Good intentions
Forum Replies Created
-
Hello @drbrown
Could you elaborate on what you mean by “pure tissue” repair? I’m not sure what, exactly, it is meant to mean. In my mind, a pure tissue repair would only be “pure” if absorbable sutures or mesh were used for the repair, leaving no foreign materials after they were absorbed. But I see that even an expert like Robert Bendavid seems to describe the Shouldice method as a pure tissue repair, even though they use stainless steel sutures. I would consider this a suture-based repair, recognizing that the sutures remain forever.
I think that the term “pure tissue” might be getting improperly used because it sounds good, similar to the term “tension-free”. Can you clear things up?
Thank you.
https://slingthemesh.files.wordpress.com/2019/06/bendavid-and-iakoviev-revival-pure-tissue.pdf
-
4/23/2018…quite a while ago, coming up on two years. I don’t remember seeing this post maybe it was in the Unapproved section at the time.
Hopefully he learned that there is little reason to have a mesh implant for an indirect hernia. None of the main reasons used for using mesh on direct hernias really apply to indirect hernias, as I understand things. The tissue is probably still strong, there is no weak spot in the fascia. The internal ring is just a bit too big. The methods that Dr. Kang and Dr. Brown have described for simply making the ring smaller via sutures seems very sensible and simple. I don’t know why anyone would consider mesh for an indirect hernia, even the surgeons. The side-effects and risk are much greater than the potential for recurrence.
-
Hello dev @dev
Many forums have a link in each post to use to report it as spam, or for breaking forum rules. I am fairly certain that the post above this one is spam.
-
Here is a paper that describes how the lightweight concept might actually be making things worse.
-
Dr. Belyansky has commented on Twitter about plugs being “evil”. It sounds like he might believe that the other mesh forms are okay. The “lightweight” mesh concept does not have much long-term data supporting it. I think that it was an idea that could easily be introduced to market using the 510(k) process so They did it. Dr. Bendavid has published very well thought out papers showing how the “lightweight” concept itself was flawed and might actually create more toxic environment for nerves.
I am an older low body fat male who had Bard Soft Mesh implanted. Soft Mesh is Bard’s lightweight version of their “Gold Standard” mesh. I was physically active and the lightweight mesh was never right. I knew it needed removing at close to two years after implantation, after trying to live with it for that whole time. I had it removed at three years. https://herniatalk.com/forums/topic/one-year-seven-months-since-mesh-removal/
The plugs are more difficult to remove I think because they make a bigger chunk that leaves a bigger void behind. More three dimensional, than the two-D flat prosthetics. The “scar plate” has to be removed with the plug.
I think that you could find a doctor who will remove the mesh and do a suture-based repair. Dr. Billing for laparoscopic, or Dr. Brown for open.
Good luck.
-
Hi alephy. Sorry for the delay in response the email Notification process does not work for my account.
I hate to send you to the Search function but I have written quite a bit about my situation. As I’ve mentioned in other posts, I had the mesh removed and there was no hernia remaining to repair. I’m not really waiting for anything anymore and coping well, like anyone who has suffered a serious medical condition might.
Here is one Topic that I pulled up using the Search function of the site. There is a lot of information already collected and posted on the site by many other people. I hate to put you off but my original descriptions are probably the best.
Good luck.https://herniatalk.com/forums/topic/one-year-seven-months-since-mesh-removal/
-
Many people have a bump or ridge at the incision line. That would be different than “swelling”. The ridge should be getting harder and smaller with time. Swelling would be soft and uncomfortable and probably get worse with activity.
At six weeks everything should be stable and constant on a day-to-day basis. Change would be slow and gradual.
-
There is only a single “official” bad mesh according to the International “Guidelines”, and that is the plug and patch. But all of the others are on the menu as “mesh” choices. They are not rated, they are considered to be all the same, apparently.
-
The proposed solution is almost identical to what happened to me, except from a male perspective. Bard Soft Mesh, bilateral laparoscopic implantation, TEP procedure. Released for full activity at ~20 days. Mesh removed three years later.
I think the the most important thing a person can realize in this situation, if they can afford it, is that if you get a suture repair and it fails you can follow it with a mesh repair. If you get a mesh repair and have problems, you’re stuck with the effects for life.
