[Good intentions]

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.

[Good intentions]

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.”

[Good intentions]

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.

[Good intentions]

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

[Good intentions]

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.

https://www.sages.org/publications/guidelines/ethical-considerations-regarding-implementation-new-technologies-techniques-surgery/

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”.

[Good intentions]

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.

[Good intentions]

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.

…

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).

…

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. … ”

[Good intentions]

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.

[Good intentions]

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.”

…

“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.”

[Good intentions]

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.

[Good intentions]

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.

… “

[Good intentions]

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.”

[Good intentions]

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

[Good intentions]

I realized that the page I had been linking here had articles about other manufacturers involved in other lawsuits.

Pretty fascinating how the wave is growing. I am just passing in fo along as it becomes available.

Here are a few new ones. Surgimesh. I provided a link about it in my other thread about Types of Mesh.

Surgimesh is part of a new polypropylene material lawsuit. This is from March 2022. They all seem to be calling out the polypropylene material. Still not calling out the mature of the mesh. The mechanics of the mesh in the body. They should focus on that too.

Typical mesh implanted, major problems, mesh removed.

https://www.lawsuit-information-center.com/surgimesh-hernia-mesh-lawsuits.html

[Good intentions]

Surgimesh is part of a new polypropylene material lawsuit. This is from March 2022.

Typical mesh implanted, major problems, mesh removed.

https://www.lawsuit-information-center.com/surgimesh-hernia-mesh-lawsuits.html

[Good intentions]

I just came across a type of mesh that I had not seen before. Some of these new products get introduced but don’t get much publicity. Hard to compete with the big guys.

Dr. Ramshaw was involved. The video is from seven years ago. It’s not clear if “Advanced Hernia Solutions” was a side venture. 2016.

The mesh is made via a non-woven method. Fibers are spun (molten material squirted from a spinneret) in a random pattern. The fibers stick together to form a flat sheet.

https://surgimesh.com/products/

https://surgimesh.com/videos/ramshaw-laparoscopic-lih-repair/

[Good intentions]

Chuck, I have written quite a bit on the forum about the recovery from mesh removal. I don’t have any strength issues. Over the years the only thing holding me back had been the knowledge that I would be sore for a few days after extended activities. Instead of hiking five miles I would only hike two, for example. Plus there was some concern about recurrence but my view is that I will just live the life I want and if I get a recurrence I’ll deal with it.

In addition, because of the stiff bulging belly left behind, certain clothes were uncomfortable. And certain motions, like working with my arms extended overhead, caused soreness in the lower abdomen. It has taken quite a while to loosen up.

Otherwise, especially when I was getting a home ready to sell and needed to do lots of lifting and moving for long periods of time, I was fully functional. I just spent more time being sore.

I also did quite a bit of physical work with the mesh implanted, over the course of a year, and I could feel that damage was happening, internal wear and tear, that eventually led to other specific physical manifestations that I’ve also written about. The more active I was the worse it got. Removing the mesh was the only possible solution for me so I have no second thoughts about it. If I have future problems, I will take appropriate actions.

[Good intentions]

Is it possible that the pain and swelling is the result of external forces causing internal irritation? Like the elastic band pressure of whatever you are wearing? I had found that certain clothes caused irritation because the waist height caused pressure at the bump left by the original direct hernia area. In my case though, there is still a piece of mesh at that spot. This lasted for years and has only resolved recently.

In other words is there a correlation between clothes and discomfort. I remember that you run a lot of miles on a regular basis. A small force might have large consequences. It might explain the seeming randomness of the problem.

I am just past five years since mesh removal and the last six months have been pretty dramatic in terms of improvement. I am doing much more and feeling fewer delayed after-effects. It might be both heartening and disheartening to suggest that you wait. If you do find a correlation with clothing or certain activities it might be worthwhile to avoid those for months at a time then retry later. See what happens.

[Good intentions]

Dr. Nguyen might be worth a call. I don’t know what exactly is involved when one doctor sells their practice to another. He might be a run-of-the-mill laparoscopy surgeon, or he might be carrying on Dr. Brown’s non-mesh work. Or maybe he uses laparoscopy for athletic pubalgia (sportsmens’s hernia) and non-mesh for inguinal hernias. Not clear.

Good luck.

https://www.sportshernia.com/no-mesh-hernia-repair/

[Good intentions]

I just came across an older article about litigation in General Surgery News. One of the Top 5 articles of 2022.

Dr. Voeller is interviewed and argues both sides of the issue. He points out that the 510(k) process has allowed untested materials in to the market, for transvaginal mesh products. But he seems to forget the fact that the hernia repair products got there the same way. He also implies that the law firms involved were attracted by the potential money involved, like that’s a bad thing. He kind of ties a knot around himself, as he seems to do when he talks about the problems with mesh. He doesn’t seem to understand the purpose of litigation in a free market, especially when regulation enforcement is as lax as it is in the United States. If a corporation injures people with poor products, they have to pay damages. Without litigation in a poorly regulated environment corporations are free to damage as many people as profits will allow.

Worth reading, even if you’ve already read it. Published March 21, 2022.

https://www.ormanagement.net/Business-Management/Article/03-22/Hernia-Mesh-and-Litigation-Where-Things-Stand/66119