Good intentions
Forum Replies Created
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Thank you for that interview Dr. Towfigh.
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She does not like the Desarda technique. She gives reasons.
@drkang might be interested in Dr. Muschaweck’s views.
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She said that she does not remove laparoscopically-placed mesh. Too difficult. So glad I found Dr. Billing.
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39 minutes and on gets interesting, re mesh. It starts with “sports hernias” but ends up talking about all hernias. Dr. Towfigh put up written questions about “sports hernias” but was talking about all hernias. Good to see that normal hernias got some discussion.
We need more Dr. Muschaweck’s. She covered just about all of the issues. She also echoed Dr. Kang’s thoughts about using different techniques for different types of hernia. There is no “one-size-fits-all” method.
She also talks about mesh removal.
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Dr. Towfigh posted the Youtube link already, at the top of the page. I have not watched the whole thing. Over an hour.
Here’s the link since sometimes the “pinned” stuff at the top is not obvious when it changes.
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It would be interesting to compare your surgeon’s notes with the Consensus Method. There might be a clue there. At the least it might offer a distraction from the pain.
Here is your other Topic where you originally discussed the problem. It looks like you had what is known as a “pantaloon” hernia.
https://herniatalk.com/forums/topic/open-no-mesh-inguinal-surgery-is-this-normal/
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Avoid creating abdominal pressure. Don’t hold your breath when you exert yourself. You can also hold your hand over the hernia to see if what you’re doing is causing it to project. A truss might be helpful also.
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They are in the reply to the interview notice.
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Thanks for posting this Jack2021. I might actually watch and ask questions, knowing who is being interviewed. I have noticed that many interview subjects defer to Dr. Towfigh’s area of expertise, at the expense of their own standing, but Dr. Muschawck has built her own reputation, world-wide. I hope that it is a good conversation.
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Please discuss with her your results of repairing professional athletes with mesh with her reluctance to use mesh on professional athletes. You have posted in the past about using mesh on professional athletes but have never reported the results of the repairs. Dr. Muschaweck is world-renowned for repairing abdominal injuries, including normal hernias, of professional athletes.
It is slightly off your topic, “sportsman’s hernia” versus “normal” hernia, but most of your viewers are here here for normal hernias. You will probably never get another chance to speak to somebody so well-known in the world of athletic endeavors. Please take advantage.
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Here is an example of where business factors could drive change in the mesh-based hernia repair industry. “workdays missed”. Once a dollar figure gets put on the problem, people with power start to think differently.
The study is broad-based, including all types of chronic pain. But the concerns are the same.
Excerpt –
” Respondents with chronic pain reported significantly more workdays missed compared with those without chronic pain (10.3 vs 2.8, P < 0.001). Overall, these findings indicate that more than 1 in 5 adults in America experiences chronic pain; additional attention to managing the burden of this disease is warranted.”
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Dr. Campanelli has been studying chronic pain from hernia repair for quite a while. Here’s a paper from 2011.
Interesting that the problem was serious enough in 2007 that a group of nine experts was assembled in 2007, eventually resulting in this work. But, somehow, the problem persists.
The same general strategy was used to produce the “Guidelines” for hernia repair.
https://link.springer.com/article/10.1007/s10029-011-0798-9
“Purpose
To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain.Methods
A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidence-based literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question.” -
Here is another reference to Dr. Koch and one of the “modified” Shouldice methods.
https://herniatalk.com/forums/topic/indirect-hernia-no-mesh-repair-by-dr-koch/
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Sorry William, maybe you are right. If you could copy the post or Topic where he discussed that, it would clear things up. I gleaned what I could in the time I had to find and read a few posts.
Here is the reference to Shouldice being bemused (apparently). The odd grammar made me think that Baris was bemused.
https://herniatalk.com/forums/topic/14-months-post-surgery/
“Both hernias only having fat coming through( bemused shouldice why DR KOCH put mesh on my indirect right inguinal hernia in the first repair)”
Could you provide a link to the Topic where Baris describes getting mesh instead of the pure tissue repair he expected? I must have missed it.
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Here’s another and Baris’s page link.
https://herniatalk.com/members/baris/
https://herniatalk.com/forums/topic/indirect-hernia-no-mesh-repair-by-dr-koch/
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I have a vague memory of a person expecting a pure tissue repair but getting a mesh repair. But I looked around and it does not appear to be Baris. Apparently he wondered, after the fact, why he had received a mesh repair. It’s not clear what he expected though when he had the repair. I think that for his first repair he just accepted what he was told was best, and they used mesh. And he had problems.
Here are some old interesting Topics, about Shouldice Hospital and about European repair options.
https://herniatalk.com/forums/topic/14-months-post-surgery/
https://herniatalk.com/forums/topic/biohernia-hernia-surgery-without-mesh/#post-22109
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Dr. Towfigh has updated her Youtube channel. I have not watched the video but it might have some value. I have to assume that the “myths” are from the perspective of the surgeon. It would be interesting to see the myths written out so patients could add their real-world experiences.
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Thanks for the reply Dr. Towfigh. I think that the innovation urge might be part of the overall problem with hernia repair problems. In the “tech” world, “new” is almost always assumed to be better. New markets to exploit. New products are heavily marketed and sold so that shareholders can make money.
But in healthcare, this urge to invent new products seems to lead to products being developed first, then homes for the products being sought out. New mesh materials, robotic methods, laparoscopy tools, etc. TelaBio mesh ventral hernia studies being used to expand in to inguinal hernia repair (31 patient studies…enough?). New techniques being developed when the new product has problems (ReBAR for Ovitex mesh). But the patient ends up as just a vessel to transport the new product to market. You are celebrating Dr. Felix as an innovator. But not a physician. You’ve also fallen in to the trap of assuming that past pedigree has value.
The value is in the results. You could argue that Dr. Felix has led a whole generation of surgeons down the primrose path of mesh implantation. He will retire eventually, leaving a large mess behind him.
My point was that, overall, it makes no sense to have a mesh promoter discuss pure tissue repairs. There is an inherent bias present. He has already shown it in his past presentations implying that people with chronic pain from mesh just need to toughen up. His past work makes it obvious that he is a poor choice to cover pure tissue repair, since pure tissue is the natural opponent to mesh repairs. The appearance alone is enough that a rational person would not choose him. His name and “pure tissue repair” do not belong together. For someone of Dr. Novitsky’s reputation, it is surprising.
Even the SAGES meetings are focused on “tech”. Where is the focus on the patient?
Somehow this organization that used to be focused on patient welfare has become a Tech Conference. Bizarre.
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I was replying to Watchful directly, and indirectly to anyone who wondered about the term. It’s a business/financial term.
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But, on the other hand, where will the people with money and influence go if Shouldice fails? Rand Paul, for example.
It might be that there are reasons for the recent “Expert’s Consensus” paper from the Shouldice Hospital. Maybe they are laying the groundwork for expansion or a move. It will probably take years before Shouldice gets pressured out, but it won’t be a surprise if it happens.