[Good intentions]

Here is a link to their practice website. The publications and the website imply that they do many Lichtenstein repairs.

https://cascadehernia.com/

https://cascadehernia.com/surgical-solutions/hernia/

[Good intentions]

Here is an earlier paper that is open access, on the same general topic. It has some very good illustrations, showing how the nerves exit the abdominal wall at different places, and of the inguinal canal and spermatic cord.

The authors seems to be well-informed. It would be interesting to know what their repair choices are.

https://www.scirp.org/html/7-2100840_47865.htm

Inguinal Neuritis in Open Recurrent Hernia Repair
Robert Charles Wright, Robert James Wright
Cascade Hernia & Heartburn Institute, Meridian Surgical Center, Puyallup, USA

“PURPOSE: To investigate the pattern of occurrence of inguinal neuritis in recurrent inguinal hernia. We hypothesize that neuritis will occur in more nerves with a wider distribution than in primary repair. METHODS: Retrospective chart review of thirty consecutive recurrent inguinal hernia repairs concentrating on the occurrence of inguinal neuritis. These are not chronic pain patients. Nerves suspected of containing inguinal neuritis were sent for histologic examination. Ilioinguinal nerves were routinely resected. Operative parameters and nerve pathology reports were reviewed. These data were compared with a recent series of one hundred consecutive primary inguinal hernia repairs with a 34% incidence of inguinal neuritis. An independent statistician from Whitman University reviewed the data. … ”

[Good intentions]

There seems to be a discrepancy between the information the authors think is collected and what they show. Identifying a bad product, one to avoid, will be impossible if the brand and trade name of the product are not collected with the rest of the operational details. It seems reasonable to assume that the industry funded registries would not collect that information.

“Operative data
Most registries record details of the operation such as urgency of the operation, hernia classification, hernia localization, operating time, operative technique, anesthesia type, mesh type, fixation technique, defect closure, drain utilization and antibiotic prophylaxis (Table 5).”

There is no mesh type category shown in the table. Beside that, how detailed would “mesh type” be? Bard 3D Max? Anatomically shaped mesh? Or just polypropylene? It would be interesting to get in to one of these registries and see the actual information that is collected.

https://link.springer.com/article/10.1007/s10029-017-1724-6/tables/5

[Good intentions]

SN, here is a video that you should watch that might add to the discussion. It is Dr. David Chen’s explanation of why he chooses open Lichtenstein. He describes possible reasons that people have problems after the procedure.

https://youtu.be/nvrpuJs8vuU

[Good intentions]

I came across this old Topic when I was searching for a post about Dr. Chen. I found the publication that Herniahelper referred to and am adding it here to fill out the discussion. It’s a very small study, 13 patients. Yet the new method is recommended as “safe”. Another market for robotic surgery. It is the state of the hernia repair field. New methods to add to the smorgasboard. No long-term results. I wonder who is using it.

https://link.springer.com/article/10.1007/s10029-020-02259-7

Robotic iliopubic tract (r-IPT) repair: technique and preliminary outcomes of a minimally invasive tissue repair for inguinal hernia
D. Huynh, N. Fadaee, B. Al-Aufey, I. Capati & S. Towfigh
Hernia volume 24, pages1041–1047 (2020)

“Conclusion
The Nyhus-inspired robotic iliopubic tract (r-IPT) repair is an MIS approach to provide a non-mesh repair in inguinal hernia. The repair is safe with acceptable preliminary outcomes in low-risk patients. We propose the r-IPT repair to be a MIS option for non-mesh inguinal hernia repair in low-risk patients.”

[Good intentions]

Sorry to fill your thread with more research papers SN. If I were considering a repair I would focus more on the qualities of the surgeon. Not so much their skill level, but who they are as people. The surgeon that implanted the mesh in me was skilled but was more of a businessman than a true doctor.

Here is the initial paper about the study I referenced above. It has a good writeup of the lack of knowledge about biologic materials, despite the fact that they were already prevalent in the market.

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3122-5

[Good intentions]

I think that the type of hernia and the results hoped for would play a big part in a decision.

I also think that the quality of the data available for a broad evaluation like that is poor. Most of what has been published over the decades has been inconclusive. For example, a few years ago Ovitex was in the news, with many surgeons promoting it. The company “went public”, meaning that they entered the stock market where investors could buy shares, and now the fanfare has died down. The stock price has dropped and the company is branching out in to other areas. There is no data other than the initial 31 patient inguinal hernia repair study by a single surgeon that suggests that Ovitex is a good idea for inguinal hernia repair.

