Good intentions
Forum Replies Created
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I only looked at the web page advertising the clinic. You mentioned a pdf file, I did not see it. It looks like you’ve checked his publications also.
Regardless, he is apparently, a Lichtenstein surgeon who uses Progrip mesh. I would guess that 99% of the web pages and brochures advertising a surgeon’s clinic all do the same thing. They show their knowledge by describing possible causes of pain, describe how they do their repair, and give no firm data about results. The closest Dr. Sadler got is “appears to be about 2%”. They use vague terms like “vast majority” and “very small” but then show that they really have no idea if their patients are doing well or not. “Endeavor to try”, “all possible steps”…he means well.
Sorry to be so critical but his web page shows that he’s just a guy who does the Lichtenstein procedure using Progrip mesh. If you want to use the one patient sample size to judge his quality, I am fairly sure that I have seen a post on the site from somebody that had Lichtenstein with Progrip.
I found this with a quick search – https://herniatalk.com/forums/topic/anyone-got-their-mesh-removed-by-dr-muschaweck/
Again, no offense intended. Just applying the critical eye to what he says. It’s a typical sales pitch.
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I don’t see him mentioning chronic pain. I pulled out a few sections below. Overall it is the typical “this is what I do and why it’s better” presentation that most hernia repair surgeons use.
The front page is odd in the way he describes using the most Pro-Grip mesh of anyone in the UK. Who would care about that, why would it matter? I think he’s trying to benefit from Medtronic’s marketing of Progrip. Riding the Pro-Grip bandwagon.
“Mr Sadler now only performs local aneasthetic hernia surgery. He is the largest single user of ProGrip mesh in the United Kingdom (approximately 4000 procedures) and has performed almost 6000 career hernia operations.”
“Oxford Hernia Clinic was pleased to be the first hernia clinic in the UK to use ProGrip™ as its preferred mesh for hernia repair and we are currently the largest user of the mesh in the UK, having performed over 4000 procedures.”
Here is one reason doctors and surgeons don’t show any interest in determining whether a hernia is direct or indirect.
“There are of two types of inguinal hernia, direct and indirect. For patients this distinction is irrelevant as the same operation fixes both types.”
He says “less painful” but does not mention long-term pain. Looks like it’s faster and cheaper. Those are good things, of course.
“Open repair is the most commonly performed procedure for inguinal hernia surgery and for the majority of hernia patients would be the technique of choice. After over 5 years of laparoscopic repair Mr Sadler reverted back to this technique because he believes when performed under local anaesthetic using it is quicker, more effective, less painful, safer (complications are very rare and less harmful compared to keyhole surgery) and far more cost effective for self paying patients compared with general anaesthetic.”
“After performing TAPP (and TEP) for many years, Mr Sadler no longer performs any keyhole surgery, favouring local anaesthetic repair (even for bilateral hernias) as he believes it is safer and more comfortable for patients.”
He uses the typical way of downplaying other methods with vague statements about risk. Mentions informed consent. Doesn’t give any numbers.
“No Mesh Technique (Bassini Type) Repair
We can repair your hernia with a “No Mesh Technique”, this is called a Bassini Type Repair, after the surgeon who described the technique in 1884. This is remained the standard way of fixing a hernia for over 100 years until the “tension free Mesh technique” became more popular. The technique works very well and many patients who had this type of repair have never had any problems.However, a ‘No Mesh Technique” will not reduce the chance of having chronic discomfort after surgery (it may even increase) and statistically your hernia is more likely to come back, especially if it is a direct hernia. Mr Sadler will discuss this option with you as part of your consent process.”
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Replying to watchful – I wonder what the Munich Hernia Center would have recommended. Linked below, I posted it in William Bryant’s Topic.
I see people on the forum doing what is done across the hernia repair industry, in over-simplifying, and suffering from the “recency” effect. The last thing they read or their strongest memory becomes their personal “status quo”. If you don’t look at the statistics you’ll end up with a different conclusion every week. The shameful thing is that we, the patients, should not have to do all of this work. The pros should have the answers for us. They don’t. Businesses are focused on getting the customers (the patients) in and out and paid up.
https://www.hernia-centre.com/hernia.html
I don’t know if they actually follow this path (every hernia repair center ad looks about the same), but they do lay out what looks like a logical approach.
“INGUINAL HERNIA SURGERY REQUIRES AN ACCURATE DIAGNOSIS TO BE MADE FIRST
Your doctor will only be able to determine which option is best for treating your inguinal hernia after a detailed examination.
Only once an accurate diagnosis has been made will your doctor draw up a meticulous plan for surgery with you and explain to you in detail what happens next.
Given that there are a great number of techniques and surgical methods available, your physical condition and past medical history will also be taken into consideration.” -
Not sure if these are the same video relabeled.
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You might have some luck looking at their repair centers and their publications.
