Good intentions
Forum Replies Created
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They also noted that if they raised the minimum level to 5, they still had 11% of people that had reported pain. Level’s 5, 6 and 7 are shown below. So, 11% of people had pain that interfered with most activities, if I read it right.
Excerpt –
“Changing the definition of pain to a score of at least 5
resulted in a chronic pain rate across the whole cohort
of 11?1 per cent, with no significant difference between
the mesh groups.…level 5 – pain present, interferes with most activities, level 6 – pain present, necessitating bed rest; and level 7 – pain present, prompt medical advice sought.”
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I missed a point that would be more important to those under 50 years of age. 19% of people under 50 had chronic pain at one year.
Excerpt from the conclusion and results abstract –
“Results: In total, 23259 male patients provided data for analysis (response rate 70?6 per cent). Rates of chronic pain after repairs using regular polypropylene lightweight mesh, composite (poliglecaprone-25) polypropylene lightweight mesh and polypropylene heavyweight mesh were 15?8, 15?6 and 16?2 per cent
respectively. Adjusted multiple logistic regression analysis showed no significant differences between regular (odds ratio (OR) 0?98, 95 per cent c.i. 0?90 to 1?06) or composite (OR 0?95, 0?86 to 1?04) lightweight mesh versus heavyweight mesh. The most striking risk factor for chronic pain was young age; 19?4 per cent of patients aged less than 50years experienced pain 1year after hernia repair (OR 1?43, 1?29 to 1?60).
Conclusion: Patient-reported chronic pain 1year after open mesh repair of inguinal hernia was common, particularly in young men. The risk of developing chronic pain was not influenced by the type of mesh.” -
I’m trying to define pathways forward for people looking for a successful result.
If you’re convinced that it was your choice of surgeon then please share the name of your surgeon. Without that, there is no value in these stories. In a way, you’re taunting people who have had a bad result. Share something useful please. So that other people can share in your success.
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Dan, here is a post I just did about a paper looking at open hernia repair with mesh. I don’t want to depress you, just let you know that people are aware of the potential problems. You just have more work ahead of you than you had hoped when you got your hernia “repaired”. Good luck.
https://herniatalk.com/forums/topic/16-pain-across-the-board-open-mesh-hernia-repair-2020-paper/
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Sorry Dan, but you have followed the path that many have.
Unfortunately, the people that have the power to collect data that would show which methods and materials work best and which should be avoided are the same people who benefit the most by not allowing that information to be collected. The medical device makers.
You should get your medical records. There is a very large number of different types and forms of mesh. Even the biologic materials are called mesh even though they barely resemble the synthetic mesh materials. Basically anything with holes in it that will allow tissue ingrowth is called mesh. And many surgeons are involved in developing these new materials and will try them on their patients, even though full long-term trials have not been completed. They just “believe”.
Get your records so that you and any surgeons that you talk to will know what they are dealing with.
Your best option might be to find a surgeon who will remove the mesh, if necessary. Most surgeons are only trained in mesh implantation and told that pain problems are not caused by mesh. Surgeons that remove mesh will recognize if your symptoms are from the mesh or from some other problem. Dr. Brown, for example, has a protocol for exploring specific nerves, along with nerves close to the mesh. @drbrown
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Your description of you is a pretty good match to me. I also chose a surgeon skilled in laparoscopic surgery. Part of a group that trained people in latest techniques and certified that they were trained. Chair of surgery at a very large clinic in a large metro area. Well-respected by colleagues. He used Bard Soft Mesh, supposedly developed for active people, to give supposedly lower chronic pain levels. Implanted using the state-of-the-art recommendations of the time, covering as much area as he could with the mesh and doing the other side also even though he only found a small lipoma. (Supposedly not recommended but many surgeons do it anyway.)
I knew that I had a problem after just a few months. Tried to live with it for a year and half. Started looking for removal options, and finally found the time and the right surgeon at three years.
So without the details of your procedure there’s no way for a person to know if they’ll end like me or end up like you. If you can get that information, it might be helpful.
