Good intentions
Forum Replies Created
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[USER=”2859″]Informedpatient21[/USER]
I really am interested in your results. You really are a good experiment, just like I was for having bilateral mesh implantation for a direct hernia on one side with fixation,and for a lipoma on the other side with no fixation. Both sides were bad, after mesh implantation, resulting in removal three years later.
I assume that you are still in the early period of healing from your Ovitex implantation. The most interesting time might be when all of the mesh should have been resorbed (based on the animal studies) and you are back to being fully active. At least as active as the synthetic mesh allows you to be. And the types of activities you engage in. Unfortunately, with the goal of one-size-fits-all, good results from sedentary people are used to justify using mesh in active people, I think. Activity matters.
I hope that you won’t see this as some sort of challenge. But there really is very little real data out there, from humans, who can describe how they feel. You are one of the few.
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I wish you the best of luck with your new hernia repair.
You did not address two of my points though.
The first is chronic pain. Animals do not tell how much pain they are experiencing. They don’t “work” either, especially in captivity. Generally, they just sit in one spot and wait to be fed. So, in my opinion, animal studies are worthless for chronic pain evaluation.
Second is the long-term results. As I said, captive animals don’t have to go to work. They sit, get fed, the mesh is excised and evaluated, or something similar. Or in this case, the site of the procedure is excised and evaluated. I don’t think that an animal study lasts more than few months does it?
Other things to note. The FDA has been asleep at the wheel for many years. The bar to go above and beyond their requirement is on the ground. The 510(k) process. So that has little value.
As far as resorbability, it might be that the tissue is indistinguishable from the patients tissue after a certain amount of time. But is the “new” tissue the good strong fascia type material or some weaker form of tissue? The basic problem of the hernia is weak tissue. So, time will tell. You will be a good experiment, especially since you are experienced in the field. I hope that you will consider yourself that way and report the results back to people that can use them.
Overall, your rationale is the same rationale that gave us the mesh that you have on the other side. In broader terms a better question would be “is Ovitex, the company, a more honorable and honest and capable company than J&J or Bard or Covidien (now Medtronic),or any of the others that supposedly used similar protocols to develop their products?”. Don’t forget companies like Atrium with their crosslinked fish oil coated synthetic mesh. No offense, but working in the medical device field is not really a good reference. That’s where all of these problems were developed.
My fundamental point was that this new material has followed the same basic path as what is out there now. There is no long term phuman data to show that it is better than what is out there. And, I assume, there are no plans to follow up and track results now that it is on the market.
I wish you the best of luck. And I hope that the results are good and that over time it will become apparent that the new product is better than what is out there. But, I’m going to guess, that there will be no way to be sure. Just stories from the internet.
Could you share more about the synthetic mesh that you have and the details of the surgery, and the original hernias (direct or indirect)? That would have some value. Your description is very broad and not very useful, at this point. Please come back, at least once a month and describe your activities and the results. Are you a runner, a weightlifter, a soccer player, etc.? Tell us how Ovitex is doing. If you can make it to two years, that would be a good selling point.
Again, no offense intended. We all want to be part of something good. I chose my screen name for a reason though.
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How long ago was the repair, and how soon after did the recurrence happen? And is it a true recurrence or just another, different type of hernia. The mesh shrinks and pulls on surrounding tissue. You might have had a direct hernia and now have indirect hernias.
I’m not sure that we, the patients, should be deciding which new meshes are good for hernia repair. When the synthetic materials were introduced they had great marketing literature also. I created a Topic a short while ago about an Ovitex mesh device, showing that it was released to market based on a single “trial” of 31 patients, by a single surgeon. No peer review, no official clinical trial, just anecdotes from a surgeon who tried it. It is essentially unproven, long-term. No data. It’s just the way the medical device field is these days, and it’s how most of today’s products ended up on the market.
[USER=”2580″]DrBrown[/USER] has probably seen cases like yours and fixed them via a suture-based repair.
