Good intentions
Forum Replies Created
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G’s comment to me in Dc’s post got me to looking for when I joined the forum. It looks like it was a few months before I had mesh removal, in 2017. This might contain my first post, I’m not sure.
My comments, above, in this thread show that I was pretty disappointed in what I had learned since having problems with the mesh implantations and the fight to get the problems solved. Not much has changed since then. Mesh removal is much easier to find on the internet now, it was very difficult even just six years ago. I found Dr. Billing’s name on a forum for runners and a couple of other sites and had to use that sparse information to make a decision. I don’t think that there were any mesh removal videos on YouTube at all. It wasn’t discussed in open like it is today. I guess that’s an improvement.
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I don’t think that your overall situation is normal so there probably aren’t many people to compare to.
One month after a bilateral hernia repair procedure is really not very long. In your first post you said that you had pain. Now you’re saying that you’re weak and a small effort “puts you out”. Are you saying that things are different now? What does that mean. Is it low energy or pain?
No offense intended but I think that you might be expecting too much too soon. While you were having the pain before surgery you were probably getting weaker overall because you were inactive. Trying to avoid the pain. Maybe you started from a lower base of overall strength.
If you read some of the older Shouldice posts you’ll see that “pulling” is one of the typical feelings after a Shouldice procedure. So that is normal, it’s the nature of the procedure. Apparently it can resolve over time.
Anyway, it doesn’t sound like you are in danger or need another surgery. I’d monitor progress of any kind and keep trying to get stronger. It’s the best that you can do. Good luck.
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I chose to go ahead with surgery because I thought that it would get me back to my full fitness and ensure that I would be free of hernias in the future. That is the way that laparoscopic mesh implantation is sold, especially Lap TEP. They make it sound like you will be bulletproof after the procedure.
If I had known the truth and the true odds I would have waited and/or chosen a different solution.
The most difficult part of the decision is understanding, really, what the risks are. That is the heart of the travesty. The risks are actively hidden from the patients. The vast majority of surgeons either don’t understand the risks themselves or have convinced themselves that they are insignificant. Or that sacrificing a few patients is okay as long as most of them do well.
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100 repairs does not tell much. 100 repairs using a variety of methods could mean just a few tissue repairs or just a few mesh repairs. The words from the eminent surgeon are standard boilerplate warnings that all surgeons use for all surgical procedures.
Have you seen the original surgery records? It might be that you have already had a mesh implantation. Prophylactic implantations are a thing, although not so much 12 years ago. But if you did have mesh implanted that adds a complication. You’ll want somebody very experienced.
Ventral hernias are apparently some of the most difficult to repair. Good luck.
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Did you try any of the recommendations in your other thread?
Be careful when you say “open repair with mesh”. The plug and patch repair is open with mesh. The PHS is open with mesh. There are many types of “open with mesh” repairs.
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It would be interesting to know if Lichtenstein used his mesh repair on all of his patients. Or if he varied the repair method based on what he found, and/or the type of hernia. It would also be interesting to try to understand how mesh became so popular. Was it a grassroots organic growth? Or something else. How did we get here?
That is the one thing that really shows the inherent bias in the Guidelines. One of the very first statements says that a pure tissue repair should only be used if mesh is not available. Who knows, maybe that’s why inexpensive mosquito netting is used in places that can’t afford the hernia netting made by the big companies.
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The body adapts to injury. The necrotic tissue gets replaced, the new collagen reforms to stronger collagen, healing happens. The initial tension is worth considering but it’s the results that matter.
In a way you are just following the logical path to the “tension-free” mesh repair concept. Which was/is a good idea to develop, but the prosthetic materials on the market today have new problems. The medical device makers have stopped trying to improve the concept (the revenue stream is very solid, the litigation has been priced in, there is no true device regulation), so here we are – lots of words, but no progress from the mesh suppliers. The meshes are all essentially the same as they were many decades ago.
