Good intentions
Forum Replies Created
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Dr. Towfigh is in that area, Beverly Hills. You’ll probably want to use your insurance. But it seems early. Wounds will often have aches and pains afterward as they fully heal. Good luck.
Interesting that Dr. Iraniha offers a wide range of hernia repair possibilities. I assume that this is the surgeon you are talking about.
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He seems to be part of the New Brunswick trauma Team but the site is not very useful for contact info.
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Here is a Twitter link. The site goes crazy with Twitter so it might not be readable.
https://twitter.com/herniadoc/status/710120065857921025?lang=en
Dr Hari Ondiveeran from New Brunswick is among few in Canada that treat complex #hernias #SAGES2016 #IHC pic.twitter.com/v4dEXved31
— Dr. Shirin Towfigh (@Herniadoc) March 16, 2016
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I found an old thread with some information.
Dr Hari Kumar Ondiveeran
https://herniatalk.com/forums/topic/mesh-removal-surgeons-in-canada/
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Not to get too focused on the lawsuits but Dr. Pulouse’s comment is timely. There is a large wave of suits about to break on the courts and it seems wise to be ready. The more exposure the better, for the patients,and the surgeons.
The suits have been delayed due to the COVID-19 pandemic but are about to start passing through the systems.
“Ultimately, Dr. Poulose said, “the current medical-legal climate is bringing up a necessary conversation in a convoluted way, but if these discussions help us make mesh, technique, post-market surveillance and patient selection more optimal, something positive can result.” “
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Here are more links to fill out the story.
https://hollislawfirm.com/atrium-sells-c-qur-hernia-mesh-line/
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Here are some links that I tried to add to the Getinge post above. Too many, I guess, didn’t get through.
https://hollislawfirm.com/atrium-sells-c-qur-hernia-mesh-line/
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The link in the post after that one about the Omega-3 coated C-QUR mesh is also broken. It turns out that Getinge sold the C-QUR product line to a venture capital firm because the litigation costs were too high, soon after they bought the product line from Atrium. Pretty fascinating…the birth, life, and death of a novel hernia repair mesh all within about 10 years.
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The link in Reply #20099 above is broken. Here is another. Getinge’s Proloop product.
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Here is another recent review article covering the wide variety of hernia repair meshes. It is very wide-ranging, the primary author is a graduate student at Stony Brook. Looks like the foundation for a thesis.
Some of the summary points are outdated though, at least for the United States. She says that open Lichtenstein is the predominant repair method but that was probably true 10-15 years ago. Today if you get referred to a surgeon you’re probably going to get a laparoscopic mesh implantation. And, in the collection of biological meshes, the new venture, Tela Bio, is not even mentioned. Things move fast in the new mesh product world though, easy to get left behind. It’s a good thorough review though, of materials, methods, and hernia types.
https://www.sciencedirect.com/science/article/pii/S2666138120300025#!
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Here is the most recent on Dr. Muschaweck and Biohernia.
https://biohernia.com/en-gb/how-biohernia-works/
https://biohernia.com/en-gb/the-operation/
https://www.fortiusclinic.com/specialists/dr-ulrike-muschaweck
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Whatever method you choose, it will affect the rest of your life. The procedures are not reversible and they all involve dissection (separation) of tissues, either via scalpel or blunt instrument, despite the size of the entry point in to the abdomen or inguinal canal. Put the appropriate amount of effort in to learning about the pros and cons of each. “Blowouts” are not really a thing with hernia mesh. Chronic pain is though.
The long-term results should be your focus. Don’t be persuaded by saving a day or two today if it will risk the decades ahead of you. Read the posts on the forum, search around the internet, ask your surgeon hard questions and see if they give direct honest answers. Good luck.
Shouldice is a good option if you go to the Hospital in Canada.
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Here is a collection of hernia focused articles from GSN. The format is difficult to use, some of the articles can be found on the main site using the search function there.
