Good intentions
Forum Replies Created
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Here is a recent paper with a pretty good short review of absorbable meshes, with references. It’s in the second section.
Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives
by Simona Mirel 1ORCID, Alexandra Pusta 1,*ORCID, Mihaela Moldovan 2 and Septimiu Moldovan 3 -
Much of Dr. Heniford’s work is in the area of ventral hernias. Which are different than inguinal hernias, the dynamics of the body movement are not the same. Something to be aware of.
I think that one reason that more absorbable or resorbable materials are not offered is because all of the mesh makers are using the 510(k) program to introduce new products. Because it’s cheaper. New products are just small variations, supposed improvements, on old products. That’s how the 510(k) program works.
I did not watch the video so am not sure what “absorbable” means here. Ovitex is called “resorbable” as opposed to absorbable.
https://www.telabio.com/assets/download/OviTex-PRS-Resorbable-IFU.pdf
Here is a recent publication with Heniford as a co-author. They are still studying polypropylene. It’s not really clear what they will do with the new knowledge.
https://link.springer.com/article/10.1007/s00464-021-08882-4
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“All the ‘pros’ about hernia mesh would have been the same for vaginal mesh. Eventually the ‘cons’, or risk of them, outweighed the ‘pros’ and it was banned. Suspect same will happen with hernia mesh.”
Actually transvaginal mesh is only banned in certain parts of the world. The mesh makers continue to sell it wherever they can.
As far as money goes, there’s no conspiracy. It’s just simple free, poorly regulated, market principles. The mesh makers have the funds to support mesh procedure training via funding schools and professional meetings, and professional marketing and sales teams. There is no similar level of funding for pure tissue repairs. The regulatory agencies in the USA have been hollowed out, and are influenced by politics and large corporations. So, the mesh makers have the advantage and they have financial incentives to promote mesh, despite the risk to the welfare of the patients.
A comparable situation is asbestos contaminated talc, used for baby powder. Johnson & Johnson continues to sell it in other countries and spends a portion of the profits on attorneys for legal defense against the law suits. Corporations have no souls.
https://www.hkjgom.org/sites/default/files/pdf/v22n1-37-vaginal.pdf
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Dr. Lorenz mentions non-mesh and mesh in his paper, linked below. The OperationHernia page is a bit misleading it focuses on mesh, not “help”.
Anyway, kind of fascinating.
“Training of Ghana Doctors in Mesh Hernia Repair: National Capacity Building Programme”
https://hernia2021.org/hernia-2021-charity-project/medtronic-operation-hernia-project
“Improving surgical education in East Africa with a standardized hernia training program – R. Lorenz, C. Oppong, A. Frunder, M. Lechner, D . M. Sedgwick, A. Tasi & R. Wiessner ”
https://link.springer.com/article/10.1007/s10029-020-02157-y
Excerpt –
“Conclusion
We have demonstrated that, medical personnel in Africa can be trained in mesh and non-mesh hernia surgery using a structured training programme.” -
And OperationHernia. The third link is most informative. The Bassini repair comes up again. Dr. Lorenz is referenced also.
https://operationhernia.org.uk/
https://operationhernia.org.uk/our-partners/
https://hernia2021.org/hernia-2021-charity-project/medtronic-operation-hernia-project
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Here is more about the author of the report that you posted William. He has really been around. It is a good sign that he is open to a better understanding of what is going on. I hope that he is sincere.
Fascinating that he is part of the Herniasurge group and also participates in the charity work in under-developed regions of the world. Back when the Herniasurge pages were open to the public, you could read about the efforts to train surgeons in mesh repair techniques through those charity efforts.
“He has also volunteered with Operation Hernia and HerniaHelp, taking part in surgical charity missions in Ghana and Haiti.”
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Thanks for finding and posting that William. It is definitely worth reading. It gives the perspective of the new surgeon. Not trained in the pure tissue repair methods but is aware of them and wants to learn them.
It is also interesting that the page that Alephy posted is so pro-mesh, but Dr. Lorenz is known for pure tissue repairs and his name is at the top of the page. The Guidelines work that was done in 2009 is still very powerful.
This excerpt from the page you posted really caught my eye. If hernia repair surgeons start using a fully formed chain-of-logic approach with long-term results for the patient in mind, his philosophy makes perfect sense.