[USER=”2580″]DrBrown[/USER]
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That is a difficult question since most laparoscopic methods start at the navel, as I understand things. It seems like TAPP should be possible but a lap surgeon would know for sure.
Shouldice and Desarda are inguinal hernia repair methods. Umbilical hernias are a different problem. They might be one of the areas where mesh is actually better than sutures.
Are you having specific problems that you can share? Somebody might have a recommendation. Good luck.
[USER=”935″]drtowfigh[/USER]
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Hello Charlotte. Dr. Towfigh will know best, of course, but it seems like you need to see a hernia specialist. Some insurance plans allow you to see certain specialists without a referral, you should check. If yours does not then changing GP’s would be a good idea. Yours seems shockingly ignorant. Post your general location and somebody might recommend a good hernia specialist.
Good luck. You can notify people using the @ symbol. [USER=”935″]drtowfigh[/USER]
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quote mitchtom6:Fascinating question. My NCAA athlete cousin had an inguinal repair, and if I recall correctly, his doctor told him he could expect it to last 10 years.
10 years, and then what? Interesting that a surgeon would offer that information. We can all probably learn a lot from the field of athletics. I wish we could hear more about how they solve their problems.
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Here is a link to Hernia’s order form. Maybe I missed a link again.
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Thank you Dr. Twofigh. Unfortunately, that article really is a “pay-per-view” article so I am unable to see the results.
My point, as it usually is, is that the means exist to identify and call out the bad materials, methods, and devices. So many people would benefit, even the device makers, in the long-term. Stop selling the bad materials today and there will be fewer lawsuits tomorrow. Their reasons for staying quiet are so short-sighted.
If they won’t do it, that leaves the marketplace. Let us know what the bad materials are so that we can refuse them when they’re offered.
I forgot to mention one more possible correlation – laparoscopy. I don’t think that anyone who has been involved in the filed for 10 years or more can not see the correlation with the increase in laparoscopic methods and the increase in mesh problems. Regardless of the specifics, the broad trends seem to match. More lap = more problems. More lap also means more mesh, they use more and cover more area.
Until somebody shows what, specifically, is going wrong, all mesh will be considered bad, and to be avoided. It’s rational.
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[USER=”2856″]mitchtom6[/USER] could you get more details about your cousin’s surgery? Many athletes or their trainers and managers seem to know to avoid mesh repairs. There are people on this forum who have described having their athletic careers ruined by mesh repairs. And there are professionals who have had their mesh removed within just a few years, in order to continue their careers.
Professional athletics seems very secretive though about injuries. I assume that they don’t want to seem like damaged goods.
Your cousin’s story would be very interesting to hear. Type of hernia, how it manifested, and the repair method and material. Even where he had it repaired if he would share that.
Good luck with your own situation.
It’s a horribly fascinating topic – https://www.theguardian.com/society/2018/nov/25/hernia-mesh-implants-cost-top-british-athlete-five-years-career-dai-greene
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There is also no breakout of the symptoms shown correlated with type of mesh. Even though the type of mesh is known. They are grouped in to the reaction and nonreaction groups. That would be the start of valuable information for patients. It’s the only way to make things better, identify the bad and get it out of the market.
Also interesting that the trade names and/or manufacturers of the biologic and hybrid mesh are shown but not the polypropylene and polypropylene with PTFE. Don’t know why that would not be disclosed too. Expanded PTFE is most likely a Gore product, but the polypropylene could be many different manufacturers. If the cause of chronic pain is unknown then it can’t be assumed that all polypropylene or all expanded PTFE is the same. Assumptions can waste a lot of time and effort.
It’s a great start, thank you to the authors, whether they meant us, the patients, as the audience or not.
“In the mesh reaction group, 17 (17%) patients had 27 (23%) mesh specimens removed (Table 1). The specimens included polypropylene (17 of 27 [63%]), polypropylene with expanded polytetrafluoroethylene (3 of 27 [11%]), biologic mesh (Strattice; Lifecell) (2 of 27 [7%]), and hybrid mesh (Zenapro; Cook Medical) (1 of 27 [4%]).
