Good intentions
Forum Replies Created
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The internal conflict, possibly even fear, for Dr. Jacob must be incredible. Here is a video showing a TAPP removal of mesh by Dr. Jacob. The video ends at about 4:30 but the audio continues. There is no follow-up information about how the patient did in the long run. This might partially explain the watchful waiting.
I feel like I am “piling on” but this situation is one in which a well-respected expert is forced to truly and objectively (hopefully) face the same fears and results that his patients do. At the least, he will gain a true understanding of what a mesh repair feels like along with an awareness of what happens n the long run.
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This would or will be a fascinating story, from a psychological perspective. Dr. Jacob is aware of the damage that mesh can do and the pain that it can cause, as a surgeon who removes mesh. He must also be aware of the general recommendation that watchful waiting is a waste of time, and could be life-threatening due to incarceration. He seems intelligent and able to determine the pros and cons of complex decisions. He is a major proponent of mesh repairs, very similar to Dr. Felix, who had his own hernia repaired with mesh.
As a person with the financial means to choose the safest route of pure tissue first, then mesh if pure tissue fails, I wonder if he will place his faith in the technology he has been benefiting from, and just go directly to the mainstream mesh repair.
I hope that he shares the details of his hernia journey as it progresses. It is not clear why he is waiting, he must have an opinion about the best possible repair method, as an expert in the field.
https://www.nychernia.com/sages-2011-inguinal-hernia-laparoscopic-vs-open-debate/
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Take your time and do lots of research. You’re worried about money but if you get a bad result money will be meaningless.
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You should just spend time reading the posts on this web forum. Nothing has changed at all over the years since the first post on the site. The materials and methods are the same. There is no special method, or level of skill, that changes the way your body will react to mesh. People that are very physically active seem more susceptible to problems.
The posts on this site are from real people discussing real experiences. The things that you will find on the medical institution sites and the device maker sites are not focused on the things that you said you are worried about. They will talk about getting back to work quickly, and recurrences, but not chronic pain.
The decision that you are about to make will probably be one of the most important decisions of your life.
Here is an abstract from a very recent paper describing the “state-of-the-situation” for mesh implantation. Good luck.
https://link.springer.com/article/10.1007/s10029-020-02297-1
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A recent article about long-term changes.
https://link.springer.com/article/10.1007/s10029-020-02297-1
Here is a link to a related topic for anyone who comes across this one in the future.
https://herniatalk.com/forums/topic/mesh-removal-training-a-new-field-of-study/
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Here is the Hernia website abstract with the payment link.
https://link.springer.com/article/10.1007/s10029-020-02297-1
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Here’s a recent and interesting article suggesting that mesh problems need to be monitored for at least 15 years to truly understand the source of the problems. An old name, Dr. Robert Bendavid, was involved before his death, along with some other well-known names like Koch, Petersen, and Grischkan.
It’s from researchgate.net so finding readable portions takes some work. Published in Hernia , a pay-per-view publication.
You can use CTRL + to blow up this preview.
Here is an image from the article.
And an excerpt.
“Purpose: Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. Methods: Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. ”
….
“Conclusions: Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks.”
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More laparoscopic removal.
https://www.sages.org/video/laparoscopic-removal-of-infected-incisional-hernia-mesh/
Making the “best” of a bad situation.
https://www.sages.org/video/reoperation-for-recurrence-with-pain-being-a-significant-complaint/
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Laparoscopic removal
Losing a testicle, I assume (lysis of spermatic cord), to solve mesh-related chronic pain.
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Humor does help, I suppose.
https://www.sages.org/video/ouch-my-groin-tips-for-safe-excision-of-inguinal-mesh/
I chose this one just because it seems to show a large piece of explanted mesh.
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I searched “mesh” on the SAGES Educational video site, then browsed through the pages. I found a few videos about mesh removal, also called mesh “excision”.
The SAGES site is slow to load a new page and does not restart at the top of the page after the new page loads, so click the page number then wait, then move the cursor up to the top of the page. Or just put the next page number at the end of the url.
https://www.sages.org/video/?fwp_video_search=mesh
I have not watched each video so can’t say how relevant they might be. There are some good shots of migrated mesh though, just in the first images.
I’ll post two links per post so that my posts don’t look like spam. Posting just to fill out the Topic.
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Thank you for the reply Dr. Towfigh. I think that you might have misunderstood the point of my post. It’s about mesh removal, not mesh implantation.
Surgeons are trained in how to implant mesh, but, apparently, mesh removal is not an “official” subject. It seems that learning about it is something that surgeons have to choose to do on their own. I think that the subject is in the same vein as the fact that there is no “mesh removal” code for reimbursement purposes. It’s something that people, apparently, don’t want to acknowledge as a problem.
