Good intentions
Forum Replies Created
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Hello Carmen. I am on a full-size computer, running Windows and a Chrome browser. I cleared the cache and history completely, every box checked, on my computer and there is still no button visible to start a new Discussion, and the “You cannot…” notification is still there. Here is an image.
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I have found the Discussion page. And used Search to find my old thread. Search on the “News Feed” page does not search the Discussion page. That explains my previous problem.
@dev (Sorry to be so demanding. Discussing the hernia repair situation is a form of catharsis for me, and HerniaTalk is a big part of it).
I have found some documents that describe the complete path to the current state of Per-Fix plug case. Pretty interesting. You can see who used the plug initially, and who removed it then used a different type of mesh to repair the defect.
“<b style=”background-color: var(–bb-content-background-color); font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>November 3, 2023 Update
We are still in the defense case in Stinson. Dr. Radke, the explanting surgeon, testified by videotape yesterday.”
Here is a recent document regarding the case, with a summary.
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The Stinson case is progressing along. This latest post makes it seem like a “reasonable” settlement is expected.
Another surgeon has been introduced to the saga. This is from the Miller and Zois link above.
Dr. Badylak is associated with a biotech company, Triad Life Sciences, Inc. https://innovamatrix.com/
Also a professor of surgery. Interesting that he is used by Bard for defense. It would be really interesting to see actual transcripts of trial testimony.
https://www.surgery.pitt.edu/people/stephen-badylak-dvm-phd-md
“November 8, 2023: On Day 14 of the Stinson bellwether hernia mesh trial, Bard called brought Dr. Stephen Badylak to the stand, a witness with a history of testifying for Bard in similar cases. In a move reflective of the parties confidence in a favorable outcome, both sides have jointly filed a motion advocating for the use of a single damages’ verdict form, a measure in accordance with Maine law. This is intended to minimize confusion among jurors and reduce the risk of potential appeals or retrials due to the issue of multiple recoveries for a single harm.”
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That is a very interesting article William, thanks for posting it. I see another familiar name, Dr. Rosen of the Cleveland Clinic, is quoted in it too. He’s one of the good guys.
What I got from the article was not so much that surgeons were learning incorrect techniques via YouTube but that the technology companies facilitated it. They didn’t care that it was wrong they just wanted to get people buying and using their equipment. Like paying to have a training center built on a public university campus. Whatever it takes to get that revenue. Patient health is secondary. It’s just the world we live in today.
I pulled a bunch of pieces from it for anybody who doesn’t want to click through. It’s pretty incredible. Worth reading the whole thing but it won’t make anybody more comfortable about any future surgery.
“Over the next 15 years, the number of times that doctors billed Medicare for a hernia component separation increased more than tenfold, to around 8,000 per year. And that figure is a fraction of the actual number, researchers said, because most hernia patients are too young to be covered by Medicare.”
” “It’s unbelievable,” Rosen said. “I’m watching reasonably healthy people with a routine problem get a complicated procedure that turns it into a devastating problem.” ”
“Component separation must be practiced dozens of times to master it, experts said. But 1 out of 4 surgeons said they taught themselves how to perform the operation by watching Facebook and YouTube videos, according to a recent survey.”
“One instructional video, paid for by another major medical device company, showed a surgeon slicing through the wrong part of the muscle with the da Vinci.
Peper Long, a spokesperson for Intuitive, said the company hired “experienced surgeons” to lead its training courses. “The rise in robotic-assisted hernia procedures reflects the clinical benefits that the technology can offer,” she said.”
“In interviews with the Times, more than a dozen hernia surgeons pointed to another reason for the surging use of component separations: They earn doctors and hospitals more money. Medicare pays at least $2,450 for a component separation, compared with $345 for a simpler hernia repair. Private insurers, which cover a significant portion of hernia surgeries, typically pay two or three times what Medicare does.”
“Intrigued by the hype, Dickens taught himself component separation by watching online videos. His first operation went well, he recalled, but a later patient developed a serious complication, necessitating an additional surgery.