The new biologic being promoted is Strattice. Similar to the way in which TelaBio created a white paper showing the weaknesses of synthetic mesh, now the Strattice people have produced a paper showing the weaknesses of Ovitex. Most of these “scientific” papers have a corporate purpose behind them.

https://link.springer.com/article/10.1007/s10029-023-02769-0

Here is a recent short paper (supplement) describing a study comparing synthetic mesh and biologic mesh. In the same person! I don’t know how they convinced these patients to be experimental subjects, but there it is. So far, at 6 months, they see no difference. 6 months is a very short time frame of course.

https://academic.oup.com/bjs/article/110/Supplement_2/znad080.012/7155931

OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL
C S Seefeldt, J Knievel, J Meyer-Zillekens, J Lange, R Lefering, M Heiss
British Journal of Surgery, Volume 110, Issue Supplement_2, May 2023

“… To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other. …”

[Good intentions]

Here is a link to that previous Topic, with the podcast and transcript. He refers to the paper that I had posted a Topic about recently which has generated some discussion. The Swedish registry study of 22,000 patients. Just coincidence, I found the new paper above just browsing Google Scholar.

https://herniatalk.com/forums/topic/chronic-groin-pain-dr-krpata-cleveland-clinic/

Chronic groin pain – Dr. Krpata – Cleveland Clinic

[Good intentions]

Pinto, if you could supply the information sources that you used to choose a pure tissue repair from Dr. Kang instead of one of the very common mesh repair methods it would help you make your points.

I looked back through your posts but can’t find an explanation of your rationale. What information led you to a pure tissue repair from Dr. Kang?

[Good intentions]

Another update. Of course, the web site is run by a law firm so the hopes expressed are focused on getting that payout. But a person still has to wonder about what happens after that. If Bard (BD) settles it will be only with the clients in the class action suit. The 200+ per month more people appearing each month will still be appearing, eventually, probably, combined to form another one. It looks like a never-ending pipeline. How will they get out of it? J&J has tried to separate various product lines under legal threat, apparently so that they can declare bankruptcy in those separated compnaies and stop the bleeding. But the courts did not allow it.

None of these products have been removed from the market. There has to be a long-term strategy. What could it be?

“May 19, 2023 Update
There was a Case Management Conference in the MDL on Wednesday looking at the progress made in getting the third and fourth bellwether lawsuits (Stinson and Bryan). The next Case Management Conference is scheduled for June 13, 2023. The hope here is that keeping the pressure on Bard in these last two trials will lead to a long-awaited settlement before either of these hernia mesh lawsuits go to trial”

From earlier in the law firm thread, below. The Perfix plug is still for sale by BD. Dr. Towfigh mentioned that plugs are the highest volume mesh repair product in the world. Maybe that’s the key. Global sales probably dwarf the lawsuit payouts.

“Stinson, a plaintiffs’ pick for trial, involves the extra-large PerFix Plug device used to repair inguinal hernias. Mr. Stinson claims difficulty with urination, weight gain, an impaired sex life, and nerve entrapment.”

https://www.bd.com/en-us/products-and-solutions/products/product-families/perfix-plug

[Good intentions]

Here is the 1933 paper.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2532339/pdf/postmedj00803-0033.pdf

And here are some more recent papers about the use of trusses.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=hernia+truss&btnG=

[Good intentions]

William I replied in that other thread so that I don’t fill Oceanic’s thread with too much extraneous stuff. Dr. Conze seems to have cut ties with HerniaSurge.

#35075 here –

https://herniatalk.com/forums/topic/herniasurge-what-happened-to-it-no-updates-no-contact-points/#post-35075

Herniasurge – what happened to it? No updates, no contact points

[Good intentions]

This is a replay for William from Oceanic’s Topic.

I think that many surgeons got roped in to the Guidelines effort without realizing what was actually happening. It seemed like a good idea to create a baseline of methods, at least to use for future reference. But the failure to follow-up on the promises to update the document, and the constant and growing problem with mesh-related pain, has probably made many of them question their association with the document. Dr. Campanelli and Dr. Conze are not shown as members of the new Collaboration group.

The Collaboration and some or all of the members were shown in a recent publication about the fairly new Scrotal Inguinal Hernia guidelines. Post #34383 in my other thread. The Journal of Abdominal Wall Surgery (JAWS, ha ha ha) is the official publication of the European Hernia Society. You can see how powerful the EHS is getting.

https://herniatalk.com/forums/topic/herniasurge-what-happened-to-it-no-updates-no-contact-points/#post-34383

https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11195/full

Here is the list of members at that time, apparently. Notice that they still talk about HerniaSurge as an existing authoritative entity but only suggest contacting authors of individual segments directly if there are questions.

HerniaSurge Collaboration
F. Agresta, F. Berrevoet, I. Burgmans, D. C. Chen (AHS), A. de Beaux, B. East, N. Henriksen, F. Köckerling, M. Lopez-Cano, R. Lorenz, M. Miserez, A. Montgomery, S. Morales-Conde, C. Oppong, M. Pawlak, M. Podda, D. Sanders, A. Sartori, M.P. Simons (former EHS secretary for quality), C. Stabilini (EHS secretary for Science), H. M. Tran (Australasian Hernia Society), N. van Veenendaal, M. Verdauguer, R. Wiessner.

