Good intentions
Forum Replies Created
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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.
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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/
https://www.sages.org/video/pantaloon-hernias/
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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.
HerniaTalk **LIVE** Q&A: Sports Hernia & Minimal Repair Technique 09/20/2022
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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.