Good intentions
Forum Replies Created
-
And, of course, as often happens, the remedy for the chronic pain is not discussed. The patients that have chronic pain from mesh implantation have very few avenues available to remedy the pain. The possible solutions are dangerous and expensive and often fail. When a person considers the full risk/reward situation for the patient alone, pure tissue repair is the obvious first choice. The push for mesh implantation over pure tissue repair is driven by the industry, not the improved welfare of the typical patient. The typical patient has more risk of permanent chronic pain today than they did twenty years ago. And that is where the lawsuits are coming from.
Promoting mesh at the various meetings will not change the reality of the situation. The chronic pain problem comes along with the mesh. It will be here as long as mesh is here.
-
Here is a study comparing TEP to Lichtenstein. TEP ends up at about 10% after 5 years, compared to about 19% for Lichtenstein. So a case can be made for TEP over Lichtenstein but the overall rate of chronic pain due to mesh cannot be downplayed.
https://academic.oup.com/bjs/article/97/4/600/6150225?login=true
“The total incidence of chronic pain in the TEP and the Lichtenstein groups respectively was 11·0 per cent (60 of 546) versus 21·7 per cent (125 of 577) at 1 year, 11·0 per cent (60 of 545) versus 24·8 per cent (144 of 581) at 2 years, 9·9 per cent (55 of 554) versus 20·2 per cent (119 of 589) at 3 years and 9·4 per cent (58 of 616) versus 18·8 per cent (124 of 659) at 5 years (Fig. 2). The frequency of any degree of chronic pain up to 5 years after operation was therefore twice as high in the Lichtenstein group as in the TEP group.”
-
Dr. Towfigh you are presenting unverifiable numbers from a group that most likely does not represent reality. At least tell people the sample size. Is this 20 patients or 200? You must realize that the numbers have little value except to show that the quality of available data is poor.
“It’s not a database that is mandatory and most surgeons performing hernia repair are not members.
1) the surgeons entering this data from their practice may not represent the whole of US surgeons
2) the majority of patients whose data is entered by the surgeon do not enter their followup long term data re how they’re doing.”
Here is a more proper, professionally done study. It is focused on open repair, but you can see where the numbers came from.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896652/
Excerpt –
“Postoperative chronic pain is a special entity within the domain of chronic pain. Chronic postoperative pain occurs following numerous kinds of surgery, from amputations to thoracotomies to inguinal hernia surgery. The chronic pain after inguinal hernia repair has been extensively studied; however, the management is still difficult. Around the globe, millions of groin hernia repairs are conducted annually1 and 8%–16% of these patients experience chronic pain to a degree that impairs their daily lives 6 months postoperatively.2,3 A few percent of these patients experience disabling pain, and due to the large number of groin hernia repairs, the number of patients with disabling pain and discomfort is an important clinical problem.4”
-
Thanks for the comment Mark T. My main point was to show the great distance between how things are now and what the authors are promoting. If they are unaware of the state of things today then they are writing about things they don’t understand. If they do know how things are then they are just writing fluff about an ideal world that will never exist. Or, as I implied, they are suggesting a tool to weed out the problem patients.
90+% of the people who visit a surgeon today with an obvious hernia will be assured of a fine result and scheduled for surgery as soon as possible with no questions asked or answered.
Again, I hate to be so cynical. I have been posting on the site for quite a while and I have not had a solid response from any surgeon showing that progress is being made to lower the 15% number. Work continues, and the people suffering with mesh problems are shunted aside. Well-meaning surgeons speak up and supply studies showing that the problem is real, but nothing is done, and vague comments are written about other possible causes. Meanwhile, every day, 15% of the people getting a hernia repaired will probably suffer pain. More will suffer discomfort, people who hear the news will lose trust in the medical profession, and the mesh-makers will collect their profits.
The failure of the hernia repair field is actually a big part of the loss of trust in the medical profession, since hernia repair is one of the most common surgeries performed today. That seems hyperbolic but anyone who is told that they need surgery will probably get on the internet and find stories about mesh.
The authors of the article are way beyond the very simple steps of just removing the bad from surgery today. The bad is allowed to coexist with the good. That just makes everything bad.
-
“it isn’t the mesh causing the problem but the way it’s put in”
Was the comment from Dr. Horne? I have not watched the video. That is in the same vein as blaming mesh problems on fixation. Without the details of what is the right way to “put it in” or the wrong way, it is a useless comment meant to divert attention from the problems with mesh. It’s just one more surgeon “protecting” the mesh industry.
Any surgeon who makes a comment protecting mesh should have information about how to make things better. Otherwise they are just acting as tools for the mesh makers. If they truly believe in what they are doing then they should be actively working to remove the “evil-doers” that are destroying their reputations.
Start removing the bad and all that’s left will be good. The mesh-makers might lose some business but without surgeons promoting the right way to do things, they’re all contaminated. Silence just lets the bad continue.
-
Faith, you said “more mesh”. Have you had a mesh implantation in the past?
-
Thank you, I see that it is.
