Good intentions
Forum Replies Created
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Why would everything in the Library of the EHS be for members only?
https://europeanherniasociety.eu/category/video/
Here is what they provide for patients that happen to find the site. Embarrassing to watch. (Beside the word patient being misspelled.)
The EHS also has no Mission Statement. What is its purpose? The more you look the more it looks like a front for the medical device companies.
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If you scroll down to the German Hernia society on the EHS chapters page and open the + button you’ll see some familiar names. Kockerling, Conze, Lorenz. I think that William might be right to focus on what’s happening in Germany. They don’t seem as tied to mesh as the EHS is. The EHS started the push to mesh and is fully invested in promoting its use, no matter what.
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Here is more from Dr. Wiese’s bio.
https://www.chirurgie-hessen.de/Martin+G.+Wiese
“Since my training in the clinics of the Main-Taunus-Kreis Bad Soden under Professor Peter Wendling, I have increasingly dealt with the topic of hernias, i.e. soft tissue fractures, in addition to general surgery. Since then I have helped to develop new procedures and have been a guest center for hernia surgery for years, and since 2016 also for international guests. With us you get an individual concept for the care of your inguinal, navel or incisional hernia, also in cooperation with neighboring clinics. A specialty is chronic groin pain and groin pain in athletes. I regularly give lectures on these topics and have performed several live pre-operations at international congresses.
Since 2016 I can be found in the Focus list of top physicians for hernia surgery without interruption.
Along with PD. dr medical Guido Woeste, I am the conference president of the German Hernia Society 2022 and a member of the extended board of the German Hernia Society.”
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I got back on to Dr. Wiese’s practice web page to see what types of procedures he performs. It looks like he has the ability to do several and chooses the one that he feels will give the best results. In another current thread there is much discussion about how surgeons tend to be “one-trick ponies”, only performing a single type of hernia repair. This is the training that today’s surgeons get, to use only mesh for hernia repair, codified by the suspect Guidelines that the EHS promotes. Very interesting that Dr. Wiese is there in Europe but chooses his own path.
Here is the text from the web site, to add to Freeman’s report of receiving a Shouldice type repair.
https://www.chirurgie-hessen.de/Leistungen
“Hernia Surgery
Individual concepts for the treatment of inguinal, navel and abdominal wall hernias, including incisional hernias
Training center for years and now international internship center and Milos training center
Conference President of the German Hernia Society 2022 together with PD. dr medical Guido Woeste
Member of the extended board of the German Hernia Society
Inguinal hernia operations with and without synthetic mesh
Abdominal wall hernias with diastasis recti using the MILOS technique
Second opinions and advice for athletes” -
Thanks for posting your story Freeman. It is great that you had a good result and know some of the details of the method.
I found a link to Dr. Wiese’s profile on the internet. It is in German but anybody can use Google to translate it.
https://www.chirurgie-hessen.de/
Also, the jameda link –
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How do you know that guy knew what he was talking about? He’s just one guy. There was probably another guy right down the hallway that would have a completely different opinion.
The guy said that they were “seeing new chronic pain cases on a weekly basis”? What does that mean? How new, like one week old, or one year since surgery? How does he know that lap mesh has a lower rate if they don’t know what the rate is for Shouldice? The conversation has the hallmarks of somebody who wanted to seem knowledgeable, but was not. Or somebody who gets their knowledge from General Surgery News.
Anyway, it’s good that the people at Shouldice seem to be continuing to learn about hernia repair in general. If they are quantifying recurrence rates then you’d think that they would be quantifying all of the “new chronic pain cases”.
In the big scheme of things, the lawsuits will still have the biggest impact I think. Money will be the driver of change. I just found another new paper about “surveillance of medical devices” that I will post.
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Four months in to 2023 and still no sign of updated Guidelines. And the link to the newsletter does not work anymore.
EHS seems to have revised their web site. Some material that you’d think would be free is members only.
https://europeanherniasociety.eu/do-mesh-devices-make-hernia-repair-easier/
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Here is an interesting (to me anyway) old Topic about the Guidelines. Post #18513 especially, two posts above this one. Dr. Bendavid is one of the few surgeons who actually did focused work on trying to understand why mesh causes pain.
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Watchful, your commentary doesn’t really say anything. It has little substance. You’re implying chronic pain equivalence based on a few forum stories and some comments from a few surgeons. “A number of people on this forum”? You know better, you spent all of that time using real research methodology before you chose Shouldice. Now you’re doing something else. Using vague words like “most” and “significant”. That is exactly what the mesh repair surgeons do.
Post up the studies you mentioned. The numbers matter. People get killed riding bicycles but that doesn’t mean that bicycles are just as dangerous as cars.
” Chronic pain is a significant issue with tissue repair as well as with mesh. It’s hard to know the exact chronic pain numbers for different types of mesh procedures, and tissue repair procedures, but it is known that tissue repair has a significant incidence of chronic pain and discomfort. There are a number of people on this forum with that problem after tissue repair (including me), studies show this problem, and most tissue repair surgeons (including the Shouldice Hospital) admit that this is an issue.”
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Here it is. The authors choose whether or not to pay for open access. Dr. Netto and his co-authors, most of who work at Shouldice, chose the paywall.
https://www.springer.com/journal/10029/how-to-publish-with-us
“Hernia is a Transformative Journal (TJ). Once the article is accepted for publication, authors will have the option to choose how their article is published:
Traditional publishing model – published articles are made available to institutions and individuals who subscribe to Hernia or who pay to read specific articles.