No offense, thanks for sharing, but without the details it’s just a story about being lucky.
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What type of hernia was repaired and what type of mesh was used? And what kind of activities do you do? Weights, biking, running, sports?
Alephy’s situation is that she is very athletic and active and fears that choosing the wrong repair method and/or material will not allow her to be as active as she wants to be, without discomfort or pain. Like me and many others have experienced with mesh repairs.
There are many variations of materials, with very little data showing how they perform in the human body. Anecdotes like yours are the best there is at this time, as far as discomfort and pain are concerned.
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What type of procedure, open or laparoscopic, and was mesh used?
There is a very large selection of materials and methods. If you don’t know what was done to you get a copy of your surgery notes from your surgeon or the facility where the work was done.
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People can just click on your name and all of your old posts will show up under Activity. The dashes in the search list you provided screw up the search if you just paste them in to the Search box.
If the original mesh was attached to the pubic bone you might have some joint-type pops and clicks since the pubic symphysis is essentially a joint in the pelvis.
Can you provide more detail on what was done, with the mesh, and the removal, and the second repair. I know it’s difficult to collect it all and to write it all down in the forum but you really have not described much about your procedures. You had a piece of “composite” mesh implanted about one year ago, and have since had it removed, and, apparently, a “Shouldice” type procedure performed to close the hernia after the mesh was removed.
Was all of the mesh removed? Did they find a hernia? Was it direct or indirect? What activities cause the popping and clicking now? It’s not clear if you are back in the gym working out, or walking, or running.
Five weeks is not very long, especially after mesh removal. The mesh caused scarring and stiffening and new tissue growth and the removal had to cut and peel through that new tissue to get the mesh out. So, even though the mesh is gone the damaged area where it was is still there.
Good luck. Take it easy and work your activity level back up slowly.
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My mistake, he’s actually playing tonight. I’d edit the original post but the forum software does not allow it. He played last week also.
If anyone has any details on what he had wrong and how they fixed it, it might offer at least one known good way to fix a hernia for a physically active person. A place to go, at least.
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If the pain rates are similar, but the solution to the “chronic pain” is much more complicated for mesh, with pain management or neurectomy or mesh removal, or all three in series, then how can mesh be the first choice?.
Besides that, many reviews have shown that the definition of “chronic pain” is often vague. The surveys are poorly designed and don’t define the truth. Many of the people on this very forum have described chronic discomfort, not necessarily “pain”, an awareness of the mesh in their body, and inability to do the things that they used to be able to do, as the source of what depresses them and can bring on thoughts of suicide. And leads them on the search to have the mesh removed.
Where is the ACHQC data, and how can a patient planning a hernia repair access it and use it? So that they can avoid the bad products. Let the free market work as it’s designed to, if the patient is supposed to be informed. Is it only for the corporations and surgeons? The talk continues but not much seems to be changing. Look at the partners in the AHSQC, linked below. Foxes and hen houses.
How can a patient find the truth? Is there anyone out there who is not tied to the mesh industry? Or is everyone just accepting their fate?
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There is a Search box on the very upper left of the first page of the forum. It’s not obvious, so maybe you missed it. No offense. You can find quite a bit about Novitsky and Jacob on the forum. I think that both of them have done Herniatalk LIVE sessions with Dr. Towfigh.
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Thank you Dr. Szotek. While I can see that you have been offended and started to slide into typical internet “shading” in your response, that post is actually the type of information that everyone that comes to this site is expecting. Real-world professional information.
In my own profession I have found that it s best to assume that the audience is well-informed and to speak to that level, rather than over-simplifying things, and leaving the audience unsatisfied.
There are still many unanswered questions, such as “do you ask your patients specifically about their comfort level or do you just assume that a “non-report” means non-existent?”.
Normally there would be an apology for offending someone who is offering their time freely to the forum, but I can’t do that here. It would be dishonest. The hernia repair field is full of misinformation and promotion, like much of today’s commercial world. It is what it is.