“During my training, I did not have a chance to learn the basics of pure tissue repair. When I started my career it was already the era of mesh repair. The evidence and multiple trials that had shown the superiority of mesh vs non-mesh repairs sanctioned those changes in surgical approach. Nevertheless, I wanted to explore the field of pure tissue repair to become familiar with the strengths and weaknesses of the groin region and its layers and to be able to tailor my approach if necessary. I believe that to become a true expert of hernia surgery, it is of utmost importance to know the anatomy of the abdominal wall and the proper management of tissue, as well as how to use fascia to support the repair. Most of all, that knowledge should be the backbone of honest, patient-oriented decision making while considering methods of hernia repair. Therefore, Shouldice, pure tissue repair, as the technique with best-proven outcomes, should be taught and used when the patient could benefit from it.”
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That looks very sketchy. All of the internet press is about novelty and investment. No data about actual studies showing efficacy. Another experiment looking for subjects.
The “co-founder” is an investment manager. They need money in order to, supposedly, start doing the work to see if it actually works. It’s just an idea at this point.
https://www.f6s.com/tomaszasecki
https://ampoleagle.com/polish-invention-could-revolutionize-the-treatment-of-hernias-p11964-125.htm
“Co-founder of Poltiss Tomasz Lasecki emphasizes that this investment will allow them to carry out the research and development work necessary to demonstrate the effectiveness and safety of this technique. “In the next stages, we will have to launch the marketing approval procedure,” he adds.”
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“It was mentioned by Dr. Towfigh during a weekly contribution from a panel guest, that
1. bio absorbable meshes do not work, and
2. that absorbable synthetic ones release possibly dangerous substances into the blood when they decompose (apologies if I misunderstood this point somehow); here the assumption seems to be that they work in preventing a recurrence?”Was this the interview with Dr. Heniford? It would help to show where you saw this so that we could see it ourselves.
Ovitex would be considered an absorbable biologic mesh. Dr. Towfigh was a proponent of Ovitex just a couple of years ago. so it’s not clear what was being discussed, if she said that. “Bio mesh” is an ambiguous word, even the synthetic meshes are sometimes called bio meshes. Because they are used in the body.
The other absorbable materials can degrade in to toxic components or normal molecules already found in the body. It depends on what the material is.
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Hello Alephy. It looks like Dr. Lorenz and/or his staff, whoever put the page together, have just taken the latest thoughts being promoted in the hernia repair field, especially “tailored repair”, and come up with a list showing many possible tailored methods. But it all starts with the European Guidelines. Mesh is still the first choice, and the list just shows the huge selection of materials and how to use them. All for the same malady.
The page says that they follow the Guidelines, but then they describe the use two types of plug repair. Even though the Guidelines recommend against the use of plugs.
I think that it is just advertising, to show that they are up to speed with the mainstream words. “Tailored repair with mesh”. It’s doubtful that they use all of the methods that they showed.
From his page –
“All inguinal hernias have long been classified in our center using European guidelines. (EHS Classification = European Hernia Society Classification). Together with requirements, risk profiles, and the patient’s wishes, this classification serves as a guideline for decisions made during surgery.”
The scare words are still used, with exclamation marks. Basically, if there’s a bump, “you could die!” –
“Do you have to operate on an inguinal hernia?
Although most inguinal hernias are harmless, they nevertheless can lead to intestinal incarceration at any time, which presents a more threatening complication. This is not only extremely painful, but it also presents an emergency and must be operated on immediately! In contrast, small inguinal hernias with flat protrusions (ultrasound diagnosis) are rather harmless, particularly in younger patients with no pre-existing conditions or pain. In this case, a deferral with constant medical supervision (about 6 weeks) is possible for the purposes of „watchful waiting“.” -
I’m just trying to add a perspective. As for the four days…if you have problems four days will seem like just a moment, a faint memory, that you wished you had spent. It’s very hard to get the point across to people planning for hernia repair that even though the procedure can be quick and seemingly simple, the results last for the rest of your life. The surgeon won’t feel it but the patient will.
Posting this made me realize that words like “major” or “minor” are meant for the surgeon on the day of surgery. But really they should use the words to describe the impact on the patient. Hernia repair is major surgery.