I read it, it’s a short piece. It is worth reading, it looks like Dr. Voeller is trying to make a point that mesh is not the cause of chronic groin pain. He uses the term “a major cause”. But if you read everything that is quoted you can see that he undercuts the very case that he is trying to make.
In the end, his words don’t really mean anything and the vast number of lawsuits show the reality of the situation. The Shouldice Hospital does not have a problem with lawsuits anywhere near the magnitude of the problem the mesh industry has. There is no large past history of lawsuits for suture-based repairs. The lawsuits have grown with the use of mesh. Professional presentations will not change that. It really is a shame though to see so many smart people are either in denial or actively protecting something that they know is wrong. It must be terrible to be a surgeon in this area at this time.
The quotes seem to be from the 2021 virtual Abdominal Wall Reconstruction Conference. Imagine attending a conference to learn about surgical methods and listening to a talk about lawsuits.
https://medstar.cloud-cme.com/course/courseoverview?P=5&EID=6091
-
I was able to expand the image from the email about the article and find that it contains a quote from Dr. Voeller stating that “trying to repair many hernias with suture alone is doomed to failure”.
The statement is really shocking, especially considering Dr. Voeller’s status in the hernia repair field, and as a surgeon at a university school of medicine. And the vagueness of the statement with its many possible meanings. Is the problem the quantity of hernias? Why would that matter? Will the hernia repair fail or the “system”? Very ambiguous. And he is a professor, teaching future surgeons.
But it’s a very good look at where the hernia repair field is today. I would insert the image but it doesn’t seem possible with the site’s software.
Monica J. Smith is the author of the article.
-
And here is one from Egypt using his technique. Click the “PDF” button in the upper right and you can read the whole paper.
-
Here is a link, below, to a recent paper from a different set of surgeons, using Dr. Guttadauro’s technique. It has a direct comparisons with conventional methods.
One of the major flaws in defining the chronic pain problem has been the survey methods used. Reading these papers it’s hard to tell what they were asking their patients, and how they were quantifying the answers. The time frames are short also.
I doubt that the method will make it to the States because there is no serious acknowledgment of the problem in the USA. It is discussed at the meetings but the actions proposed to address the problem are more about moving liability to the patient. Much discussion about “consent” but essentially none about solving the problem. The efforts are focused on how to live with the problem. Keep doing the same things that have been invested in.
Sorry to be cynical again. At least there are people in other countries working on the problem. America is not at the forefront of medical research for the benefit of the patient.
https://mail.ijsurgery.com/index.php/isj/article/view/7812/4874
And here is a later version of Dr. Guttadauro’s paper, in downloadable form.
-
It varies. The mesh makers leave it to the surgeons to decide. Some tout that their product does not need fixation, some say that it is optional. Some, like Progrip, are designed to negate the “need” for fixation. My surgeon was proud of his method of creating a space that he thought contained the mesh so that it did not need fixation, even though it was Bard SoftMesh.
Unfortunately, you will find many surgeons who are still focused on fixation (fixated on fixation) as the cause of mesh pain. The reality is that mesh pain occurs with and without fixation.
Fixation is another distraction away from the root cause of chronic pain. Beware the marketing material that promotes fixation-free mesh materials. There are many people with Progrip who have chronic pain, and no fixation.
-
I remember reading many many years ago some thoughts that one reason the human body has certain problems is because it is still adapting to walking upright. The orientation of the bones and ligaments and muscles lends itself to certain injuries. You could add to that the fact that humanity spends huge effort combating the Darwinian winnowing of the weak and the genetic causes seem plausible.
I don’t know of anyone in my family who has had a hernia and I am reasonably certain that I forced a hernia through good solid tissue by battling through some back pain so that I could play soccer, by performing an intense Valsava maneuver whenever I made a tackle. It worked for the back but then the direct hernia appeared.
Whatever the reasons, the great shame is that we on this forum are digging deeper in to it than the professionals. The professionals are learning new ways to implant mesh. New robotic tools, new materials that roll up so they’ll fit through the trocar but spring open in to a flat easy to implant shape once they get through. It’s all about how to use mesh. Here’s a video from J&J training surgeons how to get their product inside the patient.
The video that came up after this one was coincidental, if it comes up for others. Kind of telling, but it’s the world we live in.
-
It’s the money. And it’s not just mesh. The corporations have infiltrated the medical profession. Medicine is a business.
https://www.theguardian.com/society/series/the-implant-files
-
This thread has become a little bit confusing. E11270 started it to talk about a problem post-mesh removal. Pain after mesh was removed. But now dh305 is talking about a mesh problem, from mesh that still exists. I am not criticizing, just pointing out that the topic is now about a mesh problem, not a mesh removal after-effect.
On mesh problems, it seems clear that there is no specific reason for the pain except the presence of the mesh. All of these doctors that you have talked to are trying to avoid what their senses and logic tell them, instead trying to make the situation fit the narrative that they have been trained and taught to believe. Their first impulse is to reject the idea that the mesh could be the sole cease of the problem. Some big names in the field have even stated flatly that mesh does not cause pain. This is like saying that knives do not cause pain, it’s the cut that they create that causes the pain. It’s disingenuous/dishonest.
The only remedy that surgeons have tried that does not involve mesh removal is neurectomy or pharmaceuticals and they do not work well. Chronic pain has been around for decades and things are not getting better.
This doesn’t really help your problem except that maybe you can take a different view toward the next doctor you talk to. Once you realize the possibility that they are avoiding or dodging the issue the signs of their avoidance will be much clearer. Many of them will try to get away if you start talking about the possibility that the mesh is the problem. But at least you won’t waste your time once they do that.
Keep studying. Be aware of long-term changes as you go through the cycles of pain and recovery. I chose mesh removal when I realized what was happening to my body. The chronic inflammation was affecting everything around the mesh, physical problems, not just pain and discomfort.
Good luck.
-
The Hernia System is a very aggressive approach to hernia repair and it is surprising that it was used for lipomas.
Good luck with the removal. Because of the large area covered, on both sides of the abdominal wall, and the fact that a plug, effectively, was used through the internal ring, your recovery will probably take a while.
-
Is it the plug or the “Hernia system”? They are both open surgeries, that put mesh inside and outside the abdominal wall. So, surgeons like Dr. Kang or Dr. Brown or Dr. Petersen commonly do those types of removal. Dr. Meyers at the Vincera Institute also.
There are probably laparoscopic surgeons who could remove it also. Dr. Towfigh has removed plugs before. They are difficult to remove, they entangle with critical structures.
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-comfort-plug-surgical-hernia-mesh
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-hernia-system
https://twitter.com/novitskyyuri/status/1021596087600271360
plugs are evil and should not be extrapolated as all things "mesh"
— Yuri Novitsky (@NovitskyYuri) July 24, 2018
-
I just came across an article that I had found a couple of years ago, about the omentum. It might help explain the feeling of swelling and stiffness that people with hernias and hernia repair problems feel.
Apparently the omentum’s role in the body is not well understood. I get the impression that most hernia repair surgeons just think of it as some stuff that needs to be stuffed back out of the way.
https://www.sciencedirect.com/science/article/pii/S2352320419300872?via%3Dihub
From the article –
“The omentum has an established clinical property to pursue and contain the site of injury. A striking feature of the omentum is that its volume expands in response to foreign particles and inflammation. It makes a large number of immunomodulatory cells along with cells having stem cell properties in a process called Omentum Activation.
Several experimental studies have demonstrated that intra-peritoneal introduction of foreign particles can induce a dramatic increase in the omentum volume due primarily to growth factor activation and expansion of the stromal cell population”
-
Search the word “registry” on the forum and you will find quite a bit about supposed and real efforts to track the performance of mesh medical devices. Probably one of the worst fears of the mesh makers is a collection of data showing the true results of mesh implantations. When you are trying to understand what is going on just think of hernia repair as business, not medicine, run by corporations who are most concerned with revenue stream. The field is controlled by companies that make material goods. Scalpels, needles, and suture material generate far less revenue than mesh and laparoscopic equipment. Look at the companies sponsoring the meetings that surgeons attend to learn the “standard of care”. Mesh makers, robotic equipment makers, etc.
Mesh is a multi-billion dollar enterprise. Pure tissue repair destroys that revenue stream, and all of the jobs and bonuses that result from the business. Very similar to logging and oil production and tobacco production. It’s just another big business and the people involved in making it happen have little to no control. But they need their jobs so it continues.
I found this market report that even shows a connection between smoking and hernias. A win-win for the corporations.
https://www.grandviewresearch.com/industry-analysis/hernia-mesh-devices-market
Excerpt –
“Report Overview
The global hernia mesh devices market size was valued at USD 4.04 billion in 2017 and is projected to grow with a CAGR of 2.8% over the forecast period. Hernia is a condition in which the lining of the abdomen bulges out into a small sac due to weakened abdominal muscles. Smoking, poor nutrition, genetic factors, and changes in lifestyle are some of the factors contributing to the elevated incidence of hernias. Persistent coughing due to smoking is one of the key causes of this condition, thus smokers are 4 times more susceptible to this disease. “ -
I think that the reason the methods don’t work is because the body does not “realize” that something is wrong. There is no torn or damaged tissue. It is just stretched more than it should be, allowing more undamaged tissue, the omentum or bowel, to move to an area it not designed to be.
The trusses and belts keep the omentum/bowel where it should be but there is no natural shrinking mechanism to cause the hole to defect to tighten up.
The more you study hernias and hernia repair methods, the more you see the range from very simplistic thinking (shove a bundle of mesh in the void), to very complex thinking (recreate the anatomical structure as it was meant be using intricate suturing methods).
-
Hello Scarletville. I am posting the link to the one where you gave the info about your surgeon here, below, just to make it easier to find.
I noticed that you fell back on recurrence rate as a factor in choosing a surgeon. Even though this forum is full of chronic pain stories and even the surgeons agree that chronic pain is the number one issue with hernia repair today.
No offense intended, I just found it interesting. Recurrence rate is used to distract from the chronic pain issue, I think. It’s a bit disingenuous for a knowledgeable surgeon today to talk about it without also talking about chronic pain.
https://herniatalk.com/forums/topic/shouldice-vs-kang-surgery-experience/#post-30069