Good intentions
Forum Replies Created
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Here’s another interesting summary that gets in to the details of the premise being suggested for the problems. They distinguish between polyester and polypropylene. Some of it seems exaggerated but I guess that’s what lawyers do. Looks like they have their sights set on Progrip also.
It’s like reading an exciting novel in serial form.
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Here’s a summary of the Covidien MDL. Parietex is a brand name used for many mesh products including the common flat mesh sold by Medtronic.
https://www.aboutlawsuits.com/covidien-mesh-lawsuits-bellwether-trials/
https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html
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It has been pretty fascinating to follow the progress of the lawsuits focused on various hernia mesh products. Also kind of difficult since the various law firms that report on them generally don’t present information very well.
One thing I’ve noticed is that they seem to be working from a starting assumption that all mesh products are inherently “good” and that they need to find a specific defect in material or manufacturing proce4ss to show a failure on the corporation’s part. Instead of just showing that the products available are generally deficient and inadequate and that the benefits are oversold, and that the corporations know this but are letting the harm continue. They should be taking the J&J talc/asbestos path, or the tobacco or oil company strategy and showing that the corporations are valuing profits over public damage.
This summary page shows some of that. Apparently one of the cases tried to use a fire in a manufacturing plant as evidence of negligence. Instead of just showing that it’s a bad design that even the global “guidelines” recommend against.
Anyway, it’s just one benefit of getting tangled up in this mess. A new form of entertainment.
Apparently there is a new class action suit against Medtronic for their Covidien mesh. It slipped in over the last year, didn’t even notice it.
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September 23, 2023 – Coviden MDL Has Trial Dates… in 2025
The federal judge overseeing Covidien hernia mesh lawsuits in federal courts nationwide has given approval to a proposal for preparing six bellwether cases and selecting two of them for trial in early 2025. While progress has been somewhat slow in this litigation and 2025 seems like light years away, getting a trial date gets the clock moving on pushing Coviden to make meaningful settlement offers for the over 600 plaintiffs in this litigation.
…While the facts are different, this litigation is tied in the Bard MDL psychologically. A big verdict in Stinson next month would not only help the Bard plaintiffs but the other hernia mesh class actions as well.
October 28, 2022 Covidien Mesh Lawsuit Update
At a recent status conference in the Covidien hernia mesh class action MDL, the parties advised Judge Patti Saris (D. Mass.) that 170 Covidien hernia mesh cases are currently pending in federal courts, 5,700 lawsuits pending against Covidien in Massachusetts state courts (Covidien’s home state). The central issue at the status conference was the proposed discovery plan submitted by Covidien. The plaintiffs’ committee is vehemently opposed to the proposal because it would give them under one year to complete corporate discovery.
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Your post seems tailor-made to draw Dr. Towfigh’s attention. That is an amazing list of symptoms, diagnosis, and treatment.
How long from the first symptom until you sought treatment? How long did you keep working after the first symptoms? Are you still working, despite the pain? Hard to imagine a 20 year old woman doing that type of physical labor at a company like UPS.
Good luck.
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No Name, I wrote another novella. Hard to stop sometimes. The method described in that Northshore paper is really just a typical Lichtenstein and/or plug and patch method. Open the canal, move things around, place the mesh, fixate it, close and hope.
Dr. Reinhorn’s TREPP method does not enter the inguinal canal at all. It’s like laparoscopic surgery mesh placement without general anesthesia or close exposure to bowel. As far as inguinal hernia repairs go it might be the least invasive.
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I wrote a bunch of stuff below then realised that it didn’t really address your question. I think that the method described is completely different from the TREPP method of Dr. Reinhorn. TREPP comes in from the side and creates a space behind the inguinal canal in to which a piece of mesh with is placed. The inguinal canal and spermatic cord are not touched. In the paper you linked the method describes that the inguinal canal is opened and the cord manipulated just like a Lichtenstein repair.
Here’s some of what I got from the paper –
I’m not as clear on the different methods as some of the other forum members, but it looks to me like the Northshore people have created a sort of combined Lichtenstein plus plug repair. One disturbing thing about their explanation is that they conflate the use of a mesh with an absorbable component with the new method of placement and fixation. They introduce the Ultrapro as the primary factor and the new slitting and fixation as secondary. They didn’t clearly explain why they needed to do things differently. The fact they decided that they needed something new suggests that they have been having problems with their own patients. Northshore is one of the typical hernia mills. And the study is tiny, just 24 patients.
