Good intentions
Forum Replies Created
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I’m not arguing for or against Biohernia. I just can’t tell who they are. The page that you linked is only accessible if you click on the United Kingdom link. And they give a nice description of how they select “their surgeons” but they don’t tell who any of them are.
It’s all just very mysterious. We need more transparency, not more promotion of “the way we do it”. The mesh promoters do the exact same thing, and have similar criteria. Experience, number of procedures performed, etc. No data about success rate though, short or long-term. They mention it but don’t give the numbers.
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Find out more about his relation with Dr. Belyansky. Has he been trained by Dr. Belyansky, or is he just an acquaintance? Is he an expert in mesh removal or just a beginner?
Also, make sure that he knows how to address “sports hernia” problems. Most experts in “sports hernia” do not use mesh. Using mesh to fix your groin problem was probably a mistake. The mesh might be in an unusual place, from what it would be for a normal inguinal hernia.
You’ll probably have no erection problems but the possibility of other complications is still there. Good luck.
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My point is more about using the name when it’s not the actual surgeon who developed it. Like the “corrupted” Bassini procedure that Dr. Kang talks about as a reason for high recurrence rates. People said they were using the Bassini method but were cutting corners, apparently. It wasn’t really a Bassini method.
Facebook tells more. Dr. Koch is the guy behind Biohernia, maybe. his name comes up. Twitter and youtube also. The main web page is not very useful at all. It as I though, more of an agent, referring out to other facilities. They call it an “intermediary”.
https://www.facebook.com/biohernia
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Here is another site with a connection to Dr. Muschaweck. Kind of confusing, which is which.
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I hope that it is Dr. Muschaweck trying to train people in her methods. They really should have more information on their web site. Why are they blending Desarda in with Muschaweck and Shouldice? Doesn’t make sense.
On the other hand, the soccer player in that picture is Lionel Messi, maybe the best soccer player in the world. I doubt that they could use his image without his approval. He must, I assume, have had some work done by Dr. Muschaweck or a colleague.
Without the information though, the Biohernia page is just another hernia repair practice ad. All a potential patient can do is trust the words Desarda, Shouldice, or Muschaweck. It’s really a poor web page.
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Here is another paper from Dr. Burger, from 2017, in which he still uses the 2004 paper as his primary reference for suture versus mesh. He shows a multitude of different mesh options in the paper but uses the Prolene mesh 2004 paper results.
The research field is very chaotic, so many unproven materials being introduced to market, and so many different ways to use them.
This is for incisional hernias though, so not so translatable to inguinal repair.
https://www.sciencedirect.com/science/article/pii/S2211568417300037
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I think that the “crazy” numbers the surgeon quoted were probably about incisional hernias. Here is an old paper about mesh versus suture. It seems to be one of the first “evidence-based” papers supporting the use of mesh, at least that’s what they say in the comments. They started with evidence-based but then started moving ahead without evidence. Changing the parameters on the fly. “Educated” guessing.
“Regarding the overlap of the mesh. Two centimeters may actually be too little. We think we may have lower recurrence rates if we increase the overlap of the mesh, and nowadays we do.”
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I think that what was described in that story might also be called an autograft, among other possible terms. It’s actually fairly common. The story itself is more of a human interest story. I searched for the name of the main person in the story on Google Scholar and only found a couple of articles, about rat studies. It looks a lot like “cowboy” surgery, where somebody just decided to try something and it looked like it worked in the short time frame that they were in its presence. If the woman in the article has problems they could be in trouble. It’s not “standard of care”.
The authors also appear to work mostly in emergency surgery. Trauma surgeons.
Many references about about abdominal trauma and emergency surgery. Gun shots and bullet fragments. People that are already in very bad shape. Easy subjects. I think that the main “hernias” that they were working on were incisional, or ventral, hernias.It’s a neat story, and concept, but it’s unproven. And nobody is going to sponsor a study about it I think, there’s no money in it.
Hate to be a downer, but as long as the device makers control the field, it’s going to be all about new devices. New products to sell. But it doesn’t hurt to plan for the day that healthcare changes back to a patient focus.
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=%22Ian+Hodgdon%22&btnG=
https://scholar.google.com/scholar?start=20&q=%22P.+Greiffenstein%22&hl=en&as_sdt=0,48
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It might be that the more honest assessment of chronic pain rates in Switzerland comes from the way that doctors get paid. In America, apparently, most surgeons get apid by number of procedures performed. There is, again, apparently, a push toward more results-oriented pay, but it’s easy to imagine that device makers would resist this effort.
“Fee-for-service” pay is common. Hernia repair would be considered the “cash cow” of a typical surgery practice.
https://medschool.ucsd.edu/som/surgery/news-events/Pages/How-Should-Surgeons-Get-Paid.aspx
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In fewer words – 15% chronic pain rate is the new “standard of care” level. If you can’t change the result, change the rules of the game.