In the mesh nonreaction group, 84 (82%) patients had 88 (77%) mesh specimens removed for a variety of other indications not related to the mesh material itself. These other indications included pain (n = 57 [65%]), infection (n = 17 [19%]), hernia recurrence (n = 32 [36%]), neuropathy (n = 16 [18%]), and/or meshoma (n = 13 [15%]). Some patients had more than one indication for mesh removal, for example, meshoma-related pain and hernia recurrence. The specimens in this group included polypropylene (70 of 88 [80%]), polypropylene with expanded polytetrafluoroethylene (9 of 88 [9%]), expanded polytetrafluoroethylene (3 of 88 [3%]), polyester (4 of 88 [5%]), and biologic mesh (Strattice) (1 of 88 [1%]).”
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Thank you for that link. I wrote something about the paper itself but it is Unapproved. Hopefully it will be released and the following will make more sense.
Here is the image from the Twitter slide, which does not seem to be in the paper, showing the definitions of “mesh reaction” and “mesh nonreaction”. Basically, in conjunction with the Discussion from the paper, it shows that there is no predictive tool apparent for chronic pain. So, it’s still just a gamble, based on whatever information you can find out there.
From the Twitter slide –
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Thank you. I misread the “Recommended Article” fees in the sidebar as fees for this one.
I’ve read the article and don’t see a description of who explanted the mesh and/or who characterized the patients’ conditions, as “mesh reaction” or “mesh nonreaction”. It also seems that “chronic pain” is in the “nonreaction” group. Regardless, it’s a nice and simple study.
The Discussion seems to confirm even more though, that it’s just a straight-up gamble to get a mesh implantation. No way to predict if you’ll have chronic pain, according to its categorization in the “nonreaction” group. No preemptive allergy tests or similar that will show a predisposition to chronic pain. It seems to confirm how hopeless things are. Even indirectly, the fact that this study was necessary, shows that the problem is real and significant, enough so that it needs to be included in the financial planning of the medical industry. It all seems sort of crazy, like “how did we get to this point?” Putting mesh in, even though there are alternatives, and now planning how to reduce the cost of taking it out. Maybe, after the math becomes more clear, financial incentives will drive a solution for the patients.
From the paper –
“In summary, we confirm that findings of foreign-body reaction, fibrosis, and chronic inflammation are ubiquitous to explanted mesh and do not correlate with patients’ clinical symptoms. No clinical deductions can be made from the pathology findings and pathology findings would not change clinical management of the patient.”
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First, you need to know if it’s a recurrence or a different problem. If it’s a mesh reaction problem then more mesh will not help. You’ll still have the problems from the Lichtenstein procedure mesh, plus, possibly, new problems from the laparoscopic mesh placed on the other side.
The chromic discomfort and pain from mesh commonly comes from the irritation of approximate tissues by the mesh itself. Oftentimes the mesh is still “perfectly” placed, but it is inflamed and edemateous. Not rubbing on things it’s not supposed to. It’s where it should be, no recurrence. No fixation to cause problems. But the discomfort and pain exists. That is the problem that many surgeons can not get past – where is the cause of the pain? “It can’t be the mesh.” Even though the evidence is right in front of them, they can’t see it.
You should try to get more details on the actual material used and the procedure, if you can. I think that some doctors describe any anterior placement via anterior approach a “Lichtenstein” procedure. You might have a plug and patch in actuality.
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quote localCivilian:It seems like most mesh related complications occur because of surgical technique.
The evidence does not really support that. It’s the meme that supports the use of mesh but there is no proven correlation. It’s a hope, the hope that allows people to keep using mesh, the hope that with practice mesh will work. But the vast majority of the data available shows that the mesh itself is the problem. The best, most experienced surgeons have patients with mesh problems. The fallacy that surgical technique can “guarantee” a good mesh repair is something that the device makers love to hear.
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quote mitchtom6:Nov 2014 Original hernia surgery.. Healed and was more or less problem-free w/ occasional discomfort. Maintained a generally active lifestyle (jogging, limited weight lifting, rowing, caving, etc).
