Good intentions
Forum Replies Created
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Political lobbying is incredibly powerful. Oil, tobacco, pharmaceuticals, herbicides… Anything that has large quantities of money running through it is going to be lobbied for at the highest levels. Right or wrong don’t matter. Just the size of the stream of money.
“Cash cow” doesn’t necessarily have to do with profits. It’s the steady stream that matters.
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William, PSA stands for Pain with Sexual Activity. It’s in the reference. They also provided the definitions.
“BACKGROUND:
The reported incidence rates of sexual dysfunction (SD) and pain with sexual activity (PSA) after inguinal hernia repair in males vary considerably. This meta-analysis explores the rates of SD and PSA after different surgical and anesthesia types to understand patient risk after inguinal hernia repair.”” Definitions of SD and PSA focused on completion of intercourse for the former and pain with erection/ejaculation for the latter. “
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I can’t remember all of your details or past posts. But have you penciled out the actual cost of going to see Dr. Kang in South Korea? Of all of the methods out there his seems to be the most minimally invasive, in all ways. Physically and anesthesia-wise. It seems the safest.
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That is a really interesting article, thanks for posting. Dr. Andresen (not involved in the study) is one of the big names in hernia repair research.
Kind of disturbing that the conclusion of what to do with this information is only to include it in the informed-consent process with the patient. Not work on understanding the cause and fixing it.
And, of course, “open” and “minimally invasive” are used as catchalls for a huge variety of methods and materials.
The good news is that once all of the downsides of hernia repair are regularly disclosed to the patients before accepting surgery the patients can more powerfully drive improvement. By refusing to get surgeries that are not shown to avoid these problems.
Excerpt –
“CONCLUSIONS:
Sexual dysfunction and PSA are not rare after inguinal hernia repair. They should be included in preoperative discussions and as standard metrics in reporting outcomes of repair in large cohorts or trials.” -
Dr. Towfigh apparently did one of her HerniaTalk Live sessions on mesh removal recently. It’s not on her Youtueb site though, maybe it will be there later.
https://herniatalk.com/forums/topic/herniatalk-live-qa-mesh-removal-myths-facts-09-06-2022/
https://www.youtube.com/results?search_query=towfigh+Mesh+Removal+Myths+%26+Facts
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I think that only a surgeon who does both could say if one was “easier”.
It seems like you’re trying to compare the risk of your situation to somebody like myself who had laparoscopic implantation and removal. I think that laparoscopic removal is inherently riskier because of the general anesthesia, the need to cut through the peritoneum (potential for adhesions), and the fact that laparoscopic mesh is laid on top of nerves and vessels and becomes attached to some of them over time. For example, my surgeon had to sacrifice the inferior epigastric artery on one side because it was so entangled. He also had to leave a piece of mesh in, because of the risk of more damage. It’s an example of the high stakes involved in lap mesh hernia repair. If problems happen they are very very difficult to solve.
So, overall, it seems reasonable to estimate that open mesh removal is less risky than lap mesh removal. And, since Lichtenstein’s method does not involved a plug, there should be less entanglement with critical structures. That’s how it looks to me, but I’m just a person who reads a lot.
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You probably had a Lichtenstein repair. So the mesh is actually in the inguinal canal, not behind it. That’s why it would be removed by open methods, from the front. It would make no sense to enter the canal from the back of the abdominal wall via laparoscopy.
If you have your surgery notes they might have more information about the procedure that you had. Covidien (now Medtronic) also makes a plug and patch mesh, but it is not a Progrip product.
Here are a couple of links that show the material and the probable procedure.
https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html
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Here are a few places to research.
https://herniatalk.com/forums/topic/non-mesh-pure-tissue-hernia-repair-surgeons/
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I would guess that the irritation and inflammation from the hernias is affecting the nerve impulses to the bladder contraction and sphincter relaxation impulses.
Here is a reference – https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-how-it-works#:~:text=To%20urinate%2C%20your%20brain%20signals,and%20out%20of%20your%20bladder.
Do you know what type of surgery that you will have for the repair? I was also involved in physically demanding activities and had problems with mesh after my bilateral laparoscopic repair. As I studied the overall situation I got the impression that most of the people who get hernias repaired aren’t really very active. One reason that many athletes get non-mesh repairs. What type of work do you do? You might try to find an internet forum of people who do similar work and see what they know about hernia repair in your field of work.
Make sure that you browse the forum and read many posts and stories. Make an informed decision. There are many ways to get screwed up if you just accept what the system gives you. The delay in your repair appointment migth be the best thing that has happened in your situation. Good luck.
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Yes, I had posted some things about Dr. Pawlak in the past, it’s good to see that he is still engaged with the problems. The presentation about “hernia surge” guidelines looks interesting.
There is also a presentation about Guidelines updates mentioned in the program. So, people are still poking at the bear but the bear is pretty big and powerful. All we can do is hope.Here are a couple of definitions for the acronyms used in the first post and a link to more about Dr. Pawlak.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100151/
“A multidisciplinary team (MDT) in oncology is defined as the cooperation between different specialized professionals involved in cancer care with the overarching goal of improving treatment efficiency and patient care.”
https://www.childrenshospital.org/conditions/anterior-cutaneous-nerve-entrapment-syndrome
https://herniatalk.com/forums/topic/dr-m-pawlak-a-new-surgeon-worth-following-and-hoping-for/
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I did not know that Dr. Towfigh’s father had had a hernia repaired. (It’s in the comments).
Maybe some details could be shared? What type of hernia, what type of repair, how does he feel about the repair?
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Here’s an update on the Perfix plug lawsuits. It seems like the one simplest mesh product that the majority of surgeons could agree should be curtailed in its usage. One or two surgeons with the guts to say something bad about a mesh product, beyond a simple tweet. Take some action, actually drive some change.
https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html
Excerpt –
“September 9, 2022 Update
The next bellwether trial case is scheduled for trial on February 21, 2023, at 9:00 a.m. in Courtroom 311 at the federal courthouse in Columbus, Ohio. The case is Stinson v. C.R. Bard et al. We talk about this case in greater detail below. This puts real pressure on the upcoming settlement talks. Bard does not want to take another multi-million dollar verdict like it just did in Trevino.”
“May 26, 2022 Update
The big question we are getting from hernia mesh victims is when will the Stinton case, the third bellwether mesh lawsuit, go to trial? The trial date has not been set but our hernia mesh lawyers believe the trial is likely to go in October if a new trial is not granted in Milanesi.Stinson, a plaintiffs’ pick for trial, involves the extra-large PerFix Plug device that is used to repair inguinal hernias. Mr. Stinson claims difficulty with urination, weight gain, an impaired sex life, and nerve entrapment.”
https://www.bd.com/en-us/products-and-solutions/products/product-families/perfix-plug
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p.s. if you click on the forward arrowhead beside each title a dropdown menu of the individual presentations will appear. Not obvious. The recent Shouldice Expert Consensus title made the meeting. The majority of the presentations are about mesh. Some talk about the legal situation. But mesh prevails.
The Shouldice Method: an Expert’s Consensus
Cassim Degani, MBBS ,MS,FRCS[C],FACS
Abstract PresenterIrony. Dr. Felix will be talking about tissue repairs.
Tissue Repairs: The Forgotten Art
Edward Felix, MD
FacultyThe legal issues –
Mesh Lawsuits and How They May Shape Our Practice
Vahagn Nikolian, MD
Faculty -
Here’s the program, linked below. And a listing of the behind the main scene activities. At a typical meeting like this in other professions, the corporations put together a booth with examples and presentations of their products, with sales people manning the booths to make new contacts, in a large exhibit hall. They also rent out suites in the hotels for happy hours and parties in the evenings.
https://www.americanherniasociety.org/meetings-and-education/annual-meeting/program
It’s worth looking down the list below to see the true extent of corporate influence. Lots of money being spent. Very much like a trade show. Dinners, awards, happy hours. When I was a student attending the trade shows in my profession we would always try to find the best happy hour suite. The biggest corporations typically had the best ones.
https://www.americanherniasociety.org/Documents/Corporate-Support/AHS22-Corporate-Prospectus.pdf
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This episode is really interesting. I was unaware that the topic had made its way to mainstream television. It was produced in 2013, the year before I got my hernia repaired. I wonder how they came up with the concept.
It seems to dovetail well with the “Corruption of Care” article in General Surgery News.
https://ew.com/recap/greys-anatomy-season-9-episode-13/
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Here is a recent paper citing Dr. Campanelli’s Editorial. There’s only one shown. 890 “accesses”.
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Here is an interesting presentation I came across that seems relevant to the original topic.
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This web site, linked below, does a pretty good job of tracking lawsuits and has some names. One thing that you’ll find is that the lawsuits are based on the assumption that mesh devices are inherently safe and do not cause problems. The law firms are working any angle that they can find that implies the manufacturer cut corners or made a mistake in manufacturing the product. There don’t seem to be any suits yet that just say outright that the mesh product’s design is inherently flawed. The defense just points to the 85% of mesh patients that are still functional.
The plug seems like one that has the possibility to argue that the design itself is flawed. Even mesh surgeons have said that plugs are “evil”, and the “Guidelines” recommend against plugs.
Glad to see that you made it through. People, including doctors and surgeons, can’t comprehend what it’s like to have mesh problems. If there was a way to let a person borrow another person’s body for a day, no surgeon that borrowed a mesh patient’s body would ever use mesh again for inguinal hernia repair.
https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html
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Dr. Brown’s practice is still open, under new management. Hard to tell much about him, he’s trained in laparoscopic and robotic methods but the non-mesh hernia repair is still described. The focus still seems to be athletic pubalgia.
He’s down in the Bay area.
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You should get a copy of your surgery notes to see what exactly was done. There is no single method for laparoscopic surgery, there is a multitude of methods and materials. There might be something in the notes that is a clue.
Also, write your questions down before your visit and make sure to refer to them when talking to your doctor. Most doctors do not want to hear about problems after they have worked on you. Their first impulse will be to tell you to wait it out, “it’s normal”. Once you’re in that setting you will have trouble guiding the discussion. You might only see the surgeon for a few minutes.
Send a note if you can with the specific problems described to the doctor’s office so that they will be documented. As you can see from the many posts on this forum, pain from hernia repair is often discounted as not significant and/or temporary. Your specific problem might just be grouped in to the larger group of “normal” post-surgery pain. You might have to be very adamant that your problem is not normal and not acceptable.