Herniasurge – what happened to it? No updates, no contact points

[Good intentions]

Here are the three Guidelines links, 2009, 2014, and 2018.

https://link.springer.com/article/10.1007/s10029-009-0529-7

https://link.springer.com/article/10.1007/s10029-014-1236-6

https://link.springer.com/article/10.1007/s10029-017-1668-x

[Good intentions]

I’ve been curious, actually fascinated, about how the massively influential “International guidelines for groin hernia management” got produced so have been collecting the documents about its development. The original document was produced by the European Hernia Society in 2009 and listed all of the authors. It was updated in 2014, again with all of the authors listed. In 2018 they created a new group that they called the “HerniaSurge” group, and described making supporting data available and ways to contact the group if there were questions. Since then the Group has gone almost completely dark, only appearing as buried references in various documents, under a changed name, the “HerniaSurge Collaboration”. I posted about this collaboration earlier in this thread. The web site link for the Group is dead. Their Facebook page has only a few posts. Basically all of the foundational work for the Guidelines is inaccessible. The document exists as gospel, referenced with confidence by surgeons around the world, but they don’t realize that it is now an empty shell and that the original authors seem to be second-guessing their work on it.

2018 was really not that long ago. Since then Dr. Campanelli has written several editorials in Hernia journal about the chronic pain from hernia repair problem, first proclaiming that the problem was real and describing a future collection and special issue about the problem. But then finishing the project with an Editorial that suggested that the problem was not real, and that it had arisen because people expected too much from life.

https://link.springer.com/article/10.1007/s10029-017-1668-x

Published: 12 January 2018
International guidelines for groin hernia management
The HerniaSurge Group
Hernia volume 22, pages1–165 (2018)

Here is one of 80 references to the HerniaSurge group, with a dead link to a web site –

“All search strategies, tables with articles and background information will be published on HerniaSurge’s website (https://www.herniasurge.com). All articles are filed per chapter in MendeleyR reference manager.

We would like to emphasize the fact that the “International Guidelines for Groin Hernia Management” is NOT a legal document, merely guidelines. If surgeons choose not to follow strong recommendations, they should do so in consultation with their patients and document this in the medical record. …”

[Good intentions]

It’s interesting that Dr. Conze is one of the original members of the HerniaSurge group, which seems to be a shadow group now. Is this the same Conze? J. Conze?

https://link.springer.com/article/10.1007/s10029-009-0529-7

Published: 28 July 2009
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients
M. P. Simons, T. Aufenacker, M. Bay-Nielsen, J. L. Bouillot, G. Campanelli, J. Conze, D. de Lange, R. Fortelny, T. Heikkinen, A. Kingsnorth, J. Kukleta, S. Morales-Conde, P. Nordin, V. Schumpelick, S. Smedberg, M. Smietanski, G. Weber & M. Miserez
Hernia volume 13, pages343–403 (2009)

[Good intentions]

Another update. Somebody has to be doing the math about how many new cases are being produced every day. If nothing is changing in the hernia repair field, and nothing is expected to change in the legal field, then, of course, these lawsuits will continue even after a settlement. It’s very simple logic. Who will end up paying for these payouts?

“May 15, 2023 Update
As the hernia mesh class action MDL involving C.R. Bard continues to drag itself towards a conclusion, large numbers of new plaintiffs continue to join. Over the last month, 206 more cases were added to the MDL. That swells the total number of hernia mesh plaintiffs to 19,476. Since the start of the year, 1,000 new cases have been added to the Bard hernia mesh MDL.”

[Good intentions]

For what it’s worth, Dr. Billing uses the TAPP mesh implantation procedure for his hernia repairs. At least he did when I talked to him. I can’t remember the type of mesh but I think he used the procedure taught at the Mayo Clinic when he was there as a resident. Smaller well-placed pieces of mesh, only covering the defect. Not the large “cover everything” method used today. Probably similar to the procedure used in the study above. He seemed confident in his results and he stays in touch with his patients. I can’t imagine that one of his former patients would not contact him first if they had pain. He mentioned one person that had pain but I did not get the details, and I don’t know how many hernia repairs he does per year.

[Good intentions]

Here is the 2007 paper again. It has more detail, and a different author line-up.

https://academic.oup.com/bjs/article/94/5/562/6142702

Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs
M Butters, J Redecke, J Köninger
British Journal of Surgery, Volume 94, Issue 5, May 2007, Pages 562–565, https://doi.org/10.1002/bjs.5733
Published: 19 April 2007

“Results
Hernia recurrence occurred in six patients after Shouldice repair, and in one patient each after Lichtenstein and TAPP repairs. All recurrences after tension-free repairs were diagnosed within the first year after surgery. Nerve injuries were significantly more frequent after open Shouldice and Lichtenstein repairs. Patient satisfaction was greatest after laparoscopic TAPP repair.”

[Good intentions]

Without reading the full paper and seeing how they performed the surgeries, and defined pain, and queried the patients, there’s not much value in the summary. The summary is not clear, and for some odd reason, a different primary author led the effort to rewrite and republish the study results. The link to the 2007 paper contains the full publication, with data.

You can find presentations by experts in each method describing ways to go wrong. Dr. Chen produced a video about the Lichtenstein method and potential problems.

Shocking numbers can be found pretty easily on the internet.

https://www.tandfonline.com/doi/abs/10.1080/00325481.2016.1121090