Good intentions
Forum Replies Created
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There is also a Danish Registry (Database). I have seen it referenced in several papers.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096723/
https://www.dovepress.com/the-danish-inguinal-hernia-database-peer-reviewed-fulltext-article-CLEP
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There is, apparently, a Swedish Hernia registry. It’s data was used in a recent paper. Here are relevant links.
https://herniatalk.com/forums/topic/chronic-pain-after-groin-hernia-surgery-in-women/
https://www.svensktbrackregister.se/en/
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Is there supposed to be a Facebook Live link? I don’t even know what that is. There is only a Zoom link. Will it be on Youtube?
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I hope the discussion will be expansive enough to consider the possibility, in an ideal world, of choosing pure tissue as the desired first choice and mesh as the fallback if pure tissue will not accomplish the long-term objective.
The discussion should also cover the solution to complications after surgery. This, of course, would include mesh removal. In other words, if there are problems with pure tissue, what is the solution plan, and if there are problems with mesh implantation, what is the solution plan. Otherwise, it’s just another discussion about “what I do”.
It would be very interesting also to talk about Dr. Ponsky’s opinions about mesh implantation for young people. His work showed, if I recall correctly, that mesh is contraindicated for men up in to their late 30’s and early 40’s.
Here is the other Topic created and down in the main forum section, with some details about Dr. Heniford. Dr. Heniford is one of the few people in the field who might actually drive some change.
https://herniatalk.com/forums/topic/herniatalk-live-qa-pros-mesh-vs-tissue-based-hernia-repairs-2-1/
HerniaTalk **LIVE** Q&A: Pros &Mesh- vs Tissue-Based Hernia Repairs 2/1
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Dr. Heniford is an interesting surgeon, he has been aware of the problems in the hernia repair field for quite a while. It might be an interesting discussion.
https://atriumhealth.org/provider-profile/b-heniford-1558396259
You might have to sign up to read this one –
Excerpt –
“But many surgeons have called for changes in medical device regulation, particularly at last spring’s major international meeting of hernia surgeons, saying it could make surgery safer for patients. At the 2018 International Hernia Congress, surgeons appealed for long-term surveillance of mesh once it has been implanted.
“We should absolutely be tracking every implant. It’s the only way we’re going to make improvements,” said Todd Heniford, MD, the chief of gastrointestinal and minimally invasive surgery at Carolinas Medical Center, Charlotte, N.C.
He spoke from the meeting floor at the end of a packed session on advances in biomaterials. “Every patient needs to know exactly what was put into them and how it was implanted. Surgeons have to ask: Are we protecting patients or are we protecting industry? Are we protecting ourselves?” “
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Dr. Yunis, also in Florida. Also, apparently, does mesh removal.
https://www.centerforherniarepair.com/jonathan-yunis-md/
https://herniatalk.com/forums/topic/serious-need-of-finding-the-top-doc-for-mesh-removal/
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Desarda, in Florida.
https://www.centerforherniarepair.com/desarda-hernia-repair/
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The Shouldice Hospital in Canada.
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Dr. Echo, in Texas.
https://www.anthonyechomd.com/blog/how-is-the-muschaweck-repair-different
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Biohernia (Dr. Muschaweck), Europe.
https://biohernia.com/en-ie/inguinal-hernia/non-mesh-hernia-operation-methods/
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Dr. Kang’s Gibbeum Hospital.
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I had thought the web site name was familiar, it is Dr. Brown’s old web site. It seems to be true that Dr. Brown has retired. Some of my old sportshernia.com links still show Dr. Brown’s work, but with the new title and symbol. Good luck to both of them.
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A lot depends on which doctor you choose and what method they use. You can get a quote, I think, from Dr. Petersen at his NoInsurance practice, but he performs open mesh removal. If you choose a surgeon who uses the latest robotic machines they will have to charge accordingly to pay for the equipment. Robotic surgery is more expensive than laparoscopic.
I would assume at least $10,000 if you will be paying out of your own pocket, with no insurance help. It could be much higher though.
https://www.noinsurancesurgery.com/hernia/hernia-mesh-removal.htm
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Hello pinto. Greed was not mentioned anywhere. And “mesh” was not the point about Dr. Ramshaw being a businessman before a doctor. I think that you have conflated business with greed. Dr. Ramshaw is just an example of how a person seeking a simple hernia repair can end up with a doctor who has become part of the system of pushing patients through as quickly as possible. He is one of many. His article describes how it happens.
Dr. Ramshaw lowered his standard of care for each individual patient whose procedure he was overseeing, so that he could see as many as possible within a certain period of time. He described that in his article. He became a cog in the machine. In the article he described this explicitly.
The point about mesh was that Dr. Ramshaw is a mesh proponent and mesh-makers would love to have him on their side defending the use of mesh, as an expert witness, now that he has left individual patient care behind. Dr. Ramshaw has even talked about the profession of “expert witness” and how it can be lucrative. I linked the article below. The result of his being co-opted by the industrial business model of healthcare today is that he is no longer a true doctor. He has moved on to other ways to make money, and defending mesh will probably be part of that. It’s just part of the bigger story. The arc of a physician’s career.
