Good intentions
Forum Replies Created
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It looks like the issue of Hernia dedicated to chronic pain is about to be released or has been already. Dr. Campanelli has written an introductory Editorial. It kind of fits with the times, he comes very close to using the popular word “woke”. He implies that the chronic pain problem is amplified by patients being too aware and too demanding. He even uses the word “completely” as if 20 years ago is an incomprehensible amount of time. People were “different” back then. Tougher or more ignorant maybe. A little bit disappointing in that it is a form of giving up.
So, just like many of today’s huge issues this one will continue as part of the fabric of today’s modern society.
https://link.springer.com/article/10.1007/s10029-023-02750-x
“EDITOR’S CORNER
Published: 02 February 2023
Primary inguinal hernia, postoperative chronic pain and quality of life
G. Campanelli
Hernia (2023)”“It is also true that the perception of postoperative symptoms has changed completely compared with the past: today’s “self-awareness”, prioritisation of quality of life, and “demand” for perfect results have led to a situation in which postoperative symptoms tend to be overestimated compared with before.
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Nevertheless, the possibility of postoperative pain should not be underestimated, and we should indeed strive to generate more correct data, both on surgical indications and “surgical” prevention of this pain, and on the adoption of an integrated approach to these situations.”
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They don’t say. I think that most surgeons are very short-sighted about the results of their work. It’s the nature of the profession. So much can happen to a patient after they leave and there will be so many over the course of a career, that unless they are truly interested in the long-term results of a procedure they just don’t follow up. It’s too much work and they have other patients waiting.
This is where the larger regulatory and public health institutions have a role.
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Dr. Towfigh, the paper does not say that lap is better than open. It actually ends suggesting that open is the best. But, it’s about economics.
I was actually thinking of this recently. Where are the lawsuits for Lichtenstein repairs? There don’t seem to be any.
One person who might have an objective opinion about open mesh versus laparoscopic mesh would be David Chen of the UCLA Lichtenstein Amid Hernia Clinic.
Here is a recent presentation of his that is very educational in many different ways. He sounds very confident, as we were all taught to be when giving presentations. But if you look at the numbers there is still much work to do. And he does not offer a path to reach the goals he describes. He does offer things to avoid though, like plugs. You can also derive from his presentation that if you decide to get an open repair with mesh you should probably find a well-trained Lichtenstein method surgeon. Not a 10 minutes and done plug surgeon.
Overall, he is suggesting that open mesh, lap, and robotic are all about the same. He does not promote that lap mesh as better than open. The presentation is worth watching, just for general knowledge.
It is from 2017 but not much has changed, except for more robotics.
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That is an interesting comment. It kind of implies that when the mesh is removed the tissues and hernia are all returned to the pre-implantation state.
Unfortunately that is far far from the reality. There is real tissue damage done during the implantation process and as soon as the foreign body response to the mesh begins. Despite how clean the blunt dissection of the pre-peritoneal space looks through the camera lens for TEP, or the neat peeling back of the peritoneum flap for a TAPP repair.
My lower abdomen, all of the area that was in contact with the nesh, is still stiff and distorted. It continues to get better over time, but the area is nothing like it was before the mesh implantation. Patients who have their mesh removed within months probably are closer to their original state than patients like myself who waited years. But the shrinking and stiffening occurs within weeks of implantation, as the body tries to destroy or encapsulate the mesh material.
There is no “undoing” of any of the repair methods. Many do minimal damage, like Dr. Kang seems to imply for his method. Others do intentional damage, cutting flaps and dissecting cremaster tissue, in order to effect a repair. But all of the repair surgeries do some sort of damage.
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Dr. Towfigh makes a very firm statement that “If you have mesh removal after a hernia repair with mesh, you will have a hernia recurrence. Scar tissue alone is not strong enough to keep the hernia from recurring (except in some cases related to mesh removal due to infection).”
But, as far as I’ve seen, there is no evidence supporting that statement. Just like there is no registry for mesh repairs, there is no registry or followup for mesh removal. If the statement is true then there should be as many “repair after removal” stories as there are removal stories. There might be anecdotes among friendly surgeons, but there are no studies focused on the probability of hernia recurrence after mesh removal.