Your surgeon was reciting the talking points for the use of mesh over suture repair. I’ll bet that he/she does not really know how their patients are doing now. If you ask for specifics you’ll probably get “I have not heard anything bad”. Tracking costs time and money and might show something disturbing. Best not to know. It’s just today’s reality.
Good luck.
-
It’s mainly true and it’s a big selling point for mesh repairs. Many people can go back to full activities, but many of them might just feel terrible or uncomfortable while doing the activities, and/or after. But the hernia is gone.
The focus has shifted from the complete well-being of the patient to the narrow focus of fixing the defect alone. Then letting the next doctors worry about the pain, with “pain management”. It’s trending more toward specialized assembly line manufacturing principles than medicine.
-
If you search your name using the Search box in the corner your old posts will be found. In the meantime.
How did you start a new thread? I can’t find the function. I’m on a computer, not a phone. Windows.
-
Notifying @drtowfigh @good intentions @good-intentions
-
Hello. The site looks interesting. Of course there will be bugs to work out. Here are a couple of things I see right away.
There is no visible way to start a new Topic, or thread. I am using this one since it is possible to reply to an existing topic, apparently.
The MEMBERS list under FORUMS seems to show only members that have logged in since the change. Only 7 members as I write this. No way to find old members that have not logged in yet.
My screen name has been changed from “good intentions” “to “good-intentions”. A hyphen has been added. It shows on the site without a hyphen but I have to use a hyphen to log in. Can it be changed to the original name, for continuity? I think that the notification function will require the hyphen.
Thanks for keeping the site going.
-
I forgot to say that mesh removal leaves a different situation behind than when you first had the hernia. The hernia is often covered with scar tissue and does not need repair again. The surgeons who remove mesh know what to do about the old defect site.
Don’t forget that Dr. Towfigh is down in Beverly Hills. She removes mesh when appropriate.
-
Here is Topic with some details about my experience and Dr. Billing’s practice details. “Billing” is his name. There is also a comment from dog about Dr. Brown. Look for dog’s topic on his choice of Dr. Brown. If I find it I will post it, it’s on the forum somewhere.
https://www.herniatalk.com/12176-one-year-seven-months-since-mesh-removal
-
The Bay Area is not that big. Are you willing to fly, or are you looking for a taxi or Uber distance? Dr. Brown is in Fremont. Dr. Billing is in Seattle.
I went through a similar thought process when I had my original hernia repair. I should have traveled.
-
Here is Dr. Felix’s presentation.
https://www.sages.org/video/lets-be-honest-pain-after-inguinal-hernia-repair/
-
Here is a recent and fairly comprehensions article about the situation, first article linked below, and a second one from not that long ago. The article answers one of your other questions also, about approving new products.
You”ll find that instead of stopping the actions that cause pain the new advice is to clearly explain to the patient that they might have pain. Basically shifting the responsibility for decision to the patient. Informed consent. The irony is that “they” can’t understand why people don’t want mesh after explaining that there is a significant chance of pain. They’re in a bind, if they explain about pain people walk away, if they want the business they have to stay quiet. There are even surgeons out there, like Dr. Felix, who suggest that patients just need to get tougher. Stop whining.
These two articles are fascinating also because you can see how at least one surgeon is working on both sides. He suggests creating a registry that identifies bad products, but recently recommends clearly explaining to the patient that they might have pain. His second speech seems much less focused than his first.
In sum, somehow, we are all stuck, for the most part, with mesh as the standard for hernia repair. Now, it’s time to weed out the bad products, that cause pain and complications, like the plugs. That’s what a registry could do. But nobody seems to want to step up and make that happen. They’re just living with the status quo, not offending any of the device makers or fellow surgeons. Lots of talk but no action.
Individual surgeons can survey their patients, and track and report the results from the mesh products that they use. They don’t have to wait for the crowd. But I imagine that anyone who does that will feel very exposed and alone.
-
Thank you for that information Dr. Towfigh. It looks like a concession but, since the problem is pain, and animals cannot describe their pain, I don’t see a direct link to making things better. The animal studies will show tissue ingrowth and other things that might or might not be tied to pain and discomfort.
It seems like the giving of something of little value. It’s a start though.