My post wasn’t about Dr. Ramshaw. I just used him as an example. The subject of physician burnout is an important topic today. Many are not allowed to care for patients in the way that they know is best.
https://www.generalsurgerynews.com/In-the-News/Article/07-21/Tips-on-Being-an-Expert-Witness/64041
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I often use the word “industry” when I talk about the hernia repair field, because it really is a business, with pressure to get customers and keep revenue coming in. Dr. Ramshaw wrote an article about he got caught up in the mechanism of the industry and a patient of his had part of their leg amputated after a hernia repair, because of his error. He had transformed from a physician in to a businessman, no longer a true doctor, and one of his patients paid a huge cost.
Here is a link to the story and also a response to the story. So, my point was to be aware of what type of organization a person chooses for their hernia repair. The big ones will lean toward bureaucracy and displaced responsibility, where no one is really responsible for whatever happens. The doctors are just performing procedures, as quickly and cost-effectively as possible. Get ’em in and get ’em out.
As far as I can tell Dr. Ramshaw has given up surgery and is now a consultant and expert witness. Ironically, I would bet that he is used most often by the mesh companies in mesh lawsuits, since he has the air of an expert and has flatly denied that mesh is the cause of chronic pain in the past. He is a mesh promoter.
It’s a sad story for everyone involved, a good surgeon lost to the field, and the industry just keeps chugging along, impervious to the damage done.
https://www.generalsurgerynews.com/Opinion/Article/10-20/My-Worst-Surgical-Error/60834
https://www.generalsurgerynews.com/Letters-to-the-Editor/Article/02-21/Surgical-Errors/62536
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I asked Dr. Billing if he could do both sides at the same time and he said “I just can’t last that long”. An example of taking the time and effort to do things the best way possible versus trying to fit what can be done in to a time slot, I think. Plus, it’s not good to be under general anesthesia for extended periods of time.
Another thing I thought about was to be aware of the difference between a surgeon at a large practice versus one at a small practice. The surgeon at a large practice will probably have time constraints, trying to do as much as they can within the time allowed, fitting the work to the time. The individual or small practice surgeon will have more freedom, making the time fit the work. And, in the same vein, surgeons at large practices sometimes use interns or surgeons-in-training to do the work, under their guidance. Dr. Ramshaw’s story comes to mind.
It would be good for you to find out what type of mesh was used in your implantation. There is a very large variety. It will give you an idea of how straightforward the removal might be. Get the surgery notes, they should still be available. Even in 2015 there is still a wide variety of possible materials and methods that might have been used. Area of dissection, size of mesh implant, shape of implant, fixation, etc.
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I think that mesh removal is the industry’s “dirty secret”. People don’t want to talk about it because the natural follow-up questions are about why and how much the problem occurs, and if there are alternatives to mesh. The mesh industry will not even create a standardized mesh repair registry to track the quality of the implantations. They don’t want to know.
When choosing a surgeon for mesh removal make sure that you find one who will take the time to tease out the various nerves and vessels that have become entwined with the mesh. Neurectomy is often used during mesh removal, supposedly as a way to remove the source of pain, but I suspect that it is also faster. Quicker to cut the nerve than to properly dissect it from the mesh. In other words, if the surgeon says that they can have all of the mesh out in just an hour or two, that’s probably bad. My surgeon took 2-3 hours on each side.
Of course, all mesh can be removed. The question, as you’re asking, is what is the quality of life after mesh removal. Unfortunately, in today’s world, forums like this one are the only way to learn about that. There is no registry for mesh removal, with names of surgeons and results of their efforts. There is no industry support for such an effort, because it will just shine a light on a problem that they don’t want exposed.
The lawsuits are still working their way through the courts. As the financial costs to the industry become more clear there could be an effort to reduce mesh complications, But it will probably not help at all with mesh removal. Ironically, as I just posted about, the efforts of the robotics industry will probably do more for mesh removal than anything the mesh makers do.
Sorry for soap-boxing in your Topic. There are several Topics on the forum about mesh removal. Dr. Peter Billing of Kirkland, WA might still remove mesh (he removed mine), and Dr. Andrew Wright of UW Medicine, if you are in the northwest. Both are good possibilities, I think.
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It must be stressful to implant mesh using today’s state-of-the-art technology, knowing that the same technology might be used to remove it. The next step, obviously, it to plan for removal as the the mesh is being implanted. Like a surgeon using a screw to set a bone.
If you know it might have to come out, do certain things to make it easier. Do certain things that won’t result in more damage during mesh removal.
It’s good that this conflict is being shown. It just seems very strange.
Here is another article from the references of the article above giving instructions for mesh removal. It’s rare to see the cause and effect relationship stated so clearly by experts in the field.
https://link.springer.com/article/10.1007%2Fs00464-018-6558-5
Excerpt –
“Conclusions
As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.” -
I did just notice one thing about the article that is very disappointing. The first reference is the “International Guidelines” which have been called in to question by professionals, and are generally suspect since the effort was sponsored by mesh makers, and started with the premise, stated in the publication, that mesh was the preferred method of hernia repair. An example of how the framework for mesh usage persists, despite much evidence suggesting that it causes more harm than pure tissue repairs.
Laparoscopic/robotic methods need mesh for hernia repair. Without mesh those businesses will suffer greatly. The authors had to show that mesh was “preferred” by citing the “Guidelines”.
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Thanks for the reply MarkT. My comments are meant to be more rhetorical and general, about how the typical patient does not have easy access to the knowledge necessary to be “informed”.
Removing mesh is just described as another procedure to be performed, like some sort of natural occurrence to be dealt with. Imagine the doctor describing how the same tools used to implant the mesh can be used to remove it, at a hernia repair consultation. That would be an awkward conversation.