Sorry Dr. Towfigh. If you have evidence please present it. It should even be presented professionally, at a SAGES or AHS conference. If what you say is true then every surgeon who removes mesh should be firmly stating to their patients that they “will have a recurrence”, so that they can plan for the future repair. Dr. Belyansky has not done this in ajm22’s case.
Besides that, what would the repair be? More mesh? If that is the only possibility then the patient has to relive the possible horror of chronic mesh pain. If the recommended repair after mesh removal is a pure tissue repair then that begs the question of why not pure tissue in the first place.
Whenever a person takes a deep dive in to what’s going on in the hernia repair field the question of “why are we using so much mesh?” keeps forming. Mesh removal is mainstream now and the lawsuits keep growing. It must feel like you’re living in an insane world.
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Don’t let one person ruin your experience on an internet forum. Whether it’s me, or Herniated, or Pinto. The internet is a strange place where it is very difficult at times to “not look”.
On other forums that I am member of there is an “Ignore” function that can be chosen that will hide all posts from certain members so that you don’t have to read them. This forum, at the moment, does not seem to have that function.
In the meantime, if we don’t like what somebody is writing we just have to put the effort in to do it ourselves and not look. There is no obligation to respond to every post.
As far as alephy’s comments, I thought that they were reasonable. There is just a difference of opinion, I think, on the inflammatory nature of the word “Nuremberg” and its association with Hitler and the Nazi’s. It might not mean as much there as it does here in the USA. A cultural difference.
Pinto made his point early on and now is just defending his opinion. But there is really no constructive path forward. The points have been made. People’s positions have been established. There’s not much value in writing more words.
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It looks like there was a settlement in the Ethicon Physiomesh case. Ethicon and Johnson & Johnson are essentially the same company.
The writer of this article brings up the fact that the cases will probably keep coming. The mesh makers have created a lifetime of employment for the law firms. They knew better but they did it anyway. Where is/was the FDA?
https://www.millerandzois.com/products-liability/hernia-mesh-case-value/kugel-hernia/
This from almost 9 months ago:
“May 2, 2022 Update: There is a global settlement in the Ethicon Physiomesh hernia repair lawsuits. There are no settlement numbers that have been released so will know know what your individual settlement amount is.
The big question is will there be more Ethicon hernia mesh lawsuits in the future? There will still be more henria mesh lawsuits involving Physiomesh because many victims have not yet had complications. There are still many people out there with a recalled mesh inside of them.”
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I think that the problem is a matter of degree. The atrocities that happened before and during WW2 that were associated with the development of the Nuremberg Code have very little to do with what Dr. Kang is doing.
There is a saying that you might have heard that mentioning Hitler in a conversation is a sure way to end the conversation.
Hitler = WW2 = Nuremberg
Herniated could have included a reference to the Hippocratic Oath. Or he could have just talked about ethics in general. He could have eased his way in to the Nuremberg Code without using it in the title. There was no good reason to use the word Nuremberg in big bold letters to begin the Topic. Anybody who says that they expected a different response is being disingenuous. Especially somebody who knows so much about the Nuremberg Code.
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This is interesting. When J&J created Ethicon it looked like a similar attempt to separate itself from hernia mesh liability. This decision will probably influence mesh litigation cases.
https://finance.yahoo.com/news/j-j-t-bankruptcy-end-165835182.html
“(Bloomberg) — Johnson & Johnson can’t use bankruptcy to resolve more than 40,000 cancer lawsuits over its baby powder, a federal appeals court ruled.
The three-judge panel in Philadelphia sided with cancer victims, who argued that J&J wrongly put its specially created unit, LTL Management, under court protection to block juries around the country from hearing the lawsuits.” -
You chose a sensational term to get attention and got what you wanted. Now you’re off on a tangent. The effort now is not really about Dr. Kang at all. You’re defending yourself instead.
The best thing to do if you really want to discuss hernia related topics is to acknowledge that and move on. Sometimes even intelligent well-meaning people make mistakes. You made a mistake.
If you want to keep the topic going apply your accusation to other areas of hernia repair. How about the use of the 510(k) approval process for the multitude of prosthetics on the market? You can spend a lot of time on it and do some actual good. Your implication that Dr. Kang is experimenting on his patients does nobody any good.