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Here is the sequence of statements Mike M. Watchful must have been feeling down, he interpreted your words in the worst way and added his own. Sorry watchful, I know you’re disappointed about your results but your path to Shouldice was correct, based on the hernia that you thought you had. Your real problem is the poor diagnosis in the beginning, and the fact that surgeons, generally, lock in on a technique instead of having a broad skill set that allows them to choose the best option. That is, I think, a more general failing of the medical profession. Another example of surgeons doing what they do, so the diagnosis doesn’t really matter. Shouldice surgeons do Shouldice, lap TEP surgeons do lap TEP, robotic equipment surgeons do robotic lap TAPP.
Post #34620 Mike M: Pain was only bad that first week. Some tension the weeks that followed and then it fades into nothing. I can still feel something in that area but nothing of mention. You can only really feel the scar tissue the first few months maybe. The nerves seem settle down and accept the repair after a while. I am starting to “forget” I even had hernia surgery now which was the end goal.
Post #34621 watchful: This doesn’t sound so great. Having symptoms for months after surgery, and still feeling something there after a year (even if minor) isn’t great. Not bad, but not the most desired result. We need to remember that you didn’t even have a large hernia.
Excellent discussion with hernia genius JF–Watchful bryant pinto..mike m
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I should add also say that the one of the major flaws in almost every discussion of hernia repair is the lumping of all materials and techniques in to simple categories. “Mesh”, “lap”, “open”, are about as vague and undefined as can be. Now “robotic” has been introduced, as somehow separate from laparoscopy, but it’s not separate. It is actually robotic laparoscopy. The tools are controlled remotely, and moved by machinery. One of the early problems in robotic lap is that the feedback to the controls in the surgeon’s hands was poor. In other words they couldn’t tell how hard they were pulling or pushing. So, somewhat ironically, the surgeon can see more clearly, and pause to think, but has less ability to manipulate what they are seeing.
Anyway, the situation is so varied and complex that it’s easy to understand why even the pros fall back on vague and undefined descriptions of what they do. Something that people should always be aware of.
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Watchful, could you provide some references or at least more commentary about your opinions below?
Not to insult you but I’ve noticed that you seem to be trending away from the logical and rigorous approach that led you to Shouldice. Your statements are getting vague and as you say below, “generalized”. “least bad”? What does that even mean?
Again, no offense intended. I just hate to see people slide down that path of falling for the marketing and advertising, or, in your case, doubting that the good research work they did was the right way to do things.
A couple of quotes from your posts above –
“However, if I knew mesh was the way to go in my case, I would seriously consider lap mesh instead of open. You and a couple others here had a bad experience with it, but it seems to have better results overall based on studies.”
“I think that objectively and generally speaking, it has been shown to be the least bad approach all things considered. “
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Here is another reason a surgeon might pay for the accreditation. Marketing services. Never overlook that the practice of medicine is also a business.
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12 x 20 is a large piece of mesh. Was it placed for an incisional hernia or an injury of some sort? That might be part of the reason surgeons don’t want to mess with it. There is probably no viable alternative for repair after they remove it.
Dr. Muschaweck and her colleagues are probably your best possibility. She is very active in making her services available around Europe. Good luck.
https://www.fortiusclinic.com/specialists/dr-ulrike-muschaweck
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The surgeon who implanted the mesh in me was part of one of those, almost identical. I was impressed and thought it meant something. Really though, I think, it’s just side-money. “Non-profit” just means that all money collected is spent on operating the business. That includes salaries of the employees of the non-profit.
It’s just a place to get a certificate that says you do things a certain way. There is nothing in the requirements about positive results though.
It is interesting though that they apparently have an “Outcomes Database”. That’s what I would want to see. Ask to see that if you talk to the surgeon.
https://www.surgicalreview.org/wp-content/uploads/2022/10/MS-Hernia-One-Pager-101322.pdf
“7. CONTINUOUS QUALITY ASSESSMENT
All applicant surgeon must collect outcomes data on all patients who undergo hernia surgery procedures in SRC’s Outcomes Database (or a similar qualifying database).”The surgeon pays, provides supporting data, and gets a certificate.
https://www.surgicalreview.org/medical-professionals/programs/
Click through the menus on the left to see what the business is about.
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An interesting Editorial in Hernia from Dr. Campanelli. I don’t think that he understands that the people that control the narrative, by controlling the money, end up controlling the consensus. It starts with education. The societies funded by the corporations run the schools that he appears to be talking about.
He should write an Editorial suggesting full transparency about where, exactly, professional societies get their funding, in order to allow people to trust the various societies’ motives. Many nonprofits have their accounting information available on their web sites. Free for all to see. There is nothing on, for example, the EHS web site except the Sponsors page, full of logos of the device makers. It is very hard to imagine that there is no connection. Mesh is the EHS logo.
https://link.springer.com/article/10.1007/s10029-023-02788-x
EDITOR’S CORNER
Published: 15 April 2023
Evidence, consensus and schools of hernia surgery
G. Campanelli
Hernia (2023)“…
And consensus gathering becomes even more commendable when it is supported by the schools of hernia repair and abdominal wall surgery that are run by the relevant national scientific societies. …” -
Never mind, I found it. Overlooked it the first time. Good luck.
