Good intentions
Forum Replies Created
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Laparoscopy usually causes significant swelling in the first few days afterward. Very odd that your swelling was so minimal that you could still feel the original lump. Also strange that the surgeon diagnosed the femoral hernia by feel. My understanding is that femoral hernias are hard to diagnose that way.
You’ve only mentioned the lump. What about the pain from the hernia itself?
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Renowned means well-known. Might as well tell us who it was. Did they do the full official Shouldice Hospital procedure? Or one of the modified versions. Might be relevant.
Eight weeks is not very long since surgery.
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You probably meant Dr. Sbayi, not Sabayi. Did you actually talk to him or did you see his comment somewhere on the internet? A link would help a lot. Maybe you misunderstood the comment, it doesn’t really fit.
Ken had a friend from Mexico in a similar situation, seeking mesh removal. Ken seems to have disappeared from the forum though. Is there any reason that your friend couldn’t join the forum? Ken’s friend apparently did not speak English well. The “friend” questions are more likely to be not-quite-right.
Dr. Sbayi has been on Dr. Towfigh’s HerniaTalk Live YouTube channel. Good luck.
https://www.stonybrookmedicine.edu/patientcare/surgery/blog/hernia-talk-live
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Two inches is huge. I don’t think that’s correct. Good luck.
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It’s like removing the patch over a hole from a pair of jeans. The original hole is the same size as it was at the beginning of the repair. Actually, it’s usually smaller, or the tissue weakness is lessened, due to shrinkage and stiffening from collagen deposition.
That’s the premise behind the absorbable meshes. The body’s response to the foreign body causes the defect to stiffen and shrink, then the foreign body, the mesh, gets absorbed. A good idea in concept but apparently not so good in practice.
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What type of hernia? What type of physical activity do you do? Any sports?
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The numbers that you just cited come from a paper in which the researchers thenselves concluded that permanent (non-absorbable) or “late absorbable” (long-lasting) sutures are both recommended. They don’t distinguish between the two, so, in other words permanent is just as good as late absorbable. As fas as reoperation is concerned.
If you read more about absorbable sutures you might find that they don’t react the same way in the people that they are used in. Why take a chance on an absorbable suture if a permanent suture gives the same results? That seems a reasonable cause for “fear”. Fear of the unknown.
It is interesting though that they don’t mention pain at all. The paper was published in 2003. The primary author did eventually get involved in pain studies though. Here’s one from 2020.
https://www.sciencedirect.com/science/article/abs/pii/S0039606019307676
“Discussion
This nationwide registry-based questionnaire study showed a high prevalence of chronic pain 1 y after open, anterior mesh repair of 14.8% for self-gripping mesh and of 15.7% for lightweight sutured mesh. We observed no difference regarding the prevalence of chronic pain and recurrence between the 2 types of mesh; however, the use of self-gripping mesh was associated with a markedly decreased operative time.
This study represents a large number of patients, and the high rate of chronic pain…”
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You are conflating mesh repair results with pure tissue results. And, as is common with many of these types of studies, the data set is small and the time frame is short. Many of these studies are essentially worthless. A simple question is posed, poor work is done, and the results are presented as fact. Look at the numbers reported and the margin of error. It’s nonsense.
“A comparative study of inguinal hernia using monofilament non-absorbable suture versus monofilament absorbable suture in Lichtenstein tension free hernia repair at tertiary care government hospital.”
“Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value <0.05).”
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In the videos he shows that he’s suturing three layers. The first seems to be to a ligament, not sure which one. Somebody that is versed in the various methods might recognize what name it falls under or if it is a variation. The vidoes are pretty short, about 2 – 4 minutes each, but he does spend time on the repair. The removal portion is the typical cauterise and peel method.
His page says that removal and repair takes 1 – 2 hours. He makes a pretty big incision. He seems to be going through the muscle wall, not the canal. Like TREPP but without mesh. I think that Dr. Meyers does his repairs that way. But maybe he only does that for removals. I did not watch any repair only videos. And I am not informed at all about the details of the various possible ways to do removals or repairs. I am probably way off.
He also mentions general anesthesia. So, another possible reason to go to Korea. But, he is close and seems to have a good reputation. Plus he plays some good club music while he’s working.
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The plaintiff attorneys are realizing that the defendant attorneys are using delay tactics and are suggesting ways to get some cases settled.
This is from the Miller & Zois site above. Meanwhile, every day, more of the same mesh products are being implanted. Nothing has changed.
p.s. remember to use the backward arrow in this post to reply. Not the big red Reply button to the right. The red button will place your post randomly in the thread where it makes no sense.
“January 4, 2024: Plaintiffs Push for More Trials
We need more hernia mesh trials to get these cases settled. It has been too long. This litigation began in 2018. We have to turn the page in 2024.
The plaintiff’s hernia mesh lawyers believe there is a path. They have submitted a detailed memorandum to support their request for a new Case Management Order. This order is intended to set a roadmap for what should be done to speed this process up.
Strategy for Case Remand
The plaintiff’s mesh attorneys are not looking for the chaos that would come with sending all of these lawsuits home to their local federal courts. Instead, they suggest a phased approach, dealing with cases in large batches. The initial phase would include about 1,500 cases, representing a fraction of the total. They also propose a plan for which hernia mesh lawsuits to push forward. The selection criteria for these cases would be based on the severity of injuries, the duration since filing, and involvement in previous bellwether trials.
Efficiency and Justice in Trial Management
The proposal advocates for multi-plaintiff trials, which would be more efficient and cost-effective, avoiding repetitive testimony and allowing for shared trial expenses. The unspoken part? Trials with multiple plaintiffs also put more pressure on Bard.