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Here’s a new summary of the mesh litigation situation. It shows how they’ve simplified things down to where the issues can be presented to the general public. Simple explanations, some probably not quite right.
It’s hard to predict how this will all play out. Comparing the mesh MDL’s to a suit like the 3M earplug suit, you can imagine that 3M will fix the flaw in their ear plugs, pay the settlements, and everyone will move on. The damage has been remedied for the plaintiffs and the bad product is removed from the market.
These mesh suits seem more complex though. People who have learned about and followed the mesh problems probably know that there is no simple “fix” that will allow the repair industry to keep using mesh without injuring more people. The 10-15% injury rate seems well-supported over many studies. One possibility is that the defendants agree to pay for more research to understand the source of the damage to the patients. Since they probably already know some of the reasons (there has to be experts that have told them) it seems possible that new products could be developed, but they will have to go through actual product testing trials instead of the inexpensive 510(k) process. What will they do in the meantime though? Maybe surgeons will do more pure tissue repairs? Create a registry to identify the truly bad products and procedures so that they can save some of the overall business from litigation? Who knows. It will probably take years though.
https://www.lawsuit-information-center.com/hernia-mesh-litigation-update.html
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It’s an interesting topic. But I think that Herniated is really stretching things to imply that Dr. Kang’s work is similar in any way to the Nazi experiments of WW2.
It would be more proper to say that it might be unethical to hold back his knowledge if he has evidence that it is better than prevailing practice. If he has a better way he should share it so that society as a whole can benefit. But, of course, in today’s world there are many that might corrupt his method, like many have done with the Bassini and Shouldice procedures. “Modified” for speed or ease or some other reason, leading to poor results from something that is not what he intended.
If you really want to see how a large professional organization can twist in the wind of ethics, read the SAGES statement about new technologies and techniques.
They end the statement with a wishy-washy acknowledgment that market forces might be competing against individual patient welfare.
“Balancing Responsibilities to Patients and Society
Finally, the cost and value of new technologies, to each of the many constituents in healthcare, must be addressed. Forces impacting health care and its delivery are increasingly important, particularly now as the US transitions to a national health care system. (30,31) At times however, a physician’s responsibility to advocate for individual patients on the one hand, and honor the responsibility to society for stewardship of finite resources on the other hand, may be competing considerations. Physicians do have responsibilities to both, as pointed out by the ACS in its “Code of Professional Conduct” and by the American Board of Internal Medicine (ABIM) in its Physician Charter on “Medical Professionalism in the New Millennium”. (32,33) To guide physicians struggling with conflicting responsibilities, the ABIM establishes the following principle: “Principle of primacy of patient welfare…Market forces, societal pressures, and administrative exigencies must not compromise this principle”.
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Was the “other issue” in the groin known before surgery or discovered during surgery? I don’t want to dig in to the details of your ordeal but it kind of confuses the overall assessment of the Shouldice experience. Did they make the situation better or worse? Could there have been better planning if they had known?
I don’t know how much you’ve disclosed to other people about who you are but, really, we’re all anonymous here. Except for the people who use their real names. Even then, not many people will find the name on a hernia discussion forum.
Your comment about the duration of living with the indirect hernia shows that you realize that your situation is not “run-of-the-mill”. The thought occurred to me that watchful waiting can have the downside of letting the body change to adapt to the hernia, especially for those with direct hernias. Newly stretched tissue. Then when it is finally repaired the body has to re-adapt or go back to its previous state. A much better selling point for hernia repair than “you could die due to a strangulated hernia”. In your case, of course, you had already been waiting since birth so no significant time-based decision to make there. But for other people maybe it matters.
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Here is a new article from General Surgery News about incisional hernias. You are right to be concerned about finding the right surgeon for an incisional hernia. Just like in inguinal hernia repair you will find a range of views on how to repair an incisional hernia. From using mesh prophylactically, to avoiding the use of mesh if possible. Surgeons generally hate recurrences so they will do everything that they can to avoid that happening. Even if it causes constant discomfort for the patient.
A good person to talk to might be Dr. Peter Billing of Transform Weight Loss in Kirkland WA. He uses mesh for hernia repairs but he also removes mesh that is causing chronic pain. So he has a broad understanding of the issues and will focus on avoiding future pain for his patients.