Overall it really looks like somebody doodled up a new method on a napkin and started using it on patients. They’re not happy with the results of whatever they have been using, they came up with something new, tried it on 24 patients, and now are publishing a paper about it. Pretty amazing when you sit and try to absorb it. Any surgeon can do whatever they want with a piece of mesh as long as they get the patient to take liability for problems. Same problematic material, just different ways to get it in there.
From the paper –
“Methods
Upon Institutional Review Board approval, all patients who had undergone open repair of an indirect inguinal hernia using the Ultrapro mesh and the “double slit” technique between June 1, 2007 and November 1, 2012 at a single institution by one surgeon were contacted. Written consent was obtained for retrospective analysis of operative data as well as an additional office visit for prospective collection of long term follow up data. Inclusion criteria included males who were at least 18 years of age and at least 6 months out from the operation. Chart review was conducted to obtain retrospective perioperative and short term follow-up data. Long term outcome data was obtained prospectively at the additional office visit by having the patient complete a Carolina Comfort Scale and be examined by the
operating surgeon. This data was then analyzed with particular attention to chronic pain and incidence of recurrence.…
At follow up, 18 (79.3%) reported no groin pain (0/10) while 4 (16.6%) had mild groin pain (1/10), and one had (4.1%) moderate groin pain (4/10), none of the patients experienced testicular pain (Table 2). Carolinas Comfort Scale was given to all patients and revealed very minimal pain, mesh sensation and movement limitations (Table 3).
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I have to admire Chuck’s ability to draw people in to responding, like I’m doing now. And his persistence. It really is a shame that he’s wasting these qualities for this mission that he’s on, to create chaos and confusion on the forum. One giant “acting out”, to use the psych term.
Here is No Name/ UhOh!’s old profile page with his backstory.
https://herniatalk.com/members/uhoh/
I think that any mesh method that has mesh inside the internal ring next to the spermatic cord would be considered as a plug method and has the potential for problems. If you read the papers about TREPP, the main point is that the nerves and structures inside and around the inguinal canal are not disrupted during mesh placement. TREPP is about how to place the mesh with the least damage possible.
Reinhorn’s work is also interesting because he uses a type of mesh that is not common for inguinal hernia repair. He has not described why he chose that mesh over the standard open-pore uncoated mesh. In the end though there is still mesh sitting on top of structures that tend to get bound to the mesh as the body tries to encapsulate the fibers. It’s probably just as hard to remove as lap placed mesh.
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Here’s a poster presentation from Dr. Towfigh’s Beverly Hills Hernia Center.
Page 243 in the pdf Program file of the AHS 2023 meeting. It’s a tiny study, only 52 patients. Look related to Dr. Towfigh’s recent survey, which originally did not include pain as a symptom.
https://custom.cvent.com/9D6126EEBC1B404DA11E747D5B4411CE/files/955da81f74bd4068b0c320dd2aba1bdb.pdf
P98. Mesh Removal Outcomes in Patients with Mesh Implant Illness
D Huynh, C Oh, I Capati, S Towfigh
Beverly Hills Hernia CenterBackground: Most hernia repairs in the US are mesh-based. This practice is supported by research showing superiority of outcomes compared to tissue-based repairs. However, we have shown a small but growing population of patients with mesh-related systemic reactions, known as Mesh Implant Illness (MII). Common symptoms include: bloating, swelling, fatigue, headache, rash, fibromyalgia, and joint pain. As yet, there is no standard of care for this population. We report our outcomes of applying complete mesh removal as part of the treatment for suspected MII.
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Upon short-term followup averaging 10 days, MII-related symptoms improved in 62% of patients after mesh removal. By long-term followup averaging 2 years, 74% of patients reported resolution of their MII-related symptoms [Figure 1].
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More research is required for this developing disorder, with the goal of eventually reducing, preventing, and resolving MII.
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I browsed through the Program for the meeting and was kind of surprised at how much it looks like the program for past meetings. Many of the old topics are discussed, looking at similar questions like lightweight versus heavyweight mesh.
Here’s a study from a part of the world that hasn’t been discussed much. Japan. It’s a poster, so it is brief, but it might be the precursor to a full paper in the future.
From page 188 in the pdf Program file linked above.
P49. The Frequency And Risk Factors Of Chronic Postoperative Inguinal Pain In Japan: A Prospective, Longitudinal Nationwide Survey
M Narita, T Tasaki, Y Miyaki, H Miyagaki, M Kataoka, T Nitta, T Kimura, R Toshiyama, N Hama, Y Kawaguchi, N Shimada, I Sakamoto, K Takehara, Y Oshima, T Kusumoto
National Hospital OrganizationBackground: Chronic postoperative inguinal pain (CPIP) is known to be the most debilitating complications after inguinal hernia repair, while very few evidence has been reported in Japan. To determine the frequency and risk factors of CPIP, we perform a prospective, longitudinal multicentre observational cohort study.
