Good intentions
Forum Replies Created
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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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Thanks for the links and the quotes Watchful. I don’t really know what to make of them. Glib comments are often the ones that last.
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Progrip has an absorbable/degradable polymer component that might explain your autoimmune issues. It takes a while for the polymer to fully degrade, I posted a link below.
Spend some time and read the posts on the forum. As a person who was very active you probably understnad what your body is telling you. Mesh removal is mainstream now, a standard area of expertise that many surgeons are learning and touting. Robotic surgery methods are being developed to make mesh removal easier and safer. It’s just the new reality.
If you do decide to have the mesh removed be very careful in who you choose to do it. Two names that seem to get good results are Dr. Belyansky and Dr. Peter Billing.
One thing that I found when I was trying to live with mesh was that sometimes being more active actually made the pain better. I attributed it to getting fluids to move through the new poorly vascularized tissue around the mesh. If you’ve been holding back thinking that rest is best you might try to get some workouts or runs in and see what happens.
Good luck and sorry that that you’ve been caught up in the mesh mess.
Here is the link to the Progrip product, which is owned by Medtronic now. Polylactic acid (PLA) is the material that the little knobs are made from. It is unclear how long it takes for all of the PLA to disappear. 40% of the mesh is PLA.
Here is a link that actually mentions PLA.
“ProGrip™ Technology in Abdominal Hernia Surgery
Provides immediate tension-free fixation on the entire surface of the mesh – and offers surgical efficiencies and patient benefits.2,3
It does this by combining monofilament polyester with a resorbable polylactic acid (PLA) microgrip technology. So surgeons get immediate fixation that is strong, durable and comfortable.3,4,5” -
I wasn’t aware of that. Do you have a reference? I have not seen any stories about his opinions on cutting nerves.
His work on mesh-caused pain seems logical. And it leads to ideas for possible changes in the design of mesh. But, the mesh makers control the product design even though they don’t understand the medical side, and the surgeons control the medical side but don’t understand mesh design. Besides the fact that creating a new pattern of knit knots is cheap and easy to get through the 510(k) process. Doing nothing or very little is the most profitable path at this point in time.
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I hope you don’t mind ajm22 if I add a couple more articles about nerves to your Topic.
Here is a recent one that addresses specific nerves. And also an older one from Dr. Bendavid that addresses the general nerve environment. It’s interesting to contrast the two perspectives. Today’s hernia repair surgeons are trying to find a way to not create chronic pain by avoiding specific nerves, assuming that it’s the nerves that they can see that cause the pain. But Dr. Bendavid’s work proposes that the generally unhealthy environment of the tissue in vicinity of the mesh, in to which new nerves grow, can cause pain.
My chronic pain was both specific, a sharp pain where the original direct hernia was, and non-specific, a general feeling of discomfort and/or pain over the whole of the area in contact with mesh. Most surgeons have problems understanding the second scenario. They will talk about nerves regenerating but don’t seem to really think deeply about what that could mean.
https://link.springer.com/article/10.1007/s10029-019-02070-z
Dr. Bendavid’s work, with co-authors. Dr. Koch is one of them. In HTML and pdf format.
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I just posted a video from SAGES 2021 that had at least two plug removal videos contained within it. The next “bellwether” trial for hernia mesh is apparently scheduled to begin in May. It is about the Perfix plug. The process takes so long. After this trial another trial is scheduled for later in the year.
Still fascinated by the huge dilemma the mesh producers have, considering the scale of the problem. The products are still on the market, maybe because removing them from the market would be admitting that they are flawed. Plugs have been around for decades. There are thousands of potential cases waiting in the future. Johnson and Johnson tried to encapsulate their liability for asbestos/talc by spinning off that part of the business so it could go bankrupt but the courts would not allow it. How do they get out of this mess? When do they start removing bad products and trying to develop products that are actually better?
Davol was part of Bard, which is now part of Becton Dickinson, known as BD now in the medical field.
“February 9, 2023 Update
In an Order issued earlier this week, the Bard MDL judge set forth a detailed schedule for the third hernia mesh bellwether test trial (Stinson v. C.R. Bard et al.). Pretrial conferences will be held on May 2nd and 3rd and the trial itself will begin on May 15, 2023. Final witness lists are due from both sides this month. The judge also requires lawyers for all parties to submit proposed dates for a 4th bellwether trial later in the year.” -
Dr. David Chen had some interesting comments about nerves in his presentation about open Lichtenstein. At 7:20 in the video linked below.
It’s interesting that he feels the need to place so much emphasis on protecting the nerves and talks about the wrong way to do it. Suggesting that many surgeons are/were doing it the wrong way. Also good to hear that Dr. Belyansky is open-minded and confident enough to realize that his methods can be improved.
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Coming up on a month and half past the end of 2022 and still no updated hernia repair guidelines. All of the HerniaSurge links are still dead.
The last update was for abdominal wall incisions, in August of 2022.
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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.