Good intentions
Forum Replies Created
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A thought that occurs to me now and then is that a mesh repair is like an “all-in” bet in gambling. The overall odds might be in your favor but if you lose you lose a lot. A pure tissue repair is like a small bet, that, if you lose, you can still continue to seek a win.
That seems to be the disconnect a person finds when they are talking to surgeons. The surgeon sees the wins of many patients, and the losers just cease to exist, in their minds. Oh well, too bad, but look at all of these winners.
So, long-term, the results of chronic pain from mesh need to be compared to the results of chronic pain from a pure tissue repair. What are the odds of having chronic pain, what are the odds of successfully removing the chronic pain if it occurs? Chronic pain has to be considered in depth for hernia repair. If it isn’t then the patient is just making an uninformed gamble.
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It might be worthwhile to contact the Vincera Institute. Dr. Meyers has a different approach to abdominal injuries.
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Where did the thoughts originate? Where is the supporting information?
The AHSQC seems to be collecting some useful information. Apparently it is only good for a 30 day evaluation though, at this time. It says that open, lap, robotic, and Shouldice all have about the same rate of problems, for 30 days. I have not seen any studies that show that Shouldice causes more chronic pain than any mesh repair.
Finally, the major and main question of how a mesh problem is addressed compared to how a pure tissue problem is addressed is not covered. Mesh problems are much more difficult to solve than pure tissue problems.
The AHSQC is a new effort to understand the problem and, at this time, the best that they can do is to say the situation is undefined in the long-term.
https://link.springer.com/article/10.1007/s10029-019-01968-y
“Results
4613 patients met inclusion criteria. 1925 were repaired using an open technique (42%), 1841 were repaired using a laparoscopic technique (40%), and 847 were repaired using a robotic technique (18%). The Shouldice technique remains the most common tissue-based repair performed in the AHSQC. The Lichtenstein repair is the most common open mesh-based repair. Minimally invasive approaches to unilateral inguinal hernia repairs remained very common in our series. The robotic approach accounted for nearly one-third of the minimally invasive inguinal hernia repairs.Conclusion
In general, all of the repair techniques reported similar and low rates of 30-day complications. The AHSQC continues on-going efforts to improve long-term follow-up and looks forward to addressing long-term outcomes such as recurrence and chronic pain with increasing data acquisition.” -
If you want to do some research use the words erosion and migration on a search site like Google Scholar.
Here is an example, linked below. It might have some good references. Inflammation weakens tissue and weak tissue would be more prone to tears. But determining an actual cause-effect relationship seems difficult. A study of athletes with mesh implants would probably provide useful insight but athletes generally avoid the use of mesh.
Even if you determined that the mesh caused the tear would it affect your decision-making process?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746983/
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=mesh+erosion+inguinal&btnG=
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There is another, supposed registry, that was created years ago by Ethicon (Johnson & Johnson) but it is a commercial marketing endeavor. The IHMR. The results have been used to promote positive aspects of their mesh products in their sales literature but the completion of the registry and report have been delayed time after time. Only positive news is released, internally.
This is one of the foundational elements of my cynicism about corporate involvement. Beware the things that have fancy powerful names.
https://clinicaltrials.gov/ct2/show/study/NCT00622583
https://ichgcp.net/clinical-trials-registry/NCT00622583
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-mesh-ethicon
Excerpt (the misspellings are in the literature) –
“ULTRAPRO® Macroporous Partially Absorbable Mesh offers strength with reduced foreign body mass1,5 and may reduce the risk of patient complications compared with mircroporous mesh.2,6 In a study of patients from the International Mesh Hernia Registry (IHMR), patients demonstrated low rates of intra- and postoperative complications, such as seromas, and recurrence (<1%) after 1 year.2-4,7-12 In the same study, patients reported improvement in pain and movement limitations from baseline at 1 year postsurgery.2,3,7,8 ULTRAPRO Mesh withstands more than 2x the maximum abdominal pressure in healthy adults.13,14 ”
3. Data from a prospective, longitudinal study of 151 patients receiving open hernia repair with ULTRAPRO fat mesh from the International Hernia Mesh Registry (53.0% ventral/incisional, 39.7% inguinal, 7.3% other).
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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