Good intentions
Forum Replies Created
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Here is a Q&A from HerniaTalk, and a Topic from the past. I have not listened to the Q&A but will now. It’s from one year ago.
https://herniatalk.com/forums/topic/herniatalk-live-qa-with-dr-todd-ponsky-09-08-2020/
https://herniatalk.com/forums/topic/marcy-repair-in-adults-with-inguinal-hernia/
https://www.youtube.com/watch?v=CykxG7NAPN4
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Here is what looks like his latest video, from 2019. He mentions Dr. Towfigh, as his debate opponent.
It’s a shame that he is in pediatrics only. His thought process, asking why mesh is used and if it is appropriate, is what all hernia repair surgeons should be using.
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I just realized that Todd Ponsky is Jeffrey Ponsky’s son. Todd is against mesh but his father is very much a proponent of mesh. How can the apple fall so far from the tree?
Here are more of Todd Ponsky’s videos from the SAGES channel.
Father presenting son’s work – https://www.youtube.com/watch?v=0wgryuucvRg
More about mesh or no-mesh. Points out the inconsistency of the choice process – https://www.youtube.com/watch?v=DTnWZmux75I
Anyone who can should see Dr. Ponsky first, if they have a hernia.
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Here are more Todd Ponsky links, below.
Do not confuse him with Jeffrey Ponsky, who works at the Cleveland Clinic and is a full-fledged mesh promoter. The Cleveland Clinic is where many surgeons get their mesh training.
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It might seem like I am targeting Dr. Chen, with my recent comments in another thread and then this new Topic. It’s just coincidence. But Dr. Chen is the President of the largest hernia centered organization in the Americas, and also a director at a famous hernia repair center at a world-renowned medical center and university. He is also a Professor, teachng new surgeons about how things are done. Students, and colleagues, will be looking to him for guidance on what is right and what is wrong.
Here is a fairly recent paper about the poor quality of work behind the “Guidelines”. These are the same Guidelines that are on the AHS web site, recommended to all surgeons doing hernia repairs. It doesn’t take much looking to start to wonder how these Guidelines were created and how they could become the gospel for all hernia repair surgeons. It’s pretty incredible, from any viewpoint, subjective or objective. How can so many professionals be blindly following these recommendations, without question?
https://link.springer.com/article/10.1007/s10029-021-02423-7
I had already linked this paper in a recent Topic.
https://herniatalk.com/forums/topic/new-article-questioning-the-validity-of-the-hernia-guidelines/
New article questioning the validity of the Hernia Guidelines
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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/
https://www.allbiz.ca/ondiveeran-h-dr-506-648-7926
https://www.sages.org/video-author/ondiveeran-h/
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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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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