Good intentions

Dr. Brown has written about how there is a certain level of knowledge and skill required to understand how to do diagnostic injections and how to interpret the results.

Related to my first post – if the surgeon is not inclined to remove the mesh if it is determined to be the problem then they will not have mesh removal in mind as an option.…[Read more]

Sorry for the extra commentary alephy. It does look though like they have not made much progress with that material. If I’m reading Google Scholar correctly it hasn’t even been cited.

https://scholar.google.com/scholar?as_vis=0&q=Laparoscopic+Repair+of+Inguinal+Hernia+with+Biomimetic+Matrix&hl=en&as_sdt=1,48

Here is their web page. The paper you showed was published in 2012. It doesn’t look like they’ve done much with it.

Overview

It wouldn’t be a surprise if they just could not compete with the big synthetic mesh companies. Johnson & Johnson, and BD, and the others. Plastic mesh is much cheaper than anything else out there.…[Read more]

Neurectomy is supposed to be a last resort. There is quite a bit on the site about the topic. I searched Google to find the herniatalk threads, link below. Going directly to triple neurectomy seems like malpractice but that’s how things are today. Your surgeon will say they tried and send you off to pain management with your new…[Read more]

Here’s the view on the psychosomatic angle. My mesh removal surgeon found that the mesh was surrounded by edematous tissue. I don’t think that my brain produced it. I felt great before surgery and expected a good outcome.

https://medicalxpress.com/news/2020-02-team-hernia-surgery-recovery-outcomes.html

“The predictive model suggests that…[Read more]

And there is this. I have not watched it but it is probably informative. It’s the Herniatalk Q and A with Dr. Ramshaw from May 3rd.

Here are a couple more articles with his comments.

https://www.generalsurgerynews.com/In-the-News/Article/01-19/Surgeons-Call-for-Closer-Surveillance-of-Mesh-After-Implantation/53739?sub=6CB4505D3F4E7434F342E8CEDDD36EA48483E49B459AF20B8C3C8A9101426

“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me b…[Read more]

Dr. Ramshaw is a proponent of mesh repairs. In some ways, he is a denier of the premise that mesh itself causes pain or discomfort. He has stated explicitly that “mash does not cause pain”. His arguments on that topic are kind of convoluted and weak. He has his patients take a psychological exam before surgery, I believe, to see if they will…[Read more]

You’ll find quite a bit out there also, about surgeons who say they do the Shouldice procedure but actually do something different. Different sutures or a “modified” procedure. You might not actually be getting the procedure that gives the excellent results.

And, it’s not uncommon to go under general anesthesia expecting one thing and wake up…[Read more]

The “sac” is the stretched out fascia and peritoneum. It can contain intestine, or fat, or omentum. The contents of the sac can be pushed back in to the abdominal cavity before the sac is ligated. Meaning tied off, so that the “stuff” can’t get back in to it.

Don’t get drawn in to trying to translate comments about mesh repairs to pure tissue…[Read more]

Don’t take offense, but email is too easy. A paper letter will be unique and show that you’re willing to put the effort in to get what you’re looking for. Anybody can sit down and peck out a few words in an email message, hit “send”, and wait. This message here took me more effort just to log-in than actually write the message.

I know people…[Read more]

Try sending a letter. Front offices deal with a high volume of referrals and little else. They aren’t really trained in how to deal with people like you, and they probably, honestly, have little idea of what you’re talking about. Pure tissue, mesh, Shouldice, Lichtenstein, etc., means nothing to them.

A letter can be passed along to Dr. Chen,…[Read more]

Avoid the Valsava maneuver. Ironically, it is used in strength training, but can lead to weakness. I used it when I had a sore back, to stabilize my core so that I could continue to play sports. It was very effective at stabilizing my core so that my back did not hurt, but I think that it is what caused my…[Read more]

Thanks for a current account of dealing with some of the bigger names in the repair field.

I think that there is a lot of stress involved in being a hernia repair surgeon in today’s world. The doctors you talked to probably can’t really give straightforward answers, either because they don’t know or don’t believe that what they’re doing is…[Read more]

It’s not fixation, tacks, that cause problems with the nerves. It’s the tissue growth in to and around the mesh fibers, and the shrinkage that follows that is the problem. The nerves become trapped along with the mesh in a bundle of scar tissue.

The surgeon removing the mesh has to decide how much time to spend trying to peel the nerves free,…[Read more]

The device and material are barely three years old.

https://www.gore.com/news-events/press-release/synecor-preperitoneal-biomaterial-hernia-repair-device-receives-fda-approval

I added “retroperitoneal” by mistake, above. Still, my questions remain.

How does anyone know that a mesh is best for the patient, in the long-term? Beyond a two week follow appointment.

Why? What are your criteria for choosing a mesh? The “large pore” or lightweight concept has flaws, there are several recent paapers showing that lightweight has no real benefit. For inguinal hernias, retropertioneal, tissue ingrowth and incorporation are touted as desirable, so “anti-adhesive” does not seem relevant. I think that Alexander is…[Read more]

Here is a link to Gore’s sales brochure. Not a single word about the #1 problem with synthetic mesh – chronic pain – just laboratory results from old thoughts about what matters with mesh. A brochure from the 80’s, in essence. Seriously, the brochure looks like it was written in the very early days of synthetic mesh.

It’s really just another…[Read more]