Dec 2018- Regretfully started an intense stair-running workout routine which I did for several weeks. One night I crossed my legs on the couch and felt a lower abdominal “tearing” sensation, near my pubic bone / surgical site, which was alarming. However, there was no immediate pain at that time. I called off exercise for a while. A few weeks went by with no real issues.
Your previous posts must have got held up, I hadn’t seen them until now. I see that you added some detail. You say “more or less problem-free”, then describe starting intense exercise. Were you holding back over those four years? Why? The activities you mentioned are not very intense. Jogging, light weights, etc.
I don’t want to discount Dr. Towfigh’s advice but your situation is very familiar, even down to the date of hernia repair.
Your situation is similar to mine except that I started intense activity, playing competitive soccer, as soon as the surgeon said I could, three weeks after surgery. I also had bilateral implantation of Bard Soft Mesh, two 6×6″ pieces, via the TEP procedure. I also had pain at the pubic bone when I did things that stressed that area, like pullups and pushups. In TEP they like to place the mesh all the way down on to the pubic bone, to bond to the pubic bone to hold it in place, as I understand things. The lower abdomen ends up completely coated in mesh, internally, and becomes very stiff and inflexible, like a plastic bowl.
Good luck. Supply more details if you have them. You didn’t say specifically but I’ll bet that both surgeons checked for a recurrence via the manual method, and maybe ultrasound, but did not find anything.
[USER=”2856″]mitchtom6[/USER]
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“Dr. Bisgaard said ….. Even so, he still believes mesh is the best choice for hernia repair. “I do not think it’s a question of using mesh or not. I think it’s a question of furthering the evidence to show which meshes we should use and where should we place it.”
What he seems to miss is that, in the meantime, we, the patients, are essentially lab animals. Except that nobody is collecting the data from the lab animals. His words say, indirectly, that the product is unproven, as a whole. But he seems okay with continuing to do what he doesn’t fully understand. With the patients paying the price.
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I saw your other question, that Dr. Towfigh answered. It looks like you didn’t give all of the facts though.
There’s a lot not quite right in the situation that you describe. As Dr. Towfigh said mesh is not a solution for a “sports hernia”. So either your surgeon told you something wrong or you misheard what they said.
Also, if you’ve had a plug and patch already, it might be that that is the source of your problem, and that you don’t really have athletic pubalgia. It might be that you really have a mesh plug and patch problem and it needs removal. Se the tweet I attached below. Athletic pubalgia has distinct symptoms. Have read the “sticky” from the first page?
Seems like a second opinion with a hernia specialist would be in order. If you give your general location somebody might have a recommendation.
Also, can you give more details on your old repair? How long ago, what type of plug and patch, etc. Good luck.
https://www.herniatalk.com/6882-in-depth-sports-hernia-guide-infographic
https://twitter.com/Herniadoc/status/1021561699290116097
What do you see?
This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR
— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018
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quote kaspa:
So I’ll try to have it done in Europe. USA or Canada are too far away for that.The Hernia Centre in Germany has much experience with hernia repair. They work on top level athletes, who generally avoid mesh if at all possible. If I was in Europe it would be my first place to visit. I won’t be surprised if I end up there in later years anyway. I still have a piece of mesh in me and both groins are still adjusting to the damage done.
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quote kaspa:Hi. I’m new here.
I’m 51 and had my inguinal right hernia since less than 3 months ago. Something I thought it could never happen to me.
My option is a Desarda repair. I’d like to have it done by Dr. Desarda of course. But he charges a lot of money and only operates in India, and I wouldn’t like to have surgery there.
So I’ll try to have it done in Europe. USA or Canada are too far away for that. Unfortunately there are few surgeons using Desarda repair.
A good alternative would be Kugel mesh, as it only incises skin minimally, no muscle incisions of spermatic cord handling but there were quite serious side ettects in the past and I’m not sure it’s safe now.
.[/I]Hello kaspa. Try hard not conflate the methods with the materials. At this point in time there is little evidence than any mesