Good intentions
Forum Replies Created
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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.
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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
HerniaTalk **LIVE** Q&A: Mesh Removal Myths & Facts 09/06/2022
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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/
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