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Here is my thread about healing from mesh removal. Probably not really part of the topic that you intended but it does give an idea of how long the body can continue to adjust after surgery. I should update it soon, The last few months have been very good. Over five and half years since removal at the end of 2017.
https://herniatalk.com/forums/topic/healing-from-mesh-removal-surgery/
If the direct link takes people somewhere strange put this in the search box – “Healing from mesh removal surgery”.
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Still no word at all from EHS/HerniaSurge. Ten chapters being updated in the “International guidelines for groin hernia management”. The group said their work was almost done at the end of 2022. What could be causing the delay?
They should at least tell which ten chapters are outdated. It makes a person wonder about the professionalism of this huge organization. They have roped in many other national hernia repair societies and now they are all left hanging. How can any patient be confident in their surgeon if they say that they are following the Guidelines, which have been defined as outdated?
https://europeanherniasociety.eu/guidelines/international-guidelines-for-groin-hernia-management-2/
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The guidelines were developed by The HerniaSurge Group and have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. The guidelines were published in 2018 in the Journal Hernia. Ten chapters are in the process of being updated.
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The web site that I had been using to keep track of litigation seems to be slipping. I found another that seems to be up-to-date.
https://www.millerandzois.com/products-liability/hernia-mesh-case-value/
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August 16, 2023: The Bard MDL has been frustratingly quiet in August. The MDL did add 191 new cases last month, increasing the total case count for the 3rd largest MDL in the country to added to 20,126 lawsuits.August 10, 2023: The pivotal 3rd bellwether test trial is on track to begin on October 16, 2023 in the case of Stinson v. C.R. Bard, et al. (2:18-cv-01022). In preparation for that upcoming trial, the MDL Judge recently issued an Order setting last-minute discovery deadlines related to the plaintiff’s post-operative treatment last month. The order gives the parties until August 14, 2023, to complete supplemental fact depositions and until September 27 to finish additional expert depositions. The short time frame of these deadlines suggests that the judge is committed to going to trial in October without further delays.
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Here’s another one. BD’s (Bard) Ventrio ST, used by Dr. Reinhorn of Boston Hernia, in his TREPP procedure.
By the literature it would be an “off-label” usage since it is specified for ventral hernias.
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I’ve had that problem too. One work-around is to put the title of the Topic in the post and let the reader use it in the Search Forums box. It’s clunky but it will get them there.
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I tried to find something about where Medvedev had his hernia repaired but can’t. It is incredible though how much was written about the fact that he was going to have hernia surgery. Page after page of internet articles about it.
He apparently has made a very fast recovery. Which does not actually tell much. I was playing high level soccer at one month after my mesh implantation. It will be interesting to see how he does in the long term. Dai Greene also was back to training soon after his mesh implantation but had to have the mesh removed eventually. If anyone can find more about the details of Medvedev’s procedure they would be good to know. Thanks for the post William Bryant.
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The Herniamed group is interesting in that they say that they developed the registry to collect information about all types of hernia repair but have an image of mesh as the background on their homepage along with free advertisement for the big mesh makers (“Sponsors”). Kind of hard to believe that there is not some inherent bias in the effort, realized or not. It seems very similar to the EHS web page, which also uses an image of mesh as their background. They just can’t resist promoting mesh, in what seems a disingenuous way. A person can understand showing the sponsors but using the mesh as a logo for the group shows a lack of objectivity. What is the real goal?
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To improve the results and quality of hernia surgery, the non-profit organisation Herniamed was founded. This is a network of surgeons who have a particular interest in hernia surgery. The cornerstone of the Herniamed project is an internet-based quality assurance study (registry) into which all hospitals and private surgery practices can enter data, free of charge and using a scientifically corroborated standard, on the hernia operations performed by them. The results of treatment are followed up for up to ten years so that any problems occurring later can be reliably identified. Based on these findings, experts can then devise the best treatment options for patients.
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Everybody has flaws. If you focus on the flaws you miss the good stuff.
