[Good intentions]

Here is a link to Medtronic’s Progrip pages. They just introduced a polypropylene Progrip to complement the polyester.

https://www.medtronic.com/covidien/en-us/search.html#q=progrip

[Good intentions]

Six months, 1/2 year, past the committed-to deadline and still not a word about the update or the delay. Five years since the original commitment of update every two years.

It’s really looking like there’s either conflict behind the scenes or that they are just going to pretend that the commitment was never made. It must be disappointing, and embarrassing, to be a part of the whole fiasco.

The law firms certainly must be aware of the Guidelines, and should be aware of these statements about updating them to keep them current. If I was a law firm I would dig in to what is happening with this group, which now seems to be called the Herniasurge Collaboration. The whole foundation of the Guidelines was built on it being supported by a professional organization, with a contact point, and known members, with regular updates to the Guidelines. All of that has changed, in strange ways, with regular names changes and dead web sites and Facebook pages, and the commitments have not been kept.

[Good intentions]

Another update from the Lawsuit Information Center web site. The number is huge and it’s just a single person. And the foundation of the case was built on the material used, so it could be used for suits involving all devices made using that material.

It’s not polypropylene and it’s not an inguinal hernia repair device but still interesting that juries believe that the damage is real and that Bard bears responsibility.

I pulled a few of the past reports together. PET is polyethylene terephthalate, called “polyester” in a typical knitted hernia repair mesh. Polypropylene and polyester are the two main materials used in the meshes.

“May 25, 2023 Update
The Rhode Island judge in Trevino took $250,000 off the verdict but left $4.55 million intact in post-trial motions. It is hard to understand the logic behind reducing the jury’s award by even a penny after all that plaintiff has been through based on the evidence offered at trial. But in the big picture of things, the judge’s ruling is a win because leaves the lion’s share of the award intact and affirmed the key rulings that Bard had opposed.

…

August 29, 2022 Update

We have a verdict from Rhode Island: $4.8 million. Paul Trevino’s lawsuit alleged that C.R. Bard’s Ventralex hernia patch eroded into his bowel because they chose the materials they used based on price instead of safety. The jury agreed, finding both that the design was defective and that Bard to failed to warn of the risk. I’ve been saying all along I have no idea why Bard let this case go to trial. But the settlement value of Bard hernia mesh cases just went up.

August 26, 2022 Update
We could have a Rhode Island state court verdict today in a Bard Ventralex patch case, Trevino v. Bard …. stay tuned.

In Trevino, the plaintiff claims that the defendants knew or should have known that the PET ring, a component of the Ventralex Mesh, was prone to breaking or buckling, thereby increasing the risk of severe, permanent injuries. Despite these risks, the defendants intended for their product to be implanted for the purposes and in the manner that the plaintiff and her implanting physician used it.”

Here is the link.

https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html

[Good intentions]

Watchful was probably referring to the words below. The notes imply that it was problematic/unexpected, and had occurred recently, but “nonetheless” they got things done.

“bulky intact transversalis muscle that had just separated from the inguinal ligament. Nonetheless, we were able to get good reapproximation of the floor and reinforcement with mesh.”

It looks like you had a normal Lichtenstein repair. You can find quite a bit about it on the internet, and Youtube.

On the pain at night, of course, there are normal bodily functions that happen at night for men. It might be related to that. You say that you have to take ibuprofen but I wonder what would happen if you just walked around for a bit. It seems odd that a pain would appear for no reason and remain.

Anyway,as Watchful said, it’s early. Tissues got stretched out of shape when you had the hernia and then got stretched back to where they were supposed to be when you had the repair. You might try adding some things to your walking routine. Weights or stretching. See what happens. Good luck.

[Good intentions]

Some of the open mesh repairs extend all the way down to the pubic bone. That could cause pain/sensations much lower than the external incision point. There is a variety of methods and materials described as “open mesh”. That’s why I asked for details. Good luck.

One example –

https://www.hindawi.com/journals/srp/2016/6935167/

[Good intentions]

What type of activities have you been doing during the day? I have found that sometimes more activity is better than less for pain after surgery. It’s counterintuitive.

Can you share the details of the repair method? Lichtenstein, plug and patch, PHS? And the type of hernia that was repaired.

[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