Then, at a dinner meeting in Houston, he presented a video of one of his own surgeries to a group of about 50 other doctors, Dickens recalled. A more experienced surgeon interrupted to say he was operating on the wrong part of the muscle. The rebuke felt like a “red flag,” he said, and he stopped doing the procedure, although he is still a proponent of the da Vinci for other operations.
In June 2021, W.L. Gore & Associates, a medical device company that makes surgical mesh used in hernia repairs, posted a video tutorial on its website. It promised to be a step-by-step guide to component separation surgery.
A surgeon narrated as he cut the patient’s abdominal muscles, releasing tissue so he could close a hernia. But he was operating in the wrong place and likely created a new hernia, according to four surgeons who reviewed the video.
“It absolutely trashed the abdominal wall,” said Jeffrey Blatnik, who directs the Washington University Hernia Center. “It was so offensive to the point that we reached out to the company and told them, ‘You guys need to take this down.’”
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Did you guys see the picture in the publication, of the hernia? The hernia that the guy was “comfortable” with for five years was huge. You can see how the person running the scanner might have questions. It’s interesting how different cultures have different values. I can’t imagine anybody I know living with a hernia that large.
I don’t know that the relatively small hernias discussed on this forum would show up on an airport scanner.
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Follow to the post above – Dr. Grischkan is an expert witness in the case.
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October 31, 2023: Plaintiff rested his case yesterday.October 27, 2023: We said Dr. Grischkan was a key witness. All day yesterday was spend on his continued testimony.
October 26, 2023: Today is Day 9 of the Stinson trial. Yesterday, the plaintiff and David Grischkan provided testiomony. Dr. Grischkan is a board certified general surgeon who specializes in the repair of abdominal wall and inguinal hernias. He is a key plaintiff’s expert on specific causation.
Let’s take a second and recap the allegation in Stinson. The main argument from the Plaintiff is that Bard was aware of the risks associated with its PerFix Plug device but still promoted and sold it without properly warning doctors and patients.
What was the problem? Plaintiff design defect claim contends that the PerFix Plug breaks down after being implanted, leading to a prolonged inflammatory reaction in the body. So instead of putting a warning on the product giving doctors the information they need to do a risk/benefit analysis, Bard minimized the potential complications of the device, patients at an undue risk of severe and lasting harm.
Plaintiff’s lawyers also argue that this inflammatory reaction is exacerbated by poor design choices in the device’s shape, weight, and the size of its pores.
October 17, 2023: The size of the Bard hernia mesh MDL actually decreased over the last month from 20,405 to 20,369 pending cases. This is the first time ever that this class action MDL has posted a monthly decrease in pending cases. What does this mean? It is difficult to say until we see if the trend continues, but this could be a sign that we are running out of possible plaintiffs.
…”https://www.millerandzois.com/products-liability/hernia-mesh-case-value/
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It appears that BD (Bard) is going to fight these cases all the way to judgment or settlement. The lawyers assumed that they would settle but it looks like they’re taking it to court. Weird how the decision coincides with the release of the Updated Guidelines which recommend mesh for the majority of patients. Just odd.
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October 31, 2023 Update
The plaintiff concluded his case yesterday. The defendant began their defense, calling BJ J Pomerants, MD, who testifies that the plaintiff’s pre-implant injuries and conditions “affected the manner in which he perceives pain in his groin both before and after the implant surgery.” This is Bard’s classic defense of looking for someone or something to blame other than its product.October 26, 2023 Update
Our prediction that Bard would come to its senses and settle Stinson did not come to pass. We are now in Day 9 of trial and we can expect the plaintiff to close his case this week.What are the facts in Stinson? The plaintiff had a right inguinal hernia repair using the Extra-Large PerFix Plug mesh made by the Defendants.
Two years later, due to persistent pain in his right groin, Plaintiff had another surgery to see if the hernia had returned or if there was nerve damage.
During this surgery, his doctor discovered a significant amount of scarring and found a “large ball” about 2.5 cm in diameter of mesh that had bundled up next to a specific bone area. Removing this mesh was challenging for his surgeon due to the extensive scarring. After removing it, her used another Bard product – the Bard Marlex Mesh – to fix the hernia.