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Methods: Between September 2018 and March 2021, patients aged 20 years or more who planned to undergo elective inguinal hernia repair at 22 community hospitals, not hernia specialized centers, in Japan were enrolled. This study was registered in UMIN-CTR (Registry number; UMIN000033936) prior to enrollment of the first subject.
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The proportion of patients reporting sense of discomfort was 22.5% at 3M, 21.4% at 6M, 18.0% at 12M, and 15.7% at 24M. The proportion of patients reporting hyperesthesia on the skin around the wound was 6.6% at 3M, 6.5% at 6M, 5.7% at 12M, and 4.9% at 24M. The proportion of patients reporting pain at ejaculation was 2.2% at 3M, 2.6% at 6M, 2.8% at 12M, and 3.3% at 24M. Hernia recurrence was observed in 1.1%, 1.5%, 2.3%, and 2.4% of patients at 3M, 6M, 12M, and 24M, respectively.
Conclusion: This is the first large prospective cohort study aimed to demonstrate the frequency of CPIP in Japan. Although its frequency is decreased over time, it can be problematic even at 2 years after surgery. Caution should be paid in patients with preoperative pain at rest, preoperative habitual intake of analgesics, and history of transabdominal prostatectomy. Laparoscopic surgery and/or technique without mesh fixation may be the option to avoid CPIP.
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You’ve had a bilateral hernia scheduled before learning much about them? Five days?
Time is really not on your side. People often postpone their surgeries. You should postpone yours until you are sure of what you want to do.What type of hernias, how were they diagnosed, and what type of procedure? Good luck.
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The final program looks pretty good. Packed with ads, plus the topics look interesting. And it is searchable, unlike the SAGES program documents. At least AHS is transparent and easy to access. The conflicts within seem enormous though. Many of the ads are about mesh. It’s everywhere. Strattice, Tela Bio, Phasix, all within the first ten pages. The full list of “partners” fills a page. Mostly bronze with one silver and one gold.
The Program document is also packed with abstracts. Better download before they make it members only. I haven’t gone though the whole thing, it’s 277 pages.
https://custom.cvent.com/9D6126EEBC1B404DA11E747D5B4411CE/files/955da81f74bd4068b0c320dd2aba1bdb.pdf
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What type of surgery did you have in India for the varicocele, what type of hernia do you have now, and what type of surgery is planned for November 1? You might not even be a candidate for a Shouldice procedure. There are many types of hernias and many types of repair.
Good luck.
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It would be interesting to find out what methods the surgeon who took over Dr. Brown’s practice uses. You’d think that he might have been aligned with Dr. Brown’s thought process but maybe it was just a financial decision.
The web site still contains the old non-mesh descriptions. Dr. Nguyen might be worth contacting.
https://www.sportshernia.com/no-mesh-hernia-repair/
But, it might be that he just left the old stuff there and will recommend a lap procedure. Lap = mesh. Hard to imagine that he would go back to pure tissue after spending his education time on the latest lap procedures.
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Dr. Meyers and the Vincera Institute is well-known in the world of runners, and professional sports in general.
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Thanks Jack2021, those are some good references. It’s interesting that just a day of rest and a small amount of ibuprofen and things got back to normal. I was getting worried, again.
I had had a thought in the past, over the years, that cycles or number of steps seemed to bring on soreness and odd sensations, more than exertion. Kind of counterintuitive for hernia concerns but that’s what my memory and notes seem to show. Luckily, for me, my range seems to be lengthening, with more miles allowed before I have to take a day off. Actually, I think that I had moved on from monitoring distance travelled (I had been keeping a log) and was being more spontaneous and hiking and walking farther. I think that I had just hit the new limit recently.
One of your references described the motor function of one of the nerves in actuating the abdominal muscles. I wonder if that plays a part in the fact that my abdomen between the navel and about halfway to the pubic bone feels like a stiff plastic bowl.
I did a quick Google and another interesting very recent paper popped up. It describes the ilioinguinal nerve as following the spermatic cord. So, it sees what the cord sees, as far as irritation from internal abrasion or poor environment. It seems to fit what I was feeling with spermatic cord irritation.
