Good intentions
Forum Replies Created
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Here is a link to the paper. It’s been cited by 53 people according to Google Scholar. It was published in 2013.
https://www.sciencedirect.com/science/article/abs/pii/S0304395912006483
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=DQB1+*03%3A02+HLA+haplotype+&btnG=
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Dr. Campanelli seems to be thinking deeply about what it means to be a physician in today’s world and expressing his thoughts in Editorials. It will be interesting to see what the corporations think of the issues he is raising.
Here is a search page and a couple of his most recent articles.
https://link.springer.com/search?dc.creator=G.%20Campanelli
“Quality of life is the most important outcome measure of hernia repair”
https://link.springer.com/article/10.1007/s10029-022-02634-6
“Super-technology, quality of life and ethics in surgery”
https://link.springer.com/article/10.1007/s10029-022-02655-1
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I think that Dr. Towfigh touched on some possibilities for the first question in her presentation.
Here is a recent commentary that I ran across today, also about hernias in female patients. Topics generally tend to become focused then fade away as the years go by. Maybe this is the time of the female hernia. Trans vaginal mesh brought a renewed focus on mesh problems. Maybe hernia repair mesh in females will do the same again.
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Dr. Lorenz was in the LinkedIn picture and he posted soon after the Guidelines were published about one of the deficiencies of the Guidelines. It will be interesting to see if they take the obvious step, as Dr. Towfigh noted in her recent presentation, of recommending more pure tissue repairs. It’s hard to see how they could avoid it.
Excerpt –
“For many years, the only quality criteria used after a hernia operation was the recurrence rate. Subsequently, the tension-free concept was developed and is now used throughout the world. In recent years, the focus has increasingly shifted to possible chronic pain after hernia surgery. Based on these two criteria, the currently applicable “International Guidelines for Groin Hernia Management” published by the HerniaSurge Group recommends the use of mesh as a rule, either endoscopically via transabdominal preperitoneal or total extraperitoneal or in open surgery using the Lichtenstein technique.[1]
However, newer studies have shown that use of the Lichtenstein technique is possibly linked to a higher rate of postoperative pain.[2] The guidelines currently do not include alternative open surgical techniques, particularly mesh-free techniques, due to the small amount of scientific evidence. However, in recent years, numerous reports on postoperative pain after mesh implantation[3] and mesh-related complications[4] have led to increasing uncertainty among patients. Moreover, there have recently been register studies that showed at least equally good results for the mesh-free procedures for selected patients.[5],[6] Thus, the mesh-free procedures are regaining importance.[7]”
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Thanks for the reply Dr. Towfigh. There is really nothing substantial to read in that single month old LinkedIn posting, but it is something, at least.
My understanding is that Herniasurge is just a formalization of a combined effort, based on past efforts by several organizations. The same group that put together the 2009 European Hernia Society guidelines was involved. The same names plus some new ones. So, not really “impromptu”. Looks like a pretty long-term plan.
It will be interesting to see what they come up with. Especially after Dr. Campanelli’s Editorial about how “chronic pain is real” and that there will be a focus on it this year. Strange though that the Herniasurge web site is dead, and the Facebook page inactive, but somebody found the time to post on EHS’s Linkedin page.
Here is a good summary of the efforts that resulted in the Herniasurge Guidelines. And a link to the EHS guidelines of 2009.
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It seems too early to consider more surgery. Is it possible that you’re trying to exercise your body back to its old self and overworking the surgery area? I have found that the occasional extended rest time helps when aches and pains in the surgery area start to build up. It’s getting close to five years since mesh removal for me and I can still feel adjustments down there as time and activities go on.
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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.