Good intentions
Forum Replies Created
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I might have confused recurrence with chronic pain rate in one of my comments above. Here is a recent reference to a paper confirming the high chronic pain rate for TEP.
The focus on recurrence begs the question of “why did the patient see the physician in the first place?” To have their pain removed. That’s why Dr. Felix’s presentations are so frustrating to see. He completely ignores the Hippocratic oath. He will become known as the Father of Chronic Pain, I think, not the Father of Lap Mesh Placement.
Doctors seem so caught up in the bright lights of technology that they’ve forgotten why they became doctors.
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A true physician does not downplay the pain that their work causes and has caused like Dr. Felix does in his presentations. Too many surgeons seem to be so focused on spreading the neat new techniques and technologies that they are willfully ignoring the fact that mesh is over-used and has real problems associated with its use. There is no study out there that has suggested that improper mesh placement is the cause of chronic pain. To the contrary, efforts to find the cause besides the mesh itself have all failed. And, also contrary to the the recurrence myth that is being spread, recent studies are showing that laparoscopic mesh placement has a significantly higher recurrence rate than what is being propagated. I posted a paper about it recently, I will relink it below.
It would be great if somebody could truly show a clear path to reducing the risk of chronic pain and recurrence. But people like Dr. Felix are out there suggesting that patients who complain of pain and discomfort are just weak, as he does in his “Let’s be honest…” presentation. To paraphrase Dr. Felix – “let’s be honest, mesh is not the great panacea that it is being promoted as”. It just isn’t.
The mesh makers are still selling the products that the Guidelines recommend against. The Guidelines “update” seems to be delayed for some reason, even though professionals in the field have published papers to help create better Guidelines.
I am sure that you are aware that nothing of significance at all has happened in the five years since the Guidelines have been published, except advancements in ways to get more mesh in to more patients. And besides Atrium getting sued for their fish-oil coated mesh, and Bard getting sued for their polypropylene mesh plugs. Chronic pain was identified as the number one problem in the hernia repair field just a few short years ago. Right about the time that Dr. Felix started his 10 Commandments tour. Chronic pain and mesh removal is now normalized as part of mesh implantation, with new pain center businesses created to handle the new business. It’s insane.
https://herniatalk.com/forums/topic/the-state-of-teaching-hernia-repair-dr-felix/
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Another interesting paper that mentions “HerniaSurge” even though the group does not seem to exist anymore.
Also interesting in that they refer to their work as assisting in the update of the Guidelines, but note that the recurrence rates for hernia repair are still very high. The whole premise of laparoscopic mesh repair is that recurrence rates are lower. References 4-7 are all from 2018 – 2020.
It wouldn’t be a surprise if EHS or the “HerniaSurge” group have found themselves in a bind, where the review of new data shows that the 2018 Guidelines are seriously flawed. The delay and lack of communication is telling.
“The routine use of mesh in groin hernia surgery has engendered substantially decreased recurrence risk.1,2 However, current long-term reoperation rates for recurrence are still disappointing, in the range of 8% to 15%.3-7”
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Dr. Koeplin’s page is a very standard “minimally invasive” hernia repair page. Boilerplate text about strangulated hernias and death and types of hernias. The page does not mention mesh but laparoscopic procedures today all use mesh. So you will almost certainly get run-of-the-mill placement of a large piece of mesh, and most likely a piece on the other side also. There’s always something on the other side.
Good luck. They both look like “state-of-the-art” hernia repair surgeons. ~15% chance of chronic pain.
https://michaelkoeplinmd.com/general-surgery/hernia-surgery/
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It depends on what you mean by “good”. They both do laparoscopic procedures so their hernia repair method is very likely based on the use of mesh. Dr. Panait seems to be very active in research so is probably very aware of the latest issues in the field, but he is also very active in new technology like robotic-assisted surgery.
His web page has a lot and he has a Youtube channel. He holds positions in the Americas Hernia Society. Dr. Towfigh probably knows him. If you see him you will almost certainly get a synthetic mesh repair. He also does mesh removal (of course).
One of his videos shows robotics removal of a mesh plug followed by immediate placement of a large piece of flat mesh. It was a recurrence.
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Dr. Martindale at OHSU in Portland Oregon might be worth contacting. He seems to be involved in some very difficult abdominal wall reconstruction efforts, and also various associated side effects of surgery.
https://www.ohsu.edu/people/robert-g-martindale-md-phd
Here is a search of some of his recent publications. I chose “abdominal” as a specific search word. From 2018.
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This big lawsuit against C. R. Bard (now owned by Becton Dickinson) gets more interesting, and bigger. The initial description seems flawed, typical of many of these types of suits, in that they are trying to show that there was a specific defect in a product instead of showing that the product design itself is defective. But, regardless, as the suit proceeds, the extend of the damage will become more apparent.
The downside is that, according to a friend from way back who works in venture capital now, new product development is being delayed, because the corporations are waiting to see where the litigation ends up.
Here’s the latest –
“December 16, 2022 Update
As hernia mesh settlement rumors mount, 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.
It is still the second largest mass tort behind only the 3M earplugs MDL.”
Here’s the original court document for MDL-2846 –
https://www.ohsd.uscourts.gov/multidistrict-litigation-2846
“Introduction – MDL 2846
This Multidistrict Litigation (“MDL”) was created by Order of the United States Judicial Panel on Multidistrict Litigation (“JPML”) on August 2, 2018. In its August 2, 2018 Order, the JPML found that the actions in this MDL “involve common questions of fact, and that centralization in the Southern District of Ohio will serve the convenience of the parties and witnesses and promote the just and efficient conduct of this litigation.” The JPML continued that, “[a]ll of the actions share common factual questions arising out of allegations that defects in defendants’ polypropylene hernia mesh products can lead to complications when implanted in patients, including adhesions, damage to organs, inflammatory and allergic responses, foreign body.” “ -
Still nothing. Running out of time.
All there is are updated incisional closure guidelines. Or singular “guideline” as they label it.
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Hello Matt. Good to hear that you’re doing well after mesh removal. I looked up your last post on the forum and linked it below.
Can you tell who removed the mesh? People often query the forum looking for good options. Also, any details you could offer of your story, from implantation to explanation, would help others looking for solutions and things to avoid.
Good luck.
https://herniatalk.com/forums/topic/can-mesh-be-removed-from-laparoscopic-inguinal-hernia-repair/
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Here is a Google search of the site that might help. I pulled out the top two results.
https://www.google.com/search?q=site%3Aherniatalk.com+mesh+removal+canada
https://herniatalk.com/forums/topic/mesh-removal-in-bc-canada/
https://herniatalk.com/forums/topic/hernia-mesh-removal-surgeons-canada/
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I don’t know much about him. His education and publications suggest that he is at the forefront of hernia repair technology.
Today’s hernia repair centers are starting to include mesh removal as a normal part of their repertoire. They will put it in and they will take it out.
If you do get deeper in to consulting with a surgeon about your problems be aware that there will probably be a long path ahead before any surgeon will agree to remove the mesh, unless they have seen similar problems themselves and resolved them with removal. Your complete medical records from start to finish might be enough for a surgeon to make the decision though.
Unfortunately, today’s medical practitioners are pretty well siloed. Each doctor is very narrowly focused. For example, several forum members have had urological problems that resolved with mesh removal but hernia repair surgeons generally refuse to consider ufology and urologists claim ignorance about mesh complications. It can be very frustrating.
I wish that I could be more positive. But it is a lot of work to find solutions after a mesh-based hernia repair. You have to find the right surgeon.
Dr. Belyansky is another possibility. He is also at the forefront of technology, and speaks at the big conferences.
https://www.luminishealth.org/en/find-a-provider/igor-belyansky?language_content_entity=en
Dr. Jacob also.
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I don’t think that laparoscopic removal of mesh should damage a Shouldice repair. The laparoscopic procedures would be on the other side of the abdominal wall, the inside. The peritoneum would be pulled back and the mesh peeled off of the abdominal wall and critical vessels and nerves. The Shouldice repair should be untouched.
You really should try to get your medical records. There is a wide variety of laparoscopic repair methods. For example, one advantage of TAPP over TEP is that TEP avoids contact with the intestines, and also minimizes the chance of adhesions. If you had a TAPP repair it might help explain why you’re having problems. “Lap with mesh” really means very little.
Also, “robotic” is still laparoscopic. The instruments are just mechanized. But they move in the same spaces and do the same things. There is a powerful effort to promote robotic methods, around the world. It’s the latest new “tech”. But there is little evidence that robotics are better than a skilled surgeon using hand tools. You can find many publications on the subject.
Dr. Iacco did a residency at Beaumont but is now in Michigan.
https://michiganherniasurgery.com/about-us/our-team/anthony-iacco/
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Another surgeon with much experience in gut problems is Dr. Peter Billing of Transform Weight Loss. He has heard many stories and removes mesh. But he also uses (or at least used to use) mesh for laparoscopic hernia repair. So he has a certain type of objectivity. He will talk to you over the phone, somebody on the forum is scheduled for surgery with him this month.
It seems like, at the least, an open-minded surgeon would want to perform exploratory surgeon to look for physical problems and/or inflammation.
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Do you have your surgery records? It might help to know exactly what material was used and how.
Dr. Krpata at the Cleveland Clinic is leading an effort to understand chronic pain. While you might not define what you’re feeling as pain his center will still have the collected cases of many people with mesh problems.
Search “krpata” on the internet or use the link below (it is specific to krpata on herniatalk). I have also included a link to Google Scholar if you want to focus your research on professional research.
I mention often the cognitive bias that revolves around mesh. The investment in its use is enormous. Good luck.
https://www.google.com/search?q=site%3Aherniatalk.com+krpata
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The study is fairly small. I thought it was significant that they felt the need to call out the potential for outside influences, industrial companies, affecting the conclusions. It implies that they think some of what’s out there is influenced.
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Here is a web link. You have to click the dropdown arrows to see the full text.
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Here is an easier way to search the Herniatalk forum.
https://www.google.com/search?q=site%3Aherniatalk.com+umbilical&rlz
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Here are a couple of recent Topics. Not much has changed in hernia repair except the growth of robotics-assisted surgery.
https://herniatalk.com/forums/topic/pain-after-10-days-of-umbilical-hernia-laparoscopy/
https://herniatalk.com/forums/topic/umbilical-hernia-best-course-of-action/
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I don’t know that it’s true that a recurrence after a pure tissue repair is going to be bigger. As you read through posts on the forum you’ll find that many things are said about hernias that are actually not very likely. You might die, you might end up in the emergency room, etc. A recent poll of surgeons showed that most of them would wait if they had a hernia.
You said that your body does not like foreign materials. What do you mean by that? Have you had reactions to sutures or some other foreign material? That would be important to consider.
When you are talking to surgeons or reading what they have to say or watching their videos remember that they can understand recurrences. Because they can see them. They do not understnad chronic pain and discomfort because the cause is not clear. Much time is spent by the hernia repair community discussing whether or not the patient’s pain is primarily mental. In their head, and not actually physical. All surgeons learn this in medical school and during their residency and at many of the meetings that they attend. Even surgeons that run large pain clinics will wonder aloud why patients don’t want mesh after they have mesh removed for chronic pain. They are all taught that mesh does not cause pain.
Also be aware that if you have a pure tissue repair and it fails you can always get mesh. But if you have mesh problems it’s a whole new world.
There are several Topics on the forum about umbilical hernias. Try to find them and read all of them. Good luck.
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Laparoscopy surgeons can work on the whole of the inside of the abdominal wall. They are very familiar with umbilical and incisional hernias because those are the entry points for their laparoscopy tools.
I reread your post and it’s not clear that mesh removal is the solution. The explanation that “the diastasis has recurred above the bellybutton and the mesh that was placed was probably too big. Both suggested an abdominoplasty but said that removal of mesh is not an option” doesn’t really make sense. The mesh was too big but you had a recurrence?
If you’ve had a recurrence that is a big deal. I think that one issue you have is whether the discomfort is from the recurrence or from the mesh. Even though you found top surgeons in Belgium it really seems like you need to just find a better surgeon than those two. Good luck.
@drtowfigh probably knows somebody who can help.