Good intentions
Forum Replies Created
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Repairing an asymptomatic hernia is a topic of debate in the hernia repair world. Because of what you are experiencing.
Ride it out and see where you end up. Your body will adapt, it’s really just a question of how and how much.
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You’re not really saying anything Pinto. Avoiding the questions I asked, and projecting them back at me.
I was planning to get a tissue repair, at either Shouldice or Dr. Brown’s place, but I believed a good friend of mine who was a surgeon, who believed what he was being told about mesh repairs by the Chair of Surgery at his clinic. Eventually I had the mesh removed, and my friend quit the clinic, a place he had been proud to be a part of, and erased any mention of it from his employment history. Not a word, just a big gap in time. He seems to be doing well at his new place of employment. But I have not talked to him since.
You and I are on the forum for very different reasons Pinto. You seem to be here for your own amusement.
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It is not my imagination. “Supporters” were shown for past meetings. Maybe they will appear in the Final Program. The meeting is still one month away.
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Nothing useful will come of belaboring the point, trying to “win” the argument. It’s a matter of opinion, and apparently, the use of language in a philosophical discussion, which is always the case in a discussion of philosophy. A person either believes that corporations can influence health care professionals for their own profit over the safety of the patients, or they don’t. And they can have different opinions on whether or not that is evil.
Pinto, feel free to start a new Topic defending the influence of the corporations in the field of hernia repair. Why did you decide not to use their mesh products? Why did you choose a tissue repair over a mesh repair? If you believe the marketing campaigns, mesh is “safe” and lowers your probability of recurrence dramatically. You chose a side and now you’re arguing against your own decision. Are you saying that the corporations are ignorant about their own products, and the surgeons that use them also. Can ignorance lead to evil results?
Explain your decision to ignore the mesh hernia repair device marketing, and your opinion will have much more weight. You can’t play both sides.
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You raise some good points pinto.
But when you consider the living hell that many people with chronic pain have experienced from mesh implants, and translate that living hell to a young child, an adolescent or teenager or even young adults, I don’t think that Satanic inferences are far off. Remember that Satan is often thought of as the cause for people to do bad things. The person is not inherently bad. They are being manipulated or tempted in to doing bad things.
Aside from the philosophical discussion, the comparison between Dr. Ponsky’s video and the Master’s presenter’s video is pretty stark. But, even Dr. Ponsky stops short of describing what the effects of early mesh implantation might be. People are really afraid to criticize mesh at these corporation-sponsored conferences.
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I had a thought to see how Dai Greene was doing and came across his Wikipedia page. Despite the horrible toll that a mesh implant had on his career and all of the publicity about it at the time, his Wikipedia page is clean of any mention of mesh or hernia. Very strange. Maybe there is a non-disparagement agreement in place.
https://en.wikipedia.org/wiki/Dai_Greene
Here is the Guardian story which I don’t see linked above.
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Here is Dr. Ponsky’s views on mesh in children.
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Profits before health. Joe Camel. You are correct in that it is not a good direct comparison once you get beyond the motivation. My point was that both big industries really have little concern for the long-term damage that they might be causing. If they can sell product legally they will do it even if they know that they are harming people.
https://www.lung.org/research/sotc/by-the-numbers/10-bad-things-to-entice-kids
You can see in this video that even though they are dealing with children (I consider 12 years old a child) they are still only focused on recurrence. No discussion at all about the long-term effects on the child’s body development. In other fields, like joint injuries, it is well-known, for example, that the growth plate should not be disturbed or it will cause the bone growth to have problems. Always focused on the perfect one-time repair.
This video was accepted by SAGES as representative of “state-of-the-art”. It is the Masters Hernia section of their conference. They are promoting mesh repairs for children. I will post another video from Dr. Ponsky giving his views on mesh repair in children.
The more you explore the more you see mesh being promoted for everything possible. I can’t imagine being a teenager and experiencing what I experienced when I had the mesh implants as a full grown worldly adult. I am sure that I would have ended up dead, by one means or another.
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Here are a couple of the videos, and a link to BD’s web site.
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Very strange that the European Hernia Society would promote a link from their Facebook page directly to the guidelines page. Even though they are coming up on three months behind schedule for the updated Inguinal Hernia Guidelines they promised in 2022.
This is from one day ago.
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Pretty sure that Amelia Aria is somebody using a Chat Bot on the site. A word salad that is vaguely related to the topic of the thread. All of AA’s posts are like this. It’s not a real person.
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Peripheral nerves do grow back. So, the point at which they are cut is important, and how the terminal ends are handled. As Dr. Bendavid has suggested, the environment in to which they regenerate might influence the feeling of pain.
https://www.frontiersin.org/articles/10.3389/fbioe.2019.00337/full
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One last thing that I realized – if the authors’ conclusions are accepted, then the chronic pain portions of the European Hernia Society Guidelines are based on flawed data. The authors excluded contemporary studies, meaning that they focused on the types of studies that the EHS used to create the Guidelines.
So, rather than no-change, maybe they will invalidate the Guidelines completely. Or strip out all of the chronic pain conclusions and go back to recurrence only as the measure for recommendation.
Hard to see anything good for patient welfare resulting from what’s going on in the industry. Except the refinement of robotics methods for mesh removal.
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The Journal of Abdominal Wall Surgery is an Official Journal of the European Hernia Society. The EHS, the same group that is updating the Hernia Repair “Guidelines”.
The deeper you look the more you find the same people that were involved in the beginning. Any recommendations for change will contain an implicit conclusion that the original Guidelines were flawed. They are all stuck.