It’s an interesting topic, especially considering what seems to be a trend toward prophylactic neurectomy. Besides just the broad effects of disturbing so much of the network during laparoscopic mesh implantation. Unintended consequences.
https://www.ncbi.nlm.nih.gov/books/NBK556034/
Anatomy, Anterolateral Abdominal Wall Nerves
Aurimas Kudzinskas; Bruno Cunha.“Introduction
The anterolateral abdominal wall is a layered structure composed of skin, fascia, muscles, extraperitoneal fat, and peritoneum that extends from the thorax to the pelvis and bounds the abdominal cavity and its associated organs.[1] It plays an important role in the movement of the torso, stabilization of the spine, retention of a physical barrier, and increase and maintenance of intra-abdominal pressure.[2][3] Numerous nerves traverse the anterolateral abdominal wall to serve regions of the abdominal wall, pelvis, and perineum. A variety of pathologies have the potential to impact the anterolateral abdominal wall nerves, including trauma, neoplasm, and infection. Any clinical involvement of these nerves may result in pain, loss of sensation, or motor deficits and reduce an individual’s quality of life.
…The ilioinguinal nerve travels within the neurovascular plane between the transversus abdominis and internal oblique muscles until it reaches the superficial inguinal ring. At the superficial inguinal ring, the ilioinguinal nerve pierces the internal oblique muscle enters the inguinal canal, and travels along the spermatic cord (in males) or the round ligament (in females). The ilioinguinal nerve innervates the skin overlying the inguinal ligament, medial thigh, mons pubis, scrotum, root of the penis, and labia majora. It also contributes to the motor innervation of the inferior portions of the transversus abdominis, external oblique, and internal oblique muscles.
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Thanks Watchful. After taking a day off and resting, and taking one ibuprofren/Advil, the right groin pain has disappeared and other minor discomforts have crept in. I think I’ve just been overdoing it. I also think that my whole pelvic area is unbalanced after the multi-year process of mesh, mesh pain, mesh removal, mesh removal pain, etc. It’s a twisty road back.
FAI and osteitis pubis symptoms seem to fit in a minor way. Which are both kind of mystery conditions, like occult hernias and athletics pubalgia. Once the area gets screwed up I think it’s hard to get it back in to shape.
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All of the issues raised here can be answered by your surgeon. If you don’t trust your surgeon enough to believe that they won’t hand you off to an assistant then you should probably find a different surgeon. Of course, most people don’t ask too many questions or they get evasive answers when they do.
Thinking back to my initial mesh implantation I should have paid more attention to my own misgivings about the surgeon as a person. He was too smooth in his demeanor, and did some things that made me wonder, like showing me a piece of mesh while saying it was not the type that he would be using but it was close. But I wanted to believe in a professional. I had already passed on a different surgeon in the same clinic because he seemed so unenthused about what he did.
So, this question really seems to boil down to trust. If your surgeon tells you he’s feel great at the end of a day of ten hernia repairs, within a week of 50 repairs, do you believe him/her? Conversely if your surgeon says that they only do two to three surgeries a day because any more is too many, do you believe that the third one is just as good as the first?
You can go round and round. But, back to the original point – experience leads to expertise. I’m not talking about fatigue. Or trust, or large scale hernia repair mills. Just the benefits of performing many surgeries on a regular basis. Would you rather have a Marcy repair by Dr. Kang or a Marcy repair by somebody who’s only done ten over the course of a year?
I have mentioned in the past that Dr. Billing said that trying to remove all of the mesh inside me, two sides, in one go was too much. Because he would get fatigued. So, he apparently knew his limits and didn’t try to exceed them.
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How would a person seeking a surgeon evaluate the “fatigue factor”? The multi-persona person seems to go by gut feel. Can somebody suggest a number to use, some sort of break-point? Should a surgeon’s age be considered? Older people fatigue more easily.
The last statement in the post above, funnily enough, seems to have been written under the duress of fatigue (no offense, it really is kind of funny and it was late). The original topic isn’t about learning while fatigued. It’s not even really about fatigue. It’s about the experience gained by doing many surgeries of the same type.
Of course, my first post brings Dr. Kang to mind since that’s what the multi-persona person has implied in his/her posts. But it could also be applied to Desarda (Tomas) or any of the high volume lap mesh surgeons or any of the Shouldice Hospital surgeons. How many surgeries per week or day or month is too many? How old is too old?
Hearing a number and feeling like “that’s too many, they must be tired at the end of the day” doesn’t seem like a very precise way to choose.
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Stumbled across an article that seems relevant.
https://pubmed.ncbi.nlm.nih.gov/11711938/
Plast Reconstr Surg
. 2001 Nov;108(6):1618-23. doi: 10.1097/00006534-200111000-00029.
Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain
M Rab 1, J Ebmer And, A L Dellon -
Thanks David M. The take-away from your point seems to be “get an early surgery time”. Not sure that the “tired at the end of the day” really applies to the point I was making. I was talking about experience leading to precise knowledge.