I would guess that any surgeon who has done a few mesh removals would say that there are definite well-defined techniques for entering the abdomen, identifying structures, and peeling away the mesh, just like there are for mesh implantations. As the article I linked suggests, there is a need for standards of care for pelvic mesh removal but they do not exist. I think that the same is true for hernia mesh removal.
We’ll know that things are changing for the better when there is a SAGES session about mesh removal at one of the big meetings or when it’s included in their Education programs.
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I imagine that if mesh removal was a true area of research that professionals could dig in to all of this. It’s probably hard to talk about the need for research on mesh removal though. Run away.
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Here is an article exploring procedural causes for mesh migration.
Apparently there are concerns about the method of placement or the patient’s actions immediately after surgery allowing mesh migration. I can only assume, because I can’t afford to buy these articles, that surgeons are finding mesh where it is not supposed to be and they are trying to figure out how it happens, so these people set up a little experiment.
It’s a bit humorous that there is almost some victim-blaming going on. “You sat up too fast, it’s your fault!”.
https://link.springer.com/article/10.1007/s00464-003-8183-0
“Conclusions
Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group.” -
I would consider any portion of the mesh sheet that moves from its original placement to have “migrated”. Wrinkling, balling up, folding, or the whole flat piece moving downward or sideways or upward are all “migration”.
You will find accounts of surgeons finding mesh where it is not supposed to be. The assumption is that once the mesh is placed that it never moves, therefore the surgeon who placed it must have made a mistake.
I combined wound healing and mesh migration so that a person could try to understand how collagen restructuring can allow the mesh, or portions of it, to move. Most surgeons seem to think of the abdominal wall as a static structure. They don’t seem to consider the stretching and bending that occurs during normal physical activities. Many people get on to this site and discuss situations where “everything has been fine” for months or years then they strained the area and now nothing is the same. If a piece of mesh pulls from its placement on the abdominal wall, does it lay back down exactly where it came free from? If it doesn’t then it can be considered to have migrated. Many of these displacements over time can result in a lot of movement.
I just posted to broaden the view and give some more things to think about. No matter what the method or material a synthetic mesh is a foreign body that the body will continue to try to encapsulate and/or reject for as long as it is contact with body tissue.
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A 1/2% recurrence rate seems worthy of replication.
Also, I don’t think that Dr. Kang has fully described his methods. There are two, apparently. So a person can’t really determine that it’s like any other method unless they know what his is. He’s either obfuscating or he has disclosed. Sorry, but I see a contradiction there.
If you read through Dr. Kang’s post from the beginning, not just the last week or two, you can get a good idea of what his goals are. I don’t think that he’s trying to become famous. I think that he just wants people to know about successful alternatives to mesh. Not many people have the ability and/or time to research and understand the variety of non-mesh possibilities like you did. Plus he’s competing against very very powerful marketing of mesh products from the mesh makers.
Here’s the Gibbeum web site link, if anyone wants to see the marketing.
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When thinking about mesh migration, the process of wound-healing should also be considered. I think that they are linked, just by the nature of the biochemistry.
Laparoscopy is also called minimally invasive surgery (MIS) even though the actual “wound” that is created is very large. The exposed tissue is either created by tearing apart layers (peritoneum bluntly dissected from fascia) or by burning it free using a cauterizing tool. It is then exposed to the toxic gases of cauterization and the dry toxic CO2 sufflation gas during the procedure. After the mesh is placed the newly damaged tissue (the wound) has to heal, then restructuring of the tissues takes places, for years. The typical surgeon considers their job done at about 3 to 6 weeks, after the very early stages of healing have locked the damaged tissues together.
There are many sources to learn about wound-healing but here is one that is concise.
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I don’t think that the premise that open implantation requires open removal and laparoscopic implantation requires laparoscopic removal is correct. I think that the premise is based on the thought that only disturbing tissue that has already been disturbed is desirable. But the muscle wall has already been penetrated by the hernia and the mesh itself has damaged the muscle wall due to constant inflammation.
Unfortunately, because there is no effort to track or study the facts of mesh removal, we are all just left with educated guesses and opinions, or the track records of people that have removed mesh.
It’s all part of the avoidance of the reality that mesh is not the great benefit to society that it is sold as, and that there are corporate interests that only see the large revenue stream that mesh generates. It is a multi-billion dollar industry.
Still no registry of mesh devices, and certainly no conferences that include mesh removal as a topic. And, even worse, skilled surgeons are apparently deciding not to remove mesh anymore. But they still implant it.
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I have had correspondence with the Vincera Institute in the past. They might offer some advice on what is possible. They have seen mesh problems and know how to deal with them. I wish that somebody like Dr. Meyers would write a book about what he’s seen and what he thinks could/should be done to correct the mesh pain pandemic.