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“They adhere to the original (other than the steel sutures) ”
My point was if you don’t know the details you don’t know the modification. Dr. Grischkan used the word “modified”. Who really knows what those three, or anyone, are doing, if they changed the sutures maybe they thought something else wasn’t quite right. A small mod here, a small mod there…it doesn’t take much and you have a whole new technique. Two layer Shouldice was probably considered modified Shouldice, maybe it still is. If you read about why permanent sutures are used, because new collagen takes months or years to reach full strength, then even absorbable sutures are not “true” Shouldice.
Dr. Kang proposed that much of the bad press for pure tissue repairs has come from “modified” Bassini techniques being used. People see “Bassini” but it’s not really Bassini, it’s something else. Really, if it’s modified it shouldn’t even have the originators name behind it.
The same is true, maybe especially true, for mesh. Lichtenstein paved the way, and the people that have followed have exploited that for all that they can get. All kinds of crazy combinations of materials, even food supplement coated mesh materials, have been extended out from Liechtenstein’s work through the 510(k) procedure. Just because it’s different, AKA modified, doesn’t mean it’s better. Be careful what qualities you’re ascribing to these modified procedures.
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If there is no name associated with the word “modified” then modified just means different. For example, Grischkan’s modified Shouldice is a version of the Shouldice procedure but with a piece of Gore mesh, and other differences, as the modification.
https://www.herniasurgeries.com/modified/
And, as this old thread seems to show, the details get lost as the modifications are described. Like the telephone game.
https://herniatalk.com/forums/topic/dr-grischkan-modified-shouldice-technique/
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What have you been doing for activity? Walking, sitting, etc.
Seems like gravity must be involved so avoiding standing might help. Maybe he even elevating your hips to get the fluid to drain back out of the canal.My reading implies that aspiration raises the risk of infection. The surgeon will want to wait a long time to avoid that possibility.
Can you give some details of the situation? Type of hernia, repair material, etc. Not clear why a lymph node would be removed. Good luck.
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I clicked a couple more things and see that Dr. Towfigh is involved.
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These discussions about the fine details of the repair techniques are interesting, but, in the end, I think, the results are what matter.
If you want to extend the understanding over to mesh repairs then you should consider the peritoneum, the omentum, the fascia, and muscles and ligaments that get pulled as the mesh (actually mesh/tissue composite) shrinks. Omentum is often one of the materials that gets pushed through a hernia. The omentum is actually a folded portion of peritoneum. It is considered as an organ of the body.
Here is a good starting point for the peritoneum and the omentum. These parts of the body are involved in the foreign body response to the mesh. More mesh contact probably means more response, a person would guess.
https://www.frontiersin.org/articles/10.3389/fphys.2018.00738/full
A couple of excerpts –
“Background: Despite its complexity, the peritoneum is usually underestimated in classical medical texts simply as the surrounding tissue (serous membrane) of the gut.”
“Nonetheless, peritoneal cavity is usually disregarded as an empty space without clear clinical significance (Sasaki, 1999) and the peritoneum simply as the covering tissue (serous membrane) of abdominal viscera in classic physiology (Hall and Guyton, 2015; Boron and Boulpaep, 2017), and histology texts (Ross and Pawlina, 2012).”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723480/
Excerpt –
“A more conventional view of the omentum is that it plays a central role in peritoneal defence by adhering to sites of inflammation, absorbing bacteria and other contaminants, and providing leukocytes for a local immune response[3]. This review details current knowledge on the origins, structure, and function of the omentum, and discusses its role in the peritoneal cavity during various disease states.”
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Make sure that you talk about Google Scholar. It searches for professionally created journal articles, just like those that would be found in any medical library. It is not opinions and unsupported facts, but professional journals, many of them refereed.
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A recent paper with Dr. Campanelli as a co-author. Might be related to why he wrote the letter. Who knows. He started out as an author of the original mesh Guidelines and now is moving back to Shouldice as a possible choice, before mesh in certain situations. At least, a surgeon should know both, and choose appropriately. That seems like progress to me.
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Here is an interesting new article, 2021, about Shouldice, with some comments about modified methods. Dr. Campanelli, who wrote the Hernia letter about the reality of chronic pain, is a co-author.
https://pubmed.ncbi.nlm.nih.gov/33502639/
Excerpt –
“Conclusion: After a 75-year history of the Shouldice repair the technique should continue to merit consideration by all hernia surgeons. After this consensus meeting a clear binding standard of the Shouldice technique for all interested surgeons is proposed.”