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The increase in lawsuits is leading to the effort to disclose more and more to the patient. So that they can share responsibility. If you read the details of some of the bigger lawsuits you’ll find that not disclosing the possibility of chronic pain or complications is often the foundation for the suit. “The doctor did not tell me this might happen”. So, I’m not sure that you actually found a more honest practice. It might just be that they’re up to date on the legal problems in the field. So, your risk is probably the same. But you won’t be able to sue them if things go wrong. Because they told you.
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You might have to create an account. It’s easy to do, just an email and a pasword.
The discussion seems to cover all types of hernias, not just inguinal so is a little broader than what most people here expect. Still, the views are interesting. Dr. Voeller especialy, since he is a aprofessor and is well-knonw on the conference circuit.
Even for incisional hernias, the benefits of mesh are undefined. And the experts still talk about all mesh types “as “mesh”. All the same despite all the differences.
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A big part of today’s hernia repair with mesh uses the idea of “prophylactic” repair, or prevention of future hernias. I had written about this a few years ago and was told that that it doesn’t happen but I just saw a panel discussion where the question was raised and several surgeons said that they do it routinely. I’ll see if I can find it, it was in General Surgery News.
So, I think that your question will only reach a very very small audience. Dr. Kang has realized this and uses the term “type-specific repair”, as you noted. But surgeons today aren’t taught about type-specific repair. They’re only taught about preventing all future recurrences by implanting as much mesh as they can fit over all possible hernia sites. It sounds crazy but I think that it is true. The mesh is seen as a better version of the existing abdominal wall, like something Ironman would develop (so that he can carry the heavy steel suit).
I think that only two surgeons who might respond to your question have already responded in many past posts. Dr. Brown and Dr. Kang. Everyone else is still thinking in terms of recurrence. The training to answer your question well just isn’t there anymore.
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The results of your allergy test will be interesting. One potential problem though is that it will be passive or static test, probably. Whereas, in the body, the tissue is constantly moving around the mesh as you move and breathe. I would guess that there will be no allergic reaction and that the information will be used to convince you that “mesh” will be okay for you.
Don’t overlook that if you get a pure tissue repair with absorbable sutures, and you get a recurrence, you can then have a mesh implantation. Also, regarding the possibility of pain, don’t get taken in by the term “minimally invasive” if you consider laparoscopy. More tissue is invaded for laparoscopy in order to create the space, than for either pure tissue, or open with mesh, which uses smaller pieces of mesh.
Since you are going so far in educating yourself you might make a list of the different types of mesh and the different forms and try to rank them by certain characteristics. For example, the Prolene Hernia System (PHS) sounds very official and is promoted heavily but it uses a very large quantity of mesh and invades both sides of the abdominal wall, and combines that with a plug. If you were going to take all of the potentially problematic qualities of “mesh” and combine them in to one product it would probably end up looking like the PHS. It’s like they threw everything they had at preventing recurrence, with no consideration of chronic pain.
Good luck. Get a list of the polymer types they will be testing on you, and/or the brand names. It’s possible that they will only test products that they have contracted to implant, and you might not get the full picture.
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Here is a 2018 comment. Scroll down the page.
https://www.yelp.com/biz/north-penn-surgical-associates-lansdale-2
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I’m not sure but I think that I read a couple of years ago that he had retired. But here is a link.
https://doctor.webmd.com/doctor/james-goodyear-75f4e3fd-6138-48cb-a6d7-f17c910db2ab-overview
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General anesthesia adds cost. It’s also more dangerous. But, apparently, the medical industry is more comfortable with it now. More change.
I’m going to guess though, like Dr. Brown has pointed out in other posts, regarding injections to diagnose pain sources, that many of today’s surgeons probably don’t know how to do local anesthesia for open hernia repair. It’s probably part of the overall “division of labor” that is happening. Anesthesiologists do anesthesia and mesh surgeons implant mesh.
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If you open the person’s profile by clicking on their screen name or the person icon above their screen name you’ll see the option for sending a public message or private. Email notifications don’t work anymore though so they may not know about it until they log in again.
I’ve wondered before also about how private Private is? Can the administrator of the site see the Private messages? I don’t know.
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Almost all open repairs are done under local anesthesia, as I understand things. All laparoscopic repairs are done under general anesthesia.
To be clear, local means that you’re awake during the surgery, and general means that you are not.
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The Tela Bio Ovitex product line is about as perfect as things can get for a registry. A new product, relatively low volume, competing against industry products with a worsening reputation for chronic pain. Closely held by just a few people.
Create a good questionnaire and start tracking results. As they come in use them to show that it’s better than the industry “standard” of chronic pain. documented results, guaranteed to help sales.