I hope that I am wrong but all signs seem to be leaning toward no change, no improvement.
https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery
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Here is an example of work done to clarify the situation that the authors say they are attempting to clarify. Linked at the bottom of this post. If you take the authors’ word in the conclusion then it is useless.
Actually, each time I look back through the work I find that it is almost identical in poor quality to the work that they say is of poor quality. It’s very meta. A work of poor quality about work of poor quality. The more you look the more you see that is a study with an agenda.
Here is a selection of statements that should have caused the paper to be rejected. Actually, anyone can read the Limitations section and probably come to the same conclusion I did – this paper has no value. But it was published in a major journal.
“Limitations
This study is an informal review of 20 high-impact studies. It is not a comprehensive systematic review of the entire literature, and due to the nature of this study, it does not include more contemporary research.”“The applied search engine, Google Scholar, is an excellent source of freely available bibliometric data, however, it does provide some limitations.”
“Google Scholar only allows for access to the 1,000 most relevant search results for any particular search query, and thus, the literature search in this review cannot be considered entirely comprehensive [58]”
“In this review, the inclusion of studies was partially based on the overall citation count of each study. This was a pragmatic approach, and the number of citations is only a surrogate measure of study impact or quality, and the reliability and accuracy of this measure is debatable.”
“For the reasons above, we do not claim this study to be exhaustive. Nevertheless, the results and conclusions remain valid for the included studies.”
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I think that there is great value in the work. But the paper took the work and interpreted it in to a bland and useless conclusion. The authors could have pulled the good from the bad and drawn some useful conclusions. But they chose to paint all of the past studies with the same broad brush. They even took what they called bad studies and drew a conclusion. Very very unprofessional and I think it shows a bias that they probably don’t even realize that they have.
“likely exaggerated” is an unfounded conclusion, based on their own evaluation of the quality of the work. If the studies are inconclusive then the statement is a simple opinion based on bad data.
“In this review, we have explained and demonstrated that the chronic pain rates conventionally reported after inguinal hernia repair in the literature are obsolete, probably inaccurate, and likely exaggerated.”
There are other studies from years ago that have drawn similar conclusions. Some professionals, like the Carolinas group, have attempted to create new surveys/questionnaires that produce more useful data.
I just found it somewhat pointless to publish a paper that actually gives cover to any surgeon or medical device maker that wants to continue on with their bad materials and procedures. Any one of them can point to this “work” as justification for doing nothing.
When you look at the last year in sum, what started out as an overall well-meant effort to understand and improve the chronic pain from hernia repair issue seems to be petering out in to nothing.
I am going to guess that the “Guidelines” update will either be delayed indefinitely or will have essentially no substantive changes. The professional and business benefits of doing nothing are far greater than changing.
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The EHS Facebook page is up to date. They have a notice about the new Hernia issue on chronic pain. Apparently they just had a board meeting two days ago. They had to have discussed the delay in the new Guidelines. Nothing wrong with delaying if they are attempting to get things right but they really should be providing updates. And there should be a note on the current web page that the Guidelines are out of date and new ones are coming.
It’s a good place to catch links to new papers about hernia surgery.
https://www.facebook.com/people/European-Hernia-Society/100070922043834/
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The special issue/collection on chronic pain after hernia repair is out now. Some of the articles are open access, some are pay-per-view. I have posted links to several of them in the past.
I have not looked through all of them but I don’t see any signs that there are suggestions for improving outcomes, identifying possible causes, or recommending that certain products or methods be avoided. It looks like the typical report of how things are now, confirming the seriousness of the problem, but not suggesting a path forward. Even Dr. Campanelli’s editorial is deflating, as it comes close to victim-blaming in its tone, and falls back on the large number of surgeries performed as somehow justifying the large number of chronic pain cases. Ignoring the concept of percentages or ratios.
Anyway, it is a decent summary of the current state-of-the-situation from professionals in the field.
https://link.springer.com/journal/10029/volumes-and-issues/27-1
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Your whole situation seems very normal. The Progrip mesh has an absorbable component so there will be more change over time. Many people feel like they can feel the mesh inside after surgery.
I hate to say it but there is nothing that is commonly done for issues like yours. Most imaging methods cannot “see” the mesh or the people looking at the images don’t know what they’re looking at so there is no way to tell if the mesh has folded or moved.
Your surgeon has already told you to wait at least six weeks and you’re only four weeks out. You don’t have pain, just numbness and some internal irritation. It is almost certain that at your next meeting the surgeon will tell you to wait longer and see how things resolve. The standard protocol today if patients complain of pain is to refer them to pain management. There is no surgical procedure for re-adjusting the mesh if you feel like it is folded or has moved.
Ultimately it will be up to you to decide whether or not to persist in trying to make things better. Pain can be managed with pharmaceuticals but numbness just requires time and waiting for the body to respond.
But, it is still very early. At four weeks you should be okay with walking and light exercise. I found that sometimes more activity was better than rest to make things feel better. If you are just resting and taking medication you might think about getting out and about more and seeing what happens. Keeping a log of activities and their effects can help also, as you try to get back to normal.
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Your path to surgery and where you’re at now is very common, including going in for a single hernia and getting both sides repaired instead. Three entry points is probably a typical laparoscopy, not robotic. All that you can do is wait and hope. You have a good chance of being fine. Numbness is bothersome but is much much better than pain. Take it easy, but stay active. The mesh is still being surrounded by new tissue that your body is creating.
Not to make you worried but if there was nerve damage during surgery there is nothing that a surgeon can do to fix it. Many of us that have had surgery have had odd nerve sensations and numbness. I have. But your body will continue to try to get back to where it was.
Good luck. Don’t worry too much about it. What’s done is done.
You really should get your surgery records if you want to understand more. All you have to do is call and ask. They are yours.