Good intentions
Forum Replies Created
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Another suggestion – extend the time for editing beyond just a few seconds. The size of the box for writing a post is so small that you can’t actually see the whole post until you post it. Then you have about 10 seconds to proof it and fix any errors before you’re locked out.
2nd suggestion – make the box for creating a post bigger. Much bigger.
3rd- the header at the top of the page is way too big and does not scroll up and away like a normal forum header. Once a Topic is opened the header serves no purpose.
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I posted the wrong link above and can’t edit. Here’s the right one.
https://link.springer.com/article/10.1007/s00464-020-07516-5
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I remembered another organization that was focused on hernias and I dug up this old post about them. Apparently they have a Quality Assurance program also, and a study, but it’s not clear where the data gets used.
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Here’s the Facebook page. https://www.facebook.com/herniasurge/
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If you follow the logic defined in the “Guidelines” then you’ll see that these programs will spread mesh repair throughout low income regions of the world.
Guidelines say mesh is the preferred first choice > endorsed by Hernia societies > societies get involved in hernia repair training efforts > training in the “preferred” method happens in the low income regions > more mesh repairs > supported by big mesh-maker.
Marketing and sales promotion is defined as “giving back”.
Who will do the training for pain management and mesh removal?
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I might have confused Herniasurge with OperationHernia. They seem very similar.
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I might have mistaken Herniasurge for one of the other groups. Here is a typical training program, linked below. Medtronic seems involved, a big mesh-maker.
https://hernia2021.org/hernia-2021-charity-project/medtronic-operation-hernia-project
The reasoning behind it does not seem to fit the results of the abstract in the first post.
“Two significant factors form the background to this project:
1. The burden of hernias in Ghana is high. The rate of hernia repair is very low compared to the west. There is an urgent need to increase the rate of repair by increasing the number of trained surgeons to repair hernias to avoid a backlog of a million patients with hernias in 10 years
2. Most hernia repairs carried out in Ghana is by high tension Bassini repair which has a high recurrence rate. The programme trains in Mesh Repair.”
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p.s. my comment about Herniasurge being behind the program in Africa is based on past articles I’ve seen. I will try to find them and post them.
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The Herniasurge group has a program in place to train more surgeons in mesh techniques. The verbiage seems to be a bit mixed-message, the first reference is to the “International HerniaSurge Guidelines” (even though Herniasurge is not actually in the title of the Guidelines).
Herniasurge is the group that has an actual piece of mesh as their logo. Very strange how enamored they are of mesh. They have vacillated between being behind the scenes and being at the forefront. It looks like they are stepping out again as a force for promoting mesh.
https://pubmed.ncbi.nlm.nih.gov/32157505/
If a region is “Low Resource” and mesh is unaffordable how does training in mesh techniques help? The conclusion of “need for formal training” seems disconnected from the words that precede it. Seems like the need is not real. Maybe I am misinterpreting.
“Abstract
Introduction: Inguinal hernias are among the most common surgical diseases in Africa. The current International HerniaSurge Guidelines recommend mesh-based surgical techniques in Low Resource Settings (LRS). This recommendation is currently unachievable in large parts of Africa due to the unaffordability of mesh and lack of appropriate training of the few available surgeons. There is, therefore, a need for formal training in mesh surgery. There is an experience in Hernia Repair for the Underserved in Central and South America, however, inadequate evidence of structured training in Africa.” -
Just posting to show the other end of the spectrum from the pain reports from the thousands of Shouldice procedures. Here is a material, described in the paper linked below, with a perfect record. No recurrences and no pain. 31 patients.
It is definitely tough to ignore the concrete, Individual stories of pain. They have impact, for sure. But if you ignore the odds, the probability of problems, then really you’re susceptible to the person or corporation with the best sales/marketing pitch. The most convincing story. Or the most hopeful story. I ignored the odds and hoped that my professional surgeon friend knew more than I was seeing in the literature. But it turns out that he was just hoping also.
https://www.sciencedirect.com/science/article/pii/S2405857218300196
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Funny, I screwed up the title. It’s Abdominal, not American. I missed the tiny editing window.
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I found questionnaires on the ACHQC (formerly AHSQC) web site.