Open Access – when an article is accepted for publication, the author/s or funder/s pay an Article Processing Charge (APC). The final version of the published article is then free to read for everyone.
Hernia is actively committed to becoming a fully Open Access journal. We will increase the number of articles we publish OA, with the eventual goal of becoming a fully Open Access journal. A journal that commits to this process is known as a Transformative Journal.”
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Shouldice can publish the paper on their own web site. And the Hernia journal also publishes open access articles. If you want to add to the discussion, find out out how the decision is made to publish as a pay-per-view versus open access. Who makes that decision?
I am actually disparaging the hernia repair industry in whole. “They” (the people involved in the industry) have created a narrative of “informed consent” but the information that the patients need to be informed is often hidden behind paywalls.
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What type of hernia will he be repairing? How active are you? How did you get the hernia? Those are interesting questions, I think.
Good luck.
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It is saying that the type of recurrence is indirect more often for laparoscopic. The type, not the quantity. In other words, the surgeon is more likely to find an indirect recurrence in a patient that had laparoscopic surgery than in a patient that had open mesh or Shouldice.
The terminology is not very good in that strictly interpreting “recurrence” should mean that the same type of hernia re-happened. If the patient started with a direct hernia then came back with an indirect hernia that would, strictly speaking, be a new hernia. Not a recurrence. “Recurrence” is imprecise.
They also take the lax approach of, as far as can be told from the short summary, lumping all types of lap surgery and all types of mesh in to one pile of “lap mesh”. It seems wasteful to compile all of that data then do such a poor job of learning from it.
It is interesting though that Dr. Netto, who seems to have the urge to get involved in the hernia repair narrative, chose this topic to research. Trying to define the type of recurrence (or occurrence) to be expected from the type of repair. Not really clear why he thought that was important.
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It might be worthwhile to revisit some of the possibilities from the past. Here is an old Topic about Dr. Repta.
https://herniatalk.com/forums/topic/open-mesh-removal-and-non-mesh-hernia-repair-dr-remus-repta/
Open mesh removal and non mesh hernia repair-dr. Remus Repta
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Chuck and Harry, your stories are so similar you could be the same person. Writing styles and opinions too. Very interesting.
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I select and copy everything that I wrote before I hit the Submit button. I’ve lost a few posts in the past.
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A thought that I just had – any surgeon out there that uses the Bassini method will probably be considered an eccentric. Mesh has grown in to the repair field at a steady rate through the training programs at places like the Mayo Clinic. Many or most surgeons in practice today never learned how to do a pure tissue repair method.
So, when you’re talking to various medical professionals, like nurses, doctors or surgeons, ask about the oddballs that don’t use mesh or those that know the “old arts”. Many of them have probably converted to mesh or laparoscopic but there are probably resisters out there. It is dangerous to leave the herd though. They will not be “state of the art”.
Can you share some details on your mesh ordeal? The type of hernia you started with all the way to mesh removal, if you can stand reliving it. Every story is helpful in showing people what is happening out there. How even the smartest people get fooled (including the surgeons).
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Here is an older Topic from someone who was talking to a surgeon who used the Bassini method. She did not find out if it was the modified or original method though and has not been back. His name is in the last post, Dr. Wade Rosenberg, of Texas.
https://herniatalk.com/forums/topic/found-a-tissue-repair-surgeon-have-many-questions/
This is probably him –
https://www.houstonmethodist.org/doctor/wade-rosenberg/
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I have not had a recurrence. Dr. Billing did leave a small piece of mesh in the area of the original hernia though. He said it was too tangled up with critical structures to attempt its removal.
If I did have a recurrence or a new hernia I would seriously consider Dr. Kang. But I would probably also contact Dr. Billing again, because he is, to me, obviously very thorough and rigorous in choosing the best surgery for his patients. I am fairly certain that he has converted to open surgery from lap in the past, at times, and knows the anatomy well. It would be interesting to know if knows the difference between the original Bassini and the modified Bassini, and which he would choose. He started as a lap TAPP mesh surgeon but apparently has a robotics system now.
I would also spend some time researching smaller names in the hernia repair field. We are all so used to the internet now we tend to overlook people that are out there but not active or talked about on the internet. I just moved to a new place and had to find a new dentist. I was surprised at the variation in ideas about care among the few dentists I talked to. I also realized that my previous dentist had been very good.
There are good skilled surgeons out there who are just not well-known.
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It’s hard to find a clearly described comparison of chronic pain rates between the two methods. And, of course, each attempted study mashes all of the lap methods and meshes in to one big pile. Then they run the statistics and report a “significant” difference.
To the average person the word significant means “a lot” or many or something largely positive. In the world of statistics it just means that a difference can be quantified using the statistical methodology chosen. Samuel Clemens created a famous quote through his Mark Twain pen name – “Lies, damn lies, and statistics”. It could be 13% versus 15%.
Here are a couple of recent papers. It’s interesting that the other big selling point for lap mesh (the blob of materials and methods), recurrence, appears to be the same. Statistically.
https://link.springer.com/article/10.1007/s10029-019-01989-7
In this one, below, they can only “suggest” that lap mesh is better for chronic pain. Decades on and this is the best of the best – can’t really tell. People really should focus on how to fix the problem if it occurs. Include that in the how to avoid it calculation. Lap mesh removal is drastic.
https://link.springer.com/article/10.1007/s00464-022-09161-6
“Conclusion
Meta-analyses suggest that laparoscopic repairs have a lower incidence of chronic groin pain than open repair, but there is no evidence of differences in recurrence rates between laparoscopic and open repairs.”