflict of Interest: GA is the inventor of the 3D
dynamic implant. The remaining authors have…[Read more]

It looks like Insightra has formed something called the “Hernia Alliance”. Designed to promote the Proflor product. Seems very similar to HerniaSurge, designed to promote mesh use overall.

This seems to be the state of the world we live in. Get the product to market and start marketing. No outside objective way to determine which is best.…[Read more]

Here’s a description of a selling point for the product, and the brochure link below it. Get those blood vessels growing through the polypropylene structure.

https://en.wikipedia.org/wiki/Angiogenesis

https://www.insightra.com/wp-content/uploads/2019/01/PROFLOR_patient_info-1.pdf

I just came across these recent article about Insightra’s Proflor product.

It just looks like a bigger piece of mesh to me, with a significant third dimension of thickness. It springs open to fill the defect, creating a larger mass of tissue and intertwined polypropylene fibers afterward.

The brochure does have some nice simple…[Read more]

These two references reflect and were instrumental in forming my opinion, among other sources.

About 2 minutes in in the video.

And a summarized publication, with an excerpt of the conclusion.

https://pubmed.ncbi.nlm.nih.gov/30368312/

“Conclusions: Most radiologic reports issued for CT and MRI…[Read more]

Doctors trained to read/interpret images are generalists. They will only recognize the common signs of a hernia. They interpret images for a whole range of problems, and basically just look for abnormalities.

Hernia specialists who have learned to interpret images will have the advantage of correlating what they see on the image with what they…[Read more]

pinto, you are right, it shouldn’t take such extreme measures. I thought of Dr. Kang first because I remembered the post about the imaging work that they do before surgery, plus the fact that he has examined thousands (I think) of patients.

A better answer is that anyone who thinks that they might have a hernia should find a surgeon who does…[Read more]

Quite a bit has been written on the forum about how difficult it is to identify a hernia by imaging methods. Dr. Towfigh has presented and published about it.

Have you considered Dr. Kang’s Gibbeum Hospital? Apparently they do imaging the day of surgery to confirm the details of the problem. Here is a post from the forum from a patient who had…[Read more]

Here is the conclusion. PIH = primary inguinal hernias. NNT = number needed to treat, wiki link in the post above.

From wiki – “A higher NNT indicates that treatment is less effective.”

“Conclusion
The idea that mesh techniques reduce the recurrence rate in all PIHs is not supported by high level of evidence. The NNT for pure lateral hernias…[Read more]

Second one (the site does weird things with Twitter):

Tweets by BruceRamshaw

Bruce Ramshaw has created a new Twitter account, leaving MD off of the end of his name. Part of the shift.

Tweets by bruceramshawmd

Tweets by BruceRamshaw

I don’t want to “pile on” with criticizing Dr. Ramshaw. His disclosure about his surgery mistake showed that he was close to burnout. And I’m not a psychiatrist. But it seems like spreading the word about what he’s seen with his research on “mesh” (he says he’s a scientist on his web page) would be therapeutic for him, in dealing with the…[Read more]

It looks like Dr. Ramshaw is a consultant now, and has given up being a physician.

His goals seem to be so lofty that the hernia mesh problem is small to him. He has a “mission”. Like a man walking past a car accident with victims that need help because he has to get to work to design safer cars. He has important work to do and can’t be…[Read more]

Glad to hear that you’re finally getting in, the pandemic has really made a mess of things.

I still have a lump on my side/flank lower back from when I pulled a muscle in the gym lifting a heavy weight. I felt it tear and it was painful for a few days. I think that the muscle fibers ball up at the point where they tear, creating the lump. In…[Read more]

In 2011 the method was probably very similar to what was done to me in 2014. A single procedure bilateral repair was probably laparoscopic TEP or TAPP. A large cavity is created between the peritoneum and the fascia and two large pieces of mesh are slipped in between. The top of the cavity would be below the navel but pretty close to it. So…[Read more]