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If you don’t search out a surgeon who will do a non-mesh repair (better known as pure tissue repair) and specify that you want a pure tissue repair, then you will almost certainly get a mesh repair. International Guidelines have been created that recommend mesh as the first choice for hernia repair.
There is a ton on the forum. Read as many of the posts as you can.
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I just don’t understand Dr. Towfigh. I search for reasons and write them down, hoping (dreaming) that some young surgeons or students will see the travesty of using mesh for any and all hernia repairs of any type when there are safer methods available, and choose to take a different path. I try to describe things in a way that seems rational, because what’s happening does not seem rational. Money seems simple and rational.
But my comment was about the total cost, not just the remuneration for a single procedure. The investment in equipment, training, risk of extraneous costs, risk to reputation, risk of using the change as evidence in lawsuits, etc. The costs of running a business after it has been established. Change costs money.
These lawsuits are the best thing that can happen for future hernia repair patients. And surgeons. Because not much is happening at the professional guidance level besides talking. I think that mesh has become incorporated in to the hernia repair field body and will be very difficult to remove. The lawsuits are analogous to a mesh patient’s chronic pain. A strange parallel but appropriate, I think. The lawsuit pain will continue until the mesh is removed.
You wrote an article a short while back titled “Hernia Mesh and Why We Remove It”. The next in a series could be “Hernia Mesh and Why We Use It”. That would be an interesting read if it was backed by good solid data with real precise numbers. Why do surgeons use mesh? Is mesh really appropriate for any and all hernia repairs? Should mesh be used to cover all future hernia sites?
Are all meshes the same? Are there safer repair methods that don’t involve mesh?It’s a decades old problem but it is heartening to see some change even if it is small and inadequate. Thanks for continuing to support at least one small place to discuss the issues.
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What are your criteria for reputation? You’ve covered quite a range of methods in your list, from open pure tissue to open mesh implantation to laparoscopic mesh implantation.
The last name is interesting. He is an inventor/entrepreneur. Beware of people who have a vested interest in seeing a product sold. Cognitive bias is a powerful psychological force.
https://surgery.ucsf.edu/faculty/general-surgery/hobart-w-harris,-md,-mph.aspx
https://surgicalinnovations.ucsf.edu/spotlight/innovator-profiles/hobart-harris,-md,-mph.aspx
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I just added to the other Reply string above.
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The premise of the extracellular matrix (ECM) meshes is that the body will absorb them, replacing the denatured collagen with the body’s own collagen. The premise of polypropylene mesh is that the body can do absolutely nothing with it, that it is impervious to degradation. Identical starting points as far as implantation and initial hernia defect closure but completely different end points.
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Here is the abstract introduction from the referenced article.
“Extracted forms of collagen are subjected to chemical cross-linking to enhance their stability. However, traditional cross-linking approaches are associated with toxicity and inflammation. This work investigates the stabilization capacity, cytotoxicity and inflammatory response of collagen scaffolds cross-linked with glutaraldehyde (GTA), 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide, 4-arm polyethylene glycol (PEG) succinimidyl glutarate (4SP), genipin (GEN), and oleuropein. “
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Crosslinking agents (chemicals used to connect two collagen molecules) were mentioned, but in addition, the molecular structure of the fragments produced during degradation in the body might not be able to be handled well by the body’s removal mechanisms. A fragment with a crosslink could have a molecular structure that is not degradable (I think that this also applies to the C-Qur mesh that used crosslinked Omega-3 fish oil. Once it is crosslinked it is not Omega-3 oil anymore).
Here is the paragraph that I think you were referring to.
“Cross-linking strengthens the mechanical properties of the ECM and slows down degredation [68,69]. Although the properties of the mesh is improved, slower degradation rate creates a slower release of growth factors (GFs) and other cell proliferation molecules in the biological mesh [70]. Furthermore, cross-linking is associated with increased toxicity and inflammation possibly due to the presence of the crosslinking agents [69]. ”
And the reference – https://www.liebertpub.com/doi/10.1089/ten.tea.2016.0415