Good intentions

There are well-respected and well-known surgeons out there who refuse to accept that mesh can cause pain. Dr. Bruce Ramshaw, for example. Many of them will look for other reasons for the pain, like fixation, or contacting a nerve, or various other possible causes.

The damage that mesh and mesh removal causes might have made the remaining tissue…[Read more]

Here is an interesting but frustrating article about athletes and inguinal hernias. It goes in to depth about using unltrasound and Valsava to diagnose hernias. The frustrating part is that they do not describe at all the hernia repair method, but do report that the repairs seemed to alleviate pain and allow the athlete to continue in their…[Read more]

There have been comments about how surgeons use mesh in athletes but, so far, no specific success stories. Not even anonymous stories. If you follow sports you’ll often see stories about athletes who go to specific clinics to have their knee, ankle or shoulder repaired. Or stories about sports hernias. But no stories about inguinal hernia…[Read more]

I think that I would focus less on the fact they specialize in athletic pubalgia and more on the fact that professional athletes seek them out for their core injuries. To them a common inguinal hernia is probably simpler to repair than a “sports hernia”. They all avoid mesh for any purpose in repairing an injury. I think that that is telling.…[Read more]

Dr. Muschaweck is known for repairing hernias, groin strains, athletic pubalgia (sports hernia), and other ills of the professional athlete.

My reference to the porcine material was because the article mentioned specific people with “hernias”, then started talking about porcine mesh. A typical lazy journalist method of trying add interest to to…[Read more]

The critical error message is new, I just got the same thing. You clicked in the right place, but there is a problem with the site software.

@drtowfigh

Do you know the details of the repair? The type of mesh, and the surgery notes? There are many different types of mesh implanted via open surgery. And many surgeons do more than just implant mess, like performing neurectomy (cutting nerves to avoid future pain). The details might offer some clues about your best path forward.

Also, the imt…[Read more]

Here is the ACHQC youtube channel video page and a video showing how the PRO form is used.

https://www.youtube.com/channel/UCtsURlxpeI3s6zIzOmLYxKA/videos

Here is a link to the AHCQC web site and a link to the inguinal hernia Patient Reported Outcome survey form.

https://www.achqc.org/

https://www.achqc.org/uploads/general_images/ACHQC_INGUINAL_POSTOPERATIVE_ASSESSMENT_-_ENGLISH_-_6-22-20.pdf

The results do not appear to be freely available, it has to be requested. If the news is good, why not…[Read more]

I saw your post about porcine mesh material and read the attached article. It led me to look for more about Frank Lampard’s hernia (Lampard is a famous soccer player). The article seems to imply that maybe Lampard had porcine mesh used to repair a hernia. But it turns out that he had Dr. Muschaweck (I think) repair his hernia.

The Biohernia…[Read more]

A couple more links.

https://www.telabio.com/assets/download/OviTex%20Published%20Clinical%20Data.pdf

https://www.telabio.com/assets/download/White-Paper-Mesh-Performance.pdf

Tela-Bio’s Ovitex is the latest biologic to hit the market. It is made from sheep intestine, but the premise is the same – strip the tissue down to its basic collagen and assume that the human body will remodel it into human tissue.

Dr. Towfigh and Dr. Szotek are both proponents of Ovitex for inguinal hernia repair. Dr. Szotek presents at the…[Read more]

The lack of regulation in the field for new products means that many new products get introduced and sold with claims that turn out to be untrue. This is from 2014.

https://www.consultant360.com/story/porcine-mesh-hernia-grafts-do-not-promote-remodeling-and-collagen-deposition

You can look back over the years and see that blaming technique is the tool that the mesh-makers and users have used to deflect attention from the mesh. Blame the technique, but don’t name a specific technique. Claim that there is no evidence of problems inherent to mesh alone but provide no evidence, and ignore the fact that there is no…[Read more]

Hello @drtowfigh . Could you provide some follow-up on your meeting with the FDA. I know that the times have been tough, and all government agencies were seriously handicapped by the last administration (no offense to anyone’s political views, it’s just a reality), and the ongoing COVID pandmeic, but, maybe, efforts can be re-initiated? The FDA…[Read more]

I just checked, and Ethicon’s “Two Year Study”, started in 2007, is still pending. It’s a good example of an industry-managed registry.

And, of course, as often happens, the remedy for the chronic pain is not discussed. The patients that have chronic pain form ehs implantation have very few avenues available to remedy the pain. The possible solutions are dangerous and expensive and often fail. When a person considers the full risk/reward situation for the patient alone, pure…[Read more]

Here is a study comparing TEP to Lichtenstein. TEP ends up at about 10% after 5 years, compared to about 19% for Lichtenstein. So a case can be made for TEP over Lichtenstein but the overall rate of chronic pain due to mesh cannot be downplayed.

https://academic.oup.com/bjs/article/97/4/600/6150225?login=true

“The total incidence of chronic…[Read more]

Dr. Towfigh you are presenting unverifiable numbers from a group that most likely does not represent reality. At least tell people the sample size. Is this 20 patients or 200? You must realize that the numbers have little value except to show that the quality of available data is poor.

“It’s not a database that is mandatory and most surgeons p…[Read more]