The Discussion section of the paper is very relevant even today. When I was studying the situation back in 2014 I thought to myself that “there is no way that this could be continuing. The errors must have been solved by now”. It is now nine years later and nothing has really changed at all, except for more lawsuits. The new products are just small variations on old products, and copies of competitors products. No product has been identified as bad enough to be removed from the market. Laparoscopy is growing, making mesh problems even more difficult to solve. The studies keep coming back with the same approximate 15% percentage for pain problems.
The paper is worth reading because it shows that today’s problems were recognized and well-defined almost a decade ago.
I wonder what happened to the Mesh Retrieval Registry. Maybe Dr. Koch knows. He is a co-author.
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A “Mesh Retrieval Registry” has been set up by the present surgeons and pathologist and several colleagues have volunteered to participate for an in-depth study of the “Mesh-Pain” problems. A protocol will be addressed to all who would be willing to participate and contribute. Reports of such a surveillance are sure to find their way, on time, in the surgical literature. For a certain, very small segment of the surgical population, prostheses may be here to stay and it then behooves all of us to understand their pathophysiology. The next step will be the correlation of histology/pathology to the clinical presentation and severity of pain. This is presently being done and will form the basis of a later publication.
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Thank you Mark T. for reading through the full paper and sharing what you found. It’s surprising that there is so little analysis of the physical differences between the two products. The reason that one product might be better than another product. It’s brand name versus brand name. One company’s stuff competing with another company’s stuff, and they are essentially identical. Marketing and price point make the sale.
This seems to be the only difference that they could distinguish. And it looks like pure marketing hype. They just repeated what they read from the brochure.
“conforms even more to the contours of the groin region in comparison to other 3D meshes”
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Sounds like they followed the basic Lichtenstein instructions. Here’s a video from Dr. Chen of the Lichtenstein Amid Hernia Clinic at UCLA with his recommendations and how it’s done. He talks a lot about handing the nerves.
Also a link to the Medtronic product page.
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Just to round the thread out, here are the two product pages, and the MAUDE database link. Put Dextile in the brand name on the MAUDE page and you’ll see that it is now in a race with 3D Max (type 3DMax as one word to see MAUDE results). More market share = more reports and more lawsuits.
https://www.medtronic.com/covidien/en-us/products/hernia-repair/dextile-anatomical-mesh.html
https://www.bd.com/en-us/products-and-solutions/products/product-families/3dmax-mesh#overview
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm
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Thank you Mark T.
So it looks like one of those purchasing department decisions, maybe because the new product came in at a low price to get some market share. Was there a statement or two at the beginning describing what, exactly, the purpose of the study was, and why it was undertaken? “Hey, Purchasing changed our mesh, let’s compare it to the old stuff” seems like the only reason. Besides being the “first” to compare the new 3D product to 3D Max.
Disturbing also, as usual, to see the rationalizing used to try to show that the mesh is not the cause of any problems. Objectivity is hard. Not real recurrences, the surgeon’s weren’t skilled… If they are going to report “not all” they should report the actual number. If they don’t have it then they don’t know.
” As described in the results section, not all recurrences were “true” recurrences but also lipomas, although these lipomas may have formed in the interim, others have described recurrences due to missed lipomas [23]. This would suggest that these particular recurrences are not necessarily related to the mesh but to the technical execution of the surgery.”
And they describe major flaws in the study. But publish anyway. And, indirectly promote the idea that lap mesh has low pain rates, by including the percentages in the discussion. Hernia Journal does not seem to be a scientific journal at all. More of a hernia repair promotion magazine. Supposedly peer-reviewed but it doesn’t really seem that way.
The Journal is also associated with the EHS.
https://www.springer.com/journal/10029/aims-and-scope
“Hernia is a rigorously peer reviewed journal that regularly publishes specific topical issues and collections in addition to original articles, and is affiliated with the European Hernia Society (EHS), with the Asia-Pacific Hernia Society (APHS), and with the American Hernia Society (AHS).
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Not a good sign for progress. Just reporting that a new product is just as bad as an old product. -
Oops, I posted the link below, then saw that it was your thread.
Surgeon recommendation in Oregon or Washington that repairs without mesh?