October 2, 2023 Update
September was a very slow month for the CR Bard hernia mesh MDL docket. The only entry on the docket for the entire month was an Order from the MDL Judge giving the parties seven additional days to resolve a discovery dispute before the Court got involved. Meanwhile, the upcoming bellwether test trial appears to still be one for October 16th, however, and there has been a flurry of pretrial motions filed in that case.
…”https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html
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Surgeons do worry about “billowing” of the mesh in to the hernia if it is large. It is one reason that fixation might be used where otherwise it would not be. The mesh gets pushed in to the hernia before “incorporation” happens. It could also be that the mesh moved before the body tissue infiltrated it.
I assume that Dr. Muschaweck will leave the existing mesh in place and just open you up from the front to do the minimal repair, on top of the posterior mesh. I would take her advice if it was me. She has seen thousands of situations, many with professional athletes, and knows what works. Why would you second-guess her expertise?
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Thanks for following up Herminius. It’s useful to know who is still out there solving these problems. Good to see that Dr. Muschaweck is still active.
I looked up one of your original threads to fill in the story and linked it below. Could you describe how you ended up with what looks like bilateral mesh implantation after suffering what was apparently a common sports injury? Was the surgeon that implanted the mesh a common general surgeon or a member of a hernia repair specialist organization? This urge to use mesh as a fix-all for any type of groin pain seems to be an epidemic.
Also, if you have the time and patience maybe you could describe what Dr. Muschaweck found. You have traveled an interesting path that could be important to any of us that are physically active and trusting the medical community to have the right solution ready for common injuries. In today’s world it’s up to the individual to find the right solution. Ironically, “Dr. Google” is a necessity today.
https://herniatalk.com/forums/topic/last-minute-advice/#post-36549
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Here is the full review from the Trustpilot site.
There are many good reviews also, including mesh removal.
It looks like Dr. Koch worked in the area of a nerve, on which mesh was impinging. The symptoms suggest that the nerve was damaged more during the removal. Maybe neurectomy is the solution after all.
“Rated 1 out of 5 stars
Oct 3, 2023
Constant pain following partial mesh removal
I had irritation to a nerve and was booked in to have a neurectomy (left side only). I approached Biohernia and Dr Koch for a second opinion. Dr Koch explained that he could remove some of the mesh from a previous hernia operation and release pressure from the nerve and avoid a neurectomy being needed.
I flew over the Germany from the UK and met with Nahom (Biohernia) and went to the pre consultation with Dr Koch, the day before the surgery. I was shocked when I saw that the operation was to be carried out using an open technique, as my mesh was placed laparoscopically. I had emails from other experienced surgeons explaining that laparoscopic mesh should only be removed laparoscopically as it is less invasive and an open removal could leave me in debilitating pain. I had messages from Dr Sheen, Dr Kangs secretary and Sharin Towfi (all highly respected individuals in the industry) all advising that laparoscopic mesh should be removed laparoscopically. I showed these messages to Nahom and was visibly distressed and in shock after finding out Dr Koch plans to do an open procedure. Nahom explained said ‘IT WAS THE BEST WAY, DR KOCH ONLY CUTS THROUGH CONNECTIVE TISSUE’. I went into the pre consultation room and Dr Koch repeated ‘IT WAS THE BEST WAY, DON’T WORRY I HAVE DONE THIS HUNDREDS OF TIMES’. Still in shock, I returned to the hotel and was numb. I frantically looked through all the reviews and had a sleepless night.