Be very careful in choosing a surgeon. You can end up on the treadmill of repeat surgeries. Good luck.
It looks like you might have to create an account to view the article. All it takes is an email address.
https://www.generalsurgerynews.com/In-the-News/Article/01-23/hernia-prevention/69204
:CHARLOTTE, N.C.—Following laparotomy, incisional hernias occur in 5% to 20% of all patients and in up to 30% of high-risk individuals, and their impact on those who acquire them range from nuisance to catastrophic. Numerous factors drive the occurrence of incisional hernias, but surgeons and institutions can follow measures to reduce their numbers.
At the 2022 meeting of the American Hernia Society, experts discussed optimal techniques for abdominal wall closure, explored the possibility of dedicated closing teams and took a deep dive into the financial implications of incisional hernias and their prevention.
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So, why is it that only 35% of surgeons follow these guidelines, or that most only follow them to a degree? According to a survey of surgeons on their approach to abdominal wall closure, 72% use small bites and 79% use a 4:1 suture-to-wound length ratio. But it would seem most who adhere to the ideal ratio are eyeballing it, because only 16% indicated they measure the suture and wound lengths (Hernia 2019;23[2]:329-334).
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A review of claims data examining the impact of incisional hernias on total healthcare costs found an incidence rate of 9%, adding a cost of $21,000 to $29,000 per patient. The investigators also established that incisional hernias that occur within one year of the initial surgery tend to be more severe, associated with more complications and can double the cost (Surg Endosc 2018;32[5]:2381-2386).
“They make an important point about the costs we are not able to measure, such as loss of productivity and loss of earnings, which are not included in any of these estimates,” Dr. O’Neill said. … ”
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Here’s a thought for those considering bad stories about surgeon interactions. Imagine that a certain, very active and opinionated, person from the forum was interacting with a surgeon in the way that they have commented about people on this very forum. Very complementary when they need something, very negative when they don’t get what they wanted. It’s easy to imagine that the surgeon would be very irritated and short with them and try to guide them away. No surgeon wants a single patient out there on the internet trying to blame them for a bad result, trying to ruin their career, even though they have decades of history of helping other people.
Just like when evaluating surgical methods and materials you really have to consider the overall numbers and the specific cases and your own specific situation, all together. Like Amazon reviews, if you look at enough of them you will always find a reason not to purchase. It’s best to look at recent results and the collection of results as a whole.
The best way, in my opinion, to make a choice about surgery, is to try to calculate the odds of success for your own situation. Collect the information, assess its quality, apply it to your situation, make a decision.
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Here’s another update on the Bard (now owned by Becton Dickinson) hernia repair mesh multi-district litigation (MDL). It’s hard to predict how the results might affect the field of hernia repair. If the lawyers focus on the use of low quality polypropylene and the fact that Bard did not disclose it to patients or surgeons then the solution for the mesh makers going forward is just more disclosure. Business goes on, no change to the rates of chronic pain.
On the other hand though, if the lawyers show that polypropylene itself is the problem, no matter the quality, then there might be some impetus to change. The polyester fiber users will gain market share.
But, even after the settlement, if it happens, the rates of chronic pain will not change. So these types of litigation could continue for decades. If there’s chronic pain from a hernia repair mesh the discovery process will probably show that the executives knew about it and pushed the product to market anyway.
Anyway, here is the latest update and excerpts from the last three months showing how people keep joining the class. Pretty interesting to see it happening in real-time. I also included the last simple explanation of what the lawyers are focusing on to show negligence that is causing harm. Once they prove that potential harm was known but not disclosed I think it opens the door for continued discovery and future litigation.
“January 18, 2023 Update
A total of 18,403 cases are now pending in the hernia mesh class action MDL against C.R. Bard. That is an increase of 176 cases over the last 30 days, the biggest percentage increase of any mass tort MDL during that period. This high volume of new cases in this MDL has continued for several months now as we get closer to the next bellwether trial in May.”
“December 18, 2022 Update
As hernia mesh settlement rumors continue to swirl, the C.R. Bard hernia mesh MDL continues to add new cases as we slowly inch closer to a pivotal 3rd bellwether trial in May 2023 (recently postponed from February).