So, keeping some of the structure the MDL provides, they propose that case-specific discovery should be managed under the current Court’s supervision to ensure that the cases are nearly ready for trial upon transfer to the remand courts. This plan is presented as a way to accelerate the delivery of justice for plaintiffs, ensuring that their cases are resolved in a timely manner. The judge has ordered the defendants to respond on January 10th. We should get a ruling, hopefully, by the end of the month.
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Another publication about TREPP and maybe TIPP. Pre-peritoneal both. Dr. Reinhorn is the last author on the list.
These publications seem to have an inherent conflict between promoting the topic under study and objective reporting of results. Very strange that none of the authors see the mixed messaging.
The title states firmly that “Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.”
But the conclusion seems more reality based. “Conclusion
Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair.”
Also, these authors are still blending superficial concerns in the ACHQC data reporting, aesthetics, with actual performance concerns. Pain and activity restriction. Just report the individual scores. The blending is a subjective choice and waters down what many patients are really concerned about. How can the size of the scar be anywhere near as important as the other two?
At least they are still looking for alternatives. If they could just stop trying to “win” and/or promote what they are doing. Just do the work, report the results, and suggest improvements.
Another pay-per-view article. “Suggest”, “may”, “encourage”. A lot of maybe here.
https://link.springer.com/article/10.1007/s10029-023-02936-3
Hernia
<b data-test=”article-title” data-article-title=””>Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair
- Original Article
- Published: <time datetime=”2023-12-23″>23 December 2023</time>
“…
EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts.
…
<b data-test=”abstract-sub-heading” style=”background-color: var(–bb-content-background-color); font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>Conclusion
Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.”
link.springer.com
Introduction The Shouldice method for inguinal hernia repair remains the gold standard for prosthesis-free repairs. Nonetheless, international guidelines have favored posterior mesh reinforcement as the standard of care for inguinal hernia repair due to lower risk of recurrence and chronic … Continue reading
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Just another followup. These new things I ‘ve been trying have made me realize that I have been trying to get my body to adapt to the still painful lump of mesh/cord/veins/nerves in my inguinal canal, to get back to my previously normal life. But daily life is better now, taking the odd steps of suspenders and belts and bands to reduce the soreness than in trying to suffer the constant mild irritation of tight pants and belts and normal clothes. I’ve been stuck at 90-95% for years but haven’t been able to work through it. It’s like I’ve been wearing shoes that were two sizes too small for years, hoping that my feet will shrink. It’s not going to happen.
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Hello @JohnParker Thanks for the reply. If you want your replies to make sense in a chronological fashion, don’t use the big red Reply button on the side. It will place your post in some random spot in the thread. Use the small Reply button with the backward arrow in the last post. That will place your post at the end of the thread.
Are you able to access the database, as a member of the ACHQC? Do you have the ability to sort the data so that you can see if there is a prevalence of certain types of mesh or procedures or device-makers that seem to give better or worse results? Of course, a proper look would show the rate per device usage level, but the work has to start somewhere.
There has been much talk over the years about registries and some online comments about devices like the plug but nobody is creating something that a patient could use to increase their chance of a good outcome. Much talk and supposed concern but no usable results to help the individual patient. Which is kind of ironic because it makes the overall field of hernia repair look worse. The bad products and methods are staining everybody involved.
Good luck with your efforts.
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Here is the latest from the Miller &Zois web site. 600 more cases added. That’s in three months. 200 per month. 2400 per year. Doesn’t seem sustainable financially for the parties responsible. Where is the PR department talking about how they are trying to make things better?
“<strong style=”background-color: var(–bb-content-background-color); font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>December 18, 2023: Bard Hernia Mesh MDL Approaches 21,000 Cases
Back in October, the number of pending cases in the Bard hernia mesh MDL decreased for the first time ever. Since then, however, nearly 600 new cases have been added, bringing the total number of cases close to 21,000.”
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Found something. Lasse Lempainen. Looks like it’s just one guy, specializing in lower extremity issues. Seems like he might know who the good hernia surgeons are though.
https://www.lasselempainen.fi/lasse-lempainen/?lang=en
lasselempainen.fi
Lasse Lempainen - Urheiluortopedi Lasse Lempainen
Lasse Lempainen - Urheiluortopedi Lasse Lempainen
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I can’t tell. Not even sure who the surgeons are. I just thought it was interesting that these little pockets of greater ability seem to pop up, while the general ability of the surgeons in the field lags.
It reminds me that the meetings of the big societies like to have these “How I do it” sessions. Implying that each individual surgeon might have a different way to attempt the same task. Which is actually pretty scary for the patient. How does a patient know which method is best for their case? It’s really an absurd situation when you think about it, like a contest for the surgeons, with the patient as the playing field or stage.
Ideally, in my opinion, instead of surgeons demonstrating how they implant a piece of mesh or create a space during a lap procedure, instead they would demonstrate a flow-chart or decision-tree to use for helping the patient get the best result. If A exists then use method B. If C exists, use method D. An overall procedure that starts with the patient, not with the surgeon’s favorite implantation procedure.
I think that most surgeons just use their own favorite method over and over on all of their patients to “get the mesh in”.
Anyway, back to your point, you’d think that if they can learn enough to improve the average hamstring surgery that they might also be capable of improving other surgical methods. I’ll see if there’s more out there somewhere about Reece James. He plays for the England national team. Pretty important to make him healthy again, he’ll be in the news somewhere.
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The suspenders work so well that I have been wearing them every day when I go out. I also ordered a second set.
I had another thought – compression shorts or bike shorts.
It’s surprising how pants have developed and become such an important part of our lives. Now whenever I see someone in public in yoga pants or sweats I wonder if they have or have had a hernia. The waist band of today’s typical pants cuts right across the inguinal canal.
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And here.