The following morning, I decided that I couldn’t go through with the operation. I messaged Nahom early (06.30) and asked him to meet me in the lobby in the hotel. He didn’t respond to my message. As I had already paid for the operation (a significant amount) I thought it was best I went to hospital and explain myself to Dr Koch and ask for a refund. On arrival I repeated that I was uncomfortable with the procedure and again attempted to show him the messages. Dr Koch put his arm on my shoulder and said ‘I WOULD DO THIS TECHNIQUE FOR MY FAMILY, I HAVE BEEN TO COUNTLESS CONFERENCES AND IT’S THE BEST WAY’. When I heard these words (especially about family), I thought he must be right, and sat on the bed I would be going into theatre in. When I sat down, I froze, couldn’t move and said to the nurse that I’m not comfortable with this (I was a rabbit in headlights, even though I’ve had previous hernia surgeries and never hesitated once). Suddenly Nahom appeared as he was viewing operations and asked me what was wrong. I repeated what I said the previous day, that I was not comfortable with the operation as the technique he was going to use was wrong in my opinion. At this point or any other point over the previous day, Nahom and Dr Koch both failed to listen to me. I believe anyone with compassion would say ‘if you’re not comfortable then we are not comfortable, your needs come first’. Nahom just repeated ‘IT’S THE BEST WAY. DR KOCH GETS A BETTER VIEW DOING THE OPERATION USING AN OPEN TECHNIQUE’. I folded to the pressure and went ahead with the surgery.
Waking up after the operation I was told by Dr Koch and Nahom that the mesh had bulged and entrapped the nerve. The surgery was a success and I would be free to return to normal activities after four weeks.
Following the surgery, I have been in EXTREME PAIN which is constant (pre surgery I only had mild symptoms after doing sporting activities) and have never experienced anything like it. Constant pain in the left testicle and a new constant stabbing pain in the lower abdomen (feels like I have been stabbed with a knife). There is no relief and it’s been MONTHS since the operation. I have a 2-year-old and a 6-year-old. I am no longer able to play games with them, take them swimming or take part in a little kick around like I could before the operation. My daughter keeps asking me when I’m going to get better, which kills me inside. Unfortunately, my love ones suffer the most as the procedure has changed me. I also had to give up the idea of pursuing a new career (which was arranged for September 2023). I had a consultation six weeks post op and was advised by Dr Koch to take herbal medication. Safe to say I don’t feel enthusiastic about getting in touch with him again.
I have recently been to see a local specialist in the UK and he was shocked by the open approach used to remove laparoscopically placed mesh. He said if the mesh had bulged it would have shown up on my scans. He has been a specialist for years and has never known anyone do this procedure this way. I’m not sure where I go from here and I’m not sure I will make any kind of recovery. My mental health has plummeted alongside my physical health. I struggled to concentrate on anything other than the pain.
I have never left a negative review before but if I can just prevent one person making the same mistake I have, then it will be worth it.Date of experience: June 14, 2023”
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I think that lifting belts are more for the back and to help maintain form. Not preventing hernias.
Have you ever thought about the design of the typical “jock strap”. Aka athletics supporter. They have some of the elements of a truss, with the wide band across the area of the inguinal canal. It might be that the design is a result of trial and hernia but I’m pretty sure that the purpose is hernia avoidance. p.s. be careful searching for “jock strap” on the internet. Use the term “athletic supporter” instead.
I think that wearing a truss or at least a supporter is not a bad idea in the months after hernia repair surgery. Unfortunately, as I’ve noted before, surgeons today do not really think much about the healing process. They put the mesh in, wait the two to three weeks, and set their patients free. If they do think about healing time, they seem to use the typical “percentage of final strength” curves that you can find here and there, and apparently assume that 80% or whatever at some short time frame is close enough. The goal is to get people back to work as quickly as possible. If a recurrence happens they’ll just start over.
Here’s a paper from 2020 that is pretty good. I see that the authors still think of the mesh as maintaining its physical properties after the pores are filled with new tissue. They don’t seem to understand how fiber-reinforced composites work. It doesn’t have the properties of human tissue or mesh after “incorporation”.
Anyway, this might give some ideas. I pulled out a small part about tissue strength but the whole thing is worth reading. Fixation might be more important than it’s thought if the whole healing process is considered.
https://www.sciencedirect.com/science/article/pii/S2666138120300025
Engineered Regeneration
Volume 1, 2020, Pages 19-33
Engineered Regeneration
Hernia Mesh and Hernia Repair: A Review
Carmine Wang See, Tiffany Kim, Donghui Zhu“…
4.2. Mesh Reinforcement in Tissue
The purpose of using a mesh is to provide a platform for native tissue to colonize through fibrotic reactions in the tissue [52,53]. A strong mesh aponeurosis scar tissue (MAST) complex reinforces the weakened abdominal tissue when implanted. MAST formation happens when connective tissue is deposited onto the mesh pores and filament (Fig. 5) [38,44]. The newly formed MAST tissue takes about 6 months to attain 70-80% of mechanical strength of native tissue [44].