The class action lawsuit added 273 new hernia mesh cases to the MDL over the past month, increasing the total pending Bard mesh lawsuits to 18,227. The Bard hernia mesh MDL grew by 23% in 2022, adding 3,380 cases. …”
“November 17, 2022 Update
Another 166 new hernia mesh injury cases were added to the C.R. Bard class action MDL over the last month. At the beginning of the year, there were just over 15,000 plaintiffs in the MDL, that number is now up to 17,954 and growing. The continued growth in the number of pending cases should help to keep the settlement pressure on Bard’s parent company, Beckton Dickson. If we get a solid verdict for the plaintiff in the upcoming bellwether trial in February we could potentially be talking about a global settlement deal before June.”
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“September 5, 2022 Update
One of the issues that got flushed out during the Trevino trial is that C.R. Bard used a plastic resin in its mesh products even after the plastic supplier told Bard it was not safe for that use.
This was no great revelation. But the plaintiff’s lawyers developed this issue well during the trial.
C.R. Bard used a plastic made by LyondellBasell called Pro-fax 6523 in all its hernia mesh products because it was the cheapest available material that met specifications.
Bard did this although LyondellBasell deemed Pro-fax 6523 unfit for permanent implantation inside the body and specifically prohibited buyers from using it in hernia mesh products.
That C.R. Bard knowingly ignored this is a new revelation that could swing the momentum in the C.R. Bard class action lawsuit.”
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You probably meant ventral hernia repair. Also known as incisional hernia. Herniation from the incision area of a previous surgery. These are different from inguinal hernias in that they are typically outside of the inguinal region of the abdomen. The inguinal canal is not involved.
There is still much discussion ongoing about whether or not mesh is appropriate for ventral/incisional hernias. Mesh can cause foreign body chronic pain no matter where it is placed.
Can you give more details about your situation? Somebody might have advice relevant to your specific situation. Good luck.
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Hernia repair mesh made the big time in the world of mass torts. Right up there with Roundup, Camp Lejeune, and talcum powder. Here is a review.
https://www.lawsuit-information-center.com/mass-torts-2022.html
“Hernia Mesh
The hernia mesh lawsuits involve claims that mesh implants used in hernia repair surgeries were defective and resulted in complications and other injuries. The hernia mesh litigation involves 3 different MDLs, each involving different hernia mesh products made by different medical device companies. The 3 hernia mesh MDLs are:Bard Hernia Mesh MDL (In re: Davol, Inc./C.R. Bard, Inc., Polypropylene Hernia Mesh Products Liability Lit. – MDL-2846). This is the largest of the 3 with around 12,000 cases.
Ethicon Hernia Mesh MDL: (In re: Ethicon Physiomesh Flexible Composite Hernia Mesh Products Liability Lit.– MDL-2782). This has 3,500 cases and is the oldest of the hernia mesh MDLs.
Atrium Hernia Mesh MDL: (In re: Atrium Medical Corp. C-Qur Mesh Products Liability Litigation – MDL-2753) the smallest and most recent of the hernia mesh MDLs.
The hernia mesh MDLs have been around for a while compared to other mass torts. More than any other mass tort, the hernia mesh litigation got sidetracked by the pandemic shutdowns in 2020. Progress in the litigation started moving forward again in 2021, but with some disappointing initial results.… “
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Here is another Atrium product. The date at the top of the page seems wrong, there’s a 2022 update in the text but the last date is 2021.
Not fish-oil coated, just run-of-the-mill polypropylene knitted mesh.
https://www.lawsuit-information-center.com/atrium-prolite-proloop-hernia-mesh.html
Apparently a settlement was reached. I think that the products have been discontinued, I can’t find any internet Atrium pages. An internet search produces only what look like old out-dated pages about the products and law firm/lawsuit pages.
“Atrium Hernia Mesh Settlement 2022 Update
Atrium Medical Corp. will pay $66 million in settlement compensation to settle C-Qur hernia mesh lawsuits against it. The MDL has been stayed pending the finalization of that settlement.” -
Atrium C-Qur, the fish-oil coated mesh, still seems to be working its way through. Here is an update from September 26, 2022. Not so long ago.
https://www.lawsuit-information-center.com/update-atrium-hernia-mesh-lawsuits.html