Reproduced from the EuraHS form, apparently.
“Used with permission from the European Registry of Abdominal Wall Hernias (EuraHS)”
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EuraHS stands for European Hernia Society, apparently. The data is apparently collected and input to a database by individual doctors or their staff, then made available to anyone that wants to use it. A sample of a questionnaire would be interesting. I think that it is similar to efforts by the AHSQC.
This is from 2012 for ventral hernias. I assume that its use has been extended to inguinal hernias.
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Actually William, this is another area that you can separate out for your decision-making process. The surgeon’s own decision-making process. Dr. Koch is apparently a very capable surgeon. But, according to Baris’s story, he made poor decisions.
Just another aspect to consider.
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I also enjoyed hearing Dr. Muschaweck’s very logical thoughts on placing a stiff inflexible material in an area of the anatomy that has to be flexible to function properly. Why do that?
Most mesh surgeons will acknowledge that the mesh becomes stiff after it becomes “incorporated”. But they don’t seem to make the connection between the loss of flexibility and the groin discomfort that results.
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I can’t speak to anyone’s confidence in statistics. That’s a whole separate issue, personal to the person.
The main thing that I enjoyed about listening to Dr. Muschaweck was her very logical and rational decision-making process. There was no hand-waving about recurrences, or “what-aboutisms” about pure tissue repair pain occurring also. Just a simple description of choosing the simplest most effective repair method based on the patient at-hand, eventually leading to the simplest most effective mesh repair if the pure tissue repairs did not work. Her choice of repair method is based directly on the type of damage that she sees. It is never the one size fits all maximum mesh coverage repair that is used in today’s laparoscopic mesh implantation.
It was most interesting to see two surgeons on opposite ends of the hernia repair method spectrum having that discussion. Dr. Towfigh is a LAP TEP repair surgeon, which means large pieces of mesh covering the whole of myopectinaeal orifice. I actually felt a little bit uncomfortable watching Dr. Muschaweck describe her methods, knowing that Dr. Towfigh’s first choice is LAP TEP.
But that is the state of the hernia repair world today. Anybody just entering it would have no idea of how to choose a surgeon or repair method. It is chaos.
I stumbled across another of the biblically themed guides for mesh-based hernia repair. This is what you’ll get if you choose a LAP mesh repair surgeon and the surgeon is a follower of the latest and greatest ideas.
https://link.springer.com/article/10.1007/s00464-020-07449-z
“Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide”
“Rule 8: A large mesh (usually at least 10 cm craniocaudally?×?15 cm medio-laterally) may be placed covering the MPO (Indirect, Direct and Femoral triangles) with overlap of at least 3–4 cm (Fig. 9).”
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Thanks William. I wonder how Baris is doing? That Topic is four years old. @baris
The whole story looks bad for Dr. Koch.
Here is an old Topic about Biohernia. I think that you pulled a quote from it recently.
https://herniatalk.com/forums/topic/biohernia-hernia-surgery-without-mesh/
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“Don’t let perfect be the enemy of good” is a quote that I hear often.
When looking at any of these techniques or repair options or surgeons I think that the best that you can do is to try to assess the odds, the probability of a desired outcome, and the weight of solving any problems that might happen. For example, Dr. Muschaweck has, if I recall correctly from the video, done 29,000 hernia repairs. So, one Glenn Murray out of 29,000 is a tiny tiny number. 3.4 x 10^-5. 0.000034. 0.0034%. And he is a professional athlete in one of the most physically demanding sports, over time, in the world.
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Thanks William, I do remember reading that post in the past now that you’ve recalled it.
Could you possibly post the actual link that you copied the post from? It will have the date of the post and the context around it. If you’re on a phone, typically you can choose an option to copy the link then paste it in to a post.
Besides the date and the context there’s also the chance that something got miscopied. It is always a good idea to include as much information about the source as possible.
And, to that point – I read the quote as dissatisfaction with Dr. Koch, not Biohernia. It’s definitely a bad reference for Dr. Koch.
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That was a great interview. Thank you.
p.s. Real Madrid is one of the top teams in European soccer. 6:00 minutes, the comment about the 100 year anniversary of Real Madrid.