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There are different types of “open” mesh removal, just like there are different types of open repair. For example, I think that Dr. Meyers also performs open removal. But I think that they go in through the muscle, like a TREPP repair, rather than through the canal itself, like a Lichtenstein open. It would be good to learn more details about Dr. Koch’s removal method.
I found the review. I don’t see that the person has contacted Biohernia or Dr. Koch for resolution of the problem, after a six week follow-up. Not sure what to make of it. Not sure why he had the mesh removed since it was only causing mild pain.
Thanks for posting. The pressure that they put on him to go through with the operation is concerning.
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Sorry that you’re stuck in a slow process AJM. I don’t know if it helps to remind you that I had no repairs after mesh removal and I’m coming up on six years since removal and just now feeling like I can do several consecutive very active days without worrying too much about after-effects. And I’m still discovering new ways to make things better, like by buying a different type of belt. My old belt was too stiff and rubbed on the site of the hernia, I think. A softer fabric belt makes a difference.
I never expected to spend so much time focused on a single part of my body, but that’s where I am today.
Don’t get too down. Eight months is still early. The doctors don’t want to tell you that but they know.
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Thanks for the reply Peter. I was just trying to differentiate him from the vast array of hernia repair surgeons. It’s very interesting that he chose an open mesh repair instead of a laparoscopic repair, especially since he has expertise in laparoscopy apparently. I assume that it was a Lichtenstein method. Did he discuss his reasoning for the method? Sorry to pry but that has become a hot topic on the forum. The best method.
Most surgeons today choose a single method and use it on all of their patients. I have talked to three different surgeons about hernia repair and they all talked about “this is what I do”. None of them even mentioned the possibility of a different type of repair. The big societies have “method battles” at some of their meetings, with surgeons describing why the method that they use is best. It’s pretty fascinating.
There is a lot of pressure today to move to laparoscopic methods (which necessitates the use of mesh), and on to robotic if possible. The medical field has turned in to a tech entrepreneur field, with even the big professional societies like SAGES having tech-oriented inventor focused events.
Anyway, thanks for posting and good luck. I have found Dr. Liang’s article and linked it below. Looks like an email address is required at the least in order to read it.
https://www.uptodate.com/contents/robotic-groin-hernia-repair
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Are you still running 10 miles per day? I have found that resting is as important as moving. Basically, life becomes a lot more mental than spontaneous. You have to plan a balance between rest and action. You have to give up some of the things you want to do in order to let things heal and adjust.
But I’ve also found that eventually the extensive thought and planning is not as necessary. In my case it took years.
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Good morning Carmen. @Carmen_Calvo I was able to create a title and write text but I got an error message when I clicked on Post. Here is an image. Progress!
“! Error: Forum ID is missing.”
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Hello @CursedGroin I managed to find your original post using Google search. I’ve seen your conversation with Herminius and was trying to go back to see what his original symptoms and procedures were and came across your thread instead. If I find it I’ll reply to it and see if it comes back to life.
Alos posting here just to see if I get updates or can follow along with a discussion. The HerniaTalk forum is in bad shape right now, I hope that somebody finds a solution. It might be that Dr. Towfigh has grown tired of it and is phasing it out. Who knows.
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Thanks for the story Dave @mrhernia So, so far, two success stories. One for the original Desarda repair, and one for Dr. Conze.
Do you know if the 2008 Desarda was done with permanent sutures or absorbable? I have seen a drift toward absorbable sutures in various methods, but as far I can understand, that’s probably a bad idea. Nothing wrong with permanent if the repair is done correctly, I think.
Good luck.
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Sensei, you’re back. Who did your repair?