The HerniaTalk forum is described so “The management of this forum would like to encourage a free and open discussion of all topics relating to hernias on this hernia discussion forum.” and invites surgeons to contribute their knowledge. So thank you for that, your post really is very informative. But I’m not sorry for pointing out the flaws in your presentation. As someone who was fooled by the promotion of Bard Soft Mesh and the pitch that “it’s the surgeon’s experience that matters”, I think that I have every right to be cynical.
I hope that you’ll get over your sense of offense and continue to post, just with more complete transparency. There’s nothing wrong with getting paid for consulting. The conflict of interest just needs to be shown. It’s common across all professions.
My intent was not offend you, but to let the other readers of the thread know the full story, and give you the opportunity to share, as you did. The things that should have been shown at the beginning, so that they can make that “informed decision” that you describe in your post.
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“We have not observed any chronic groin pain and we suspect that these implants will continue to perform at the highest level. ”
How do you evaluate chronic pain and discomfort? Not observing is the same thing that the synthetic mesh surgeons say. They haven’t heard anything. Not knowing does not mean it doesn’t exist.
And I know of at least one patient from a surgeon on your list who had pain from the reinforced Ovitex mesh and had the mesh removed because of it.
Dr. Szotek, your comments sound exactly like those of the surgeons using the fully synthetic meshes. Low recurrence rates and no “observations” of pain. And “suspecting” that the product will have good long-term results is hard to comprehend.
I hope the product works as well as you all are hoping it will. But any good research scientist can see that there is much more hope than evidence for the wholesale use of this product.
And, as I’ve noted in other posts, you really should be telling people that you are a paid consultant for Tela Bio. You made $148,000 in fees from Tela Bio last year. It’s just not right to promote a product that you’re getting paid to develop, without letting people know. It’s not ethical. Even though this forum seems like just a few people gabbing about hernia repair, people are going to use your promotion of this product to make decisions that will affect the rest of their lives. Full, detailed disclosure is the right thing to do.
These are real people with real lives and families. Not just names on the internet.
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Dr. Slooter has been mentioned on the site before. Here is a thread about him, below, and another surgeon, Dr. Conze.
Search through the site, most of the surgeons that are known for mesh removal and hernia repair have been discussed in the past on the forum. There is a Search bar at the upper left of each page.
It would help you to know the type of mesh that was used, I think.
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Everyone is “reassured” by what looks like a good idea. It’s the unintended and unaddressed side effects that are the problem.
Good luck.
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Only posting so people can see the product. It is essentially a variation of the common plug-and-patch. Plugs are the only product that most surgeons will speak up against using. They create quite a mess, apparently.
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Bilateral mesh implantation is very common. It is almost the standard for laparoscopic mesh repair today. And successful mesh removal without destroying the peritoneum is also common. The fact that you’ve had a recurrence on both sides almost suggests that “incorporation” of the mesh did not happen as it is supposed to. It’s only been four months, but it should have “locked in” to surrounding tissue within weeks.
Your surgeon seems to be anticipating the worst case. There are surgeons in Germany that can and do remove mesh successfully, maybe you can get over there. I would get a second opinion. Your problem is not unusual. A surgeon that removes mesh as part of their practice will have the experience to tell you what you need. Planning for IPOM seems extreme. It has its own set of problems.
Good luck.
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Not all, just some. There is a very wide variety of procedures and mesh materials, that all fall under the category of “open repair”.
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They have to go beyond the edges of the hernia to find good tissue to attach to. How far they go can depend on the type of repair. Some of them use quite a bit of extra material. The Onstep repair (BD) pushes mesh all the way down to the pubic bone, for example. Here are a few of J&J open repair materials. The center pillar represents the hole and the two large pieces are the overlapping mesh, for the tissue to grow in to. The plug and patch pushes the plug in to the hole and uses the flat mesh to hold it in place.
“Anterior approach” means open repair.
https://www.jnjmedicaldevices.com/en-US/product/prolene-polypropylene-hernia-system
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-hernia-system
https://www.jnjmedicaldevices.com/en-US/product/prolene-3d-patch-polypropylene-mesh