“he spent thousands of hours researching hernias…traveled all over visiting surgeons…”
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Who is JF? If he wants to stay anonymous, what are his qualifications, at least?
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I don’t know how big it was. I had a visible peaked bump, probably about one inch wide and 1/4 inch tall (guessing) when standing that disappeared when laying down. It was only a problem after intense physical activity. Not during, but after, like the day after a soccer game I would have pain while raking leaves in the yard. Occasionally things like a twisted testicle would occur. The pain and problems always resolved after a few days. I was aware of the issues with hernia repair and had decided to try to live with it and keep doing the things I wanted to do.
Eventually it was a choice of giving some things up or having surgery. I was leaning heavily toward Dr. Brown or Shouldice but then found the head of surgery at a big clinic who was part of a group that trained people in laparoscopy, who also had a very good referral from my friend who was a surgeon (in a different specialty) and had had his own hernia repaired years before. I found out afterward that he had had a Lichtenstein repair. I also found out later that my surgeon was still fine-tuning his implantation method from the year before but he never said what he was trying to fix. I also found out later that he had had a semi-professional soccer player as a patient before and the patient had ended up going to Florida to have his mesh problems worked out. Yet he still took a chance on me.
My experience has all of the hallmarks of what is wrong with hernia repair today. Surgeons mindlessly doing what they do, because it is what everyone else does, and they can’t admit mistakes. If my surgeon had been honest he would have discussed the problems that he had with the other soccer player with me before he accepted me as a patient. But he hid it from me and downplayed it later. Pretended that he didn’t know why the guy had problems. But he did know that there were problems with the repair that he did.
In the big scheme of things my big mistake was not trusting my own judgement, using what I had learned about hernia repair at the time. There was really no reason for me to believe that the surgeon I chose was any different from all of the other hernia repair surgeons. They are all learning from the same sources. People like Dr. Felix, traveling the world giving presentations about the 10 Golden Rules, and the Repair Guidelines that were sponsored by Bard and Ethicon years ago.
If I was starting over I would trust the most the surgeon that can clearly describe the pros and cons of each repair method. The ones that can only talk about “here’s what I do” are really just automatons.
Sorry for the diatribe. It really is a dangerous and difficult process. Good luck.
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Here is the last notice about the updated guidelines. From the EHS newsletter of October 2022. The prior newsletters seemed to be about every 3-4 months. They are way behind.
https://www.europeanherniasociety.eu/ehsnewsletter18
And here is what appears to be the official EHS publication, according to the newsletter. I would expect the updates to be published here, possibly. The scrotal inguinal hernia guidelines are.
https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery
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I just realized that even the EHS has a piece of mesh as part of their logo. Basically they are flying a mesh flag. It is really very strange. It’s almost like worship.
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Here is a short reminder/summary of where my cynicism and skepticism come from. Dr. Towfigh provided the LinkedIn link above, recopied below, that showed that HerniaSurge is an extension of the efforts of the European Hernia Society (EHS). Supposedly they were almost finished with the updates to the 2018 Hernia Repair Guidelines, which were originally supposed to be updated every two years. So far there are no updates, only a new subset of Guidelines for scrotal inguinal hernias.
We are now three months past the promised date. There is no sign that some significant event has occurred that would cause a delay. What is going on? I see now that they only promised “recommendations”, with a publication of some sort. Where is it? Who decides on whether or not to update the Guidelines with the recommendations? Even if there is no change there should be a communication about the results.
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Hello watchful. One of your paragraphs caught my eye. I think that you have over-simplified, maybe kind of extrapolated from how easy it looks to implant the mesh. The thought that the peritoneum is a weakly attached membrane that can be easily peeled from the fascia, to allow a piece of innocuous woven plastic mesh to be placed between it and the fascia.
I am at five years plus since mesh removal and the area that has had the peritoneum peeled off of the mesh, repositioned, and sewed back together is not really close to the way it was before surgery, although some fo my past posts seem hopeful. It is still stiff and gets sore after things like extended walks. It is much better than with the mesh but the damage that was done is still very obvious, even today. I still feel like somebody who suffered a severe accident eight years ago (a mesh-based hernia repair) and is still recovering. My broken collar bone and damaged ankles and knee all seemed very significant when they happened but they have recovered to a much higher degree than the ravaged mesh area.
“One last thing on this is that most tissue repairs (including Shouldice) aren’t really reversible. The anatomy is changed, and you can’t go back to the original if you have problems. With mesh, you can have the mesh removed. This can be a difficult and complex surgery, but it’s at least possible to get pretty close to a “normal” groin since the anatomy isn’t modified.”