Good intentions
Forum Replies Created
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I think that I am the only person on the forum who had mesh removal by Dr. Billing. Many surgeons who do mesh removal laparoscopically do not attempt another repair. Most of them opt to wait and see if there is a recurrence. Often, apparently, the remaining tissue is stiff enough that there is no recurrence.
On the other hand, there are surgeons who will remove one piece of mesh and replace it with another, “just in case”. They might also perform neurectomies. There are people, some on this forum, who are stuck in a cycle of surgery after surgery, as one procedure leads to another.
In my case, Dr. Billing did not attempt another repair as he did not see any hernias, and he did not do any neurectomies. And I have been doing very well. But he spent much more time removing the mesh than many surgeons seem to do. Some surgeons are proud of how fast they can get in and get out. I think that that might be a reason for neurectomies. Easier and faster to cut the nerves than tease them off of the mesh.
If you have conversations with a surgeon make sure that you are prepared beforehand. Many of us will expect to remember all of out questions and be able to ask them once we get inside but once we get in to the doctor’s office, the doctor tends to run the conversation. You will leave the meeting with many unanswered questions if you don’t have a list before you start.
Also, many surgeons will get upset if you question what they plan to do. Despite all of the well-publicized problems with hernia repair many of them think that what they are doing is somehow different. Even though they are using the same methods and materials.
Good luck Ronnie. Keep detailed notes as you do your research. It can be very confusing especially when you’re suffering the pain. Don’t let my negativity dissuade you from your efforts. I’m just trying to shine a light on potential pitfalls.
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“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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I can understand owning intellectual property. I have had the thought that if the individual doesn’t own it that a large corporation can take it and bury it. I am fairly certain that their are much better mesh-type prosthetic materials possible but the mesh-making corporations are fine with the their existing product line. Chronic pain is the cost of doing business for them.
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Dr. Krpata at the Cleveland Clinic.
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Dr. Yunis might be worth contacting.
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Look at the description of the first three pictures in the paper linked below, and the picture in Dr. Towfigh’s tweet. The ProFlor plug was removed due to recurrence after three years (how did that happen if the repair was “finalized” and the defect obliterated?). The plug looks just like the Perfix plug that Dr. Towfigh removed. All contracted and filled with new tissue.
It’s almost like they are showing that their claims don’t match the reality. The ProFlor ends up just like the other plugs.
Many doctors don’t use the term “scar tissue”. It’s all just tissue in different stages of regeneration.
Anyway, I think that the key issues are return of function and quality of life. That’s the reason that people let any kind of plastic be inserted in to their body. Time will tell on Proflor. Insightra has been bought by a venture capital company and they will promote this product until they sell the company to a larger medical device company or until they package it up for a public offering to the market. That’s what venture capital firms do. It’s all about the money. They have to generate excitement. Tela Bio followed a similar path with their Ovitex products.
https://www.mdpi.com/2079-4983/13/4/253
https://twitter.com/novitskyyuri/status/1021596087600271360
plugs are evil and should not be extrapolated as all things "mesh"
— Yuri Novitsky (@NovitskyYuri) July 24, 2018
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Here is another new paper about this. I’m kind of shocked at how much effort is put in to hiding the fact that this device is just a giant plug and patch. All of the words used to describe it seem meant to obfuscate and sensationalize. His latest paper seems to be claiming that the damaged tissue is completely recreated. The product is the ultimate hernia repair devices. It’s incredible. The selling is really accelerating for this one. Venture capital needs rapid returns.
One major flaw in the claims is that polypropylene fibers do not have good fatigue resistance. If what he claims is true, then the product will almost certainly fail from fiber fatigue and failure, from the constant motion that he describes. Lots of sharp pointy fiber ends in the defect. Polypropylene was probably chosen because it will slip through the 510(k) protocol for rapid market introduction. A good inventor would have researched the the fiber qualities needed for the product and went out and found the proper material. If the product does what he says it is almost guaranteed to fail. If it doesn’t, it’s just another plug.
https://www.mdpi.com/2079-4983/13/4/253
“Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin
by Giuseppe Amato 1,*,Giorgio Romano 1,Vito Rodolico 2ORCID,Roberto Puleio 3ORCID,Pietro Giorgio Calò 4ORCID,Giuseppe Di Buono 1,Luca Cicero 5,*,Giorgio Romano 6ORCID,Thorsten Oliver Goetze 7 andAntonino Agrusa 1”
“5. Conclusions
All of the above would appear to confirm that, unlike the ordinary 50-year-old treatment concept with conventional flat static meshes, the 3D dynamic responsive structure of the ProFlor device attracts tissue growth factors acting as a true regenerative scaffold. The updated physiological and pathogenetically coherent treatment concept embodied by ProFlor seems to represent a game changer in the intricate realm of inguinal hernia repair. Effectively, ProFlor probably embodies a new category of hernia devices presenting with completely new and updated concepts for the treatment of inguinal protrusions: fixation-free deployment, permanent defect obliteration, dynamic responsive behavior, and regenerative scaffold. These innovative concepts constitute a turning point for the cure of inguinal hernia and may represent the basis for the development of more advanced devices for the future therapy of this frequently occurring disease.” -
Thank you for the very detailed post. That’s a shame that Dr. Grishkan has failed you so dramatically. The glowing info on the internet makes you wonder if there is any way at all to know for sure if a surgeon is competent. Your story makes one wonder if Dr. Grishkan is losing his facilities. Front office people often bend procedures to keep the practice running smoothly. I think that sometimes the physician is unaware of what’s really going on. But in your case Dr. Grishkan just seemed to drop the ball. His web page reads like somebody focused on high volume.
Good luck. Be careful and try to accept any healing that seems to be happening. Don’t think, or believe if someone tells you, that more surgeries will quickly get you to where you want to be. The one difference that I noticed between Dr. Billing, who removed the mesh inside me, and the surgeon who implanted it, was that Dr. Billing told me to “take it easy” after surgery, especially when I told him how much better I felt after mesh removal. Let things heal. As opposed to the implant surgeon who told me I was free to do whatever I wanted to do after just 21 days.
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Adding a recent thread from somebody who had a repair from Dr. Brown. The practice is run by Dr. Richard Nguyen now.
https://herniatalk.com/forums/topic/no-mesh-hernia-surgery-with-dr-brown/#post-33038
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I hope you don’t mind my adding a few things to your Topic G. It would be great to find that Dr. Brown’s methods had been fully transitioned to a new surgeon though.
Here is a separate web page about Dr. Nguyen. He seems to be from the weight loss world, like Dr. Billing (who removed the mesh I had).
https://lifetimesurgical.com/dr-nguyen/
Another page from Dr. Nguyen’s new practice, the sportshernia web site. It looks promising but it’s hard to tell if these are his thoughts or just left over from the old web site, although Dr. Nguyen’s name is there. It’s promising. I think that he should be on anyone’s “no-mesh” list for a consultation.
https://www.sportshernia.com/sports-hernia-approach/sports-hernia-options-operation/
“There are two different surgical procedures used to treat sports hernias. One is the open operation. The other is a laparoscopic procedure with mesh. Both can yield excellent results. Dr. Nguyen prefers the open operation.
During the laparoscopic operation, it is difficult to see all the nerves and tendons. Thus some damage may be missed and not treated. The laparoscopic procedure also involves placing a large piece of plastic mesh to reinforce the lower abdominal wall; the muscles are not repaired only patched; the mesh can potentially cause problems from shear stresses and nerve damage and shrinkage. The mesh is tough to remove if it becomes a problem.”
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Thanks for the follow-up G. It’s good to know that it is possible to have a good hernia repair. There must still be surgeons out there like Dr. Brown. They just need to be sought out.
I wonder if the surgeon who took over Dr. Brown’s practice uses Dr. Brown’s methods. It doesn’t seem like he would. The web site is very confusing, with new material seeming to contradict old material. Laparoscopic and robotic methods depend on the use of mesh.
“About the Doctor
Dr. Richard Nguyen is a board certified General Surgeon and is fellowship trained in Minimally Invasive and Bariatric Surgery from Vanderbilt University. He has helped to pioneer single incision laparoscopic procedures as well as being da Vinci Robot Certified. He currently trains other surgeons in both of these fields, contributing to the further innovation of surgical techniques. Dr. Nguyen has been practicing in San Jose since 2007 and a surgeon since 2001, working with the most cutting-edge techniques available.”https://www.sportshernia.com/why-not-mesh/
“None of the current meshes are compatible with the body. Because of this, chronic pain is a significant problem. If the benefits of mesh greatly outweighed the difficulties of mesh, then it might make sense to use mesh. But that is not the case! When you compare the results of a sports hernia repair with and without mesh in athletes, the long term results are much better without mesh. None of the Sports Hernia Experts use mesh. Also, when you compare the results of inguinal hernia repairs in young men, the results are better without mesh. In all other groups of patients, non-mesh hernia repairs have less pain than mesh hernia repairs.
Please do not let your surgeon use mesh.”
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So that looks like one of the modified Shouldice methods that have been discussed in other threads on the forum. I am not familiar with all of the ins and outs of the variations like others are. Vicryl is an absorbable suture material. Prolene is polypropylene.
The runaround that you’re getting is very typical for all types of medical procedures today, unfortunately. Surgeons and specialists are becoming more like workers on a factory assembly line. They do their little part then move the product down the line. Sorry, this does not help your situation but it might give you incentive to search for 2nd, 3rd, and 4th opinions.
Not all doctors are bureaucratic. Some are very independent and passionate about their work. Keep searching. Good luck.
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It doesn’t sound like you went to the Shouldice Hospital. Can you give details on the “method”? The materials used, how many layers, the type of hernia that was repaired, etc. The more details the better.
No offense, but by the post you are just a person who had a repair that the surgeon called “Shouldice method”. Not really clear where you started or what you had done. There is hope, I’m still getting better almost 5 years after mesh removal. The body can take a long time but it will just keep trying. Healing can be slow.
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Hello Katherine. Here is a video that you might get some value from watching. I’ve included the link to a Topic I just created. I wish that it was more positive but the reality is that it seems to show that you are at even more risk than a man, in choosing to have a hernia repaired. But, conversely, maybe you can contact the presenter and get some good advice. Good luck.
https://herniatalk.com/forums/topic/gender-specific-hernia-repair/
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Finally, the true owners of the product.
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Here is the message from the Inightra.com page –
“Insightra Medical Inc and all its subsidiaries are now owned and operated by Tennessee Medical Innovations Inc (TNMI)
Please visit http://www.tn-mi.com to find out about the company and our products:” -
If you search “Insightra.com you’ll see the message about tn-mi.
tn-mi has been acquired by a company called Mundomedis.
https://tn-mi.com/mundomedis-acquires-us-medical-device-manufacturer-tnmi/
Munomedis is a venture capital company focused on the medical device market. Venture capital only cares about return on investment. Products have to sell.
“ABOUT MUNDOMEDIS
Mundomedis is a global incubator for startup and early-stage medical device companies and serves as a growth accelerator for more advanced medical device companies. Located in Dubai Silicon Oasis, a fully integrated technology park with the aim to foster technology and entrepreneurship, Mundomedis utilizes its global network of strategic partners, distributors, manufacturers and healthcare providers to:– Raise Capital
– Assist and drive M&A strategies
– Develop global sales and marketing strategies
– Build and expand distribution channels
– Source suppliers and assist in outsourcing production
– Support in Regulatory AffairsFor more information about Mundomedis visit: http://www.mundomedis.ae “
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The company that sells it, Insightra, has apparently been bought by a medical devices company.
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It’s already for sale in the USA and India.
https://www.insightra.com/wp-content/uploads/2019/01/PROFLOR_patient_info-1.pdf
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Hello William. My point was that the problems have been clearly identified but no action is being taken to remove them. The bad products are still for sale all over the world. Dr. Pauli explains how the bad products got in to the market, through the 510(k) program, then describes how it will be harder to introduce new products. In sum, the bad products will remain and product development will be hindered. The horse is out of the barn, they closed the door, and they’re happy to let the bad horses run free, making everybody money, from implantation to pain clinics to explantation.
But no attempt to prevent the problems by removing the bad products or procedures. Lots of talk, the same things repeated over and over, very supposedly conscientious, but no actions taken. Nobody is brave enough to criticize an actual mesh product and push for its removal from the market. The most direct that I’ve seen is “plugs are evil” from a Dr. Novitsky tweet in response to a Dr. Towfigh tweet about a plug removal and all of the damage that the plug caused. Plugs are still being promoted, markets being developed, in foreign countries.
The large organizations like SAGES are more focused on fostering tech entrepreneurs. It’s all very commercial and corporate. Like it’s all a popular cable TV show. Better faster technology to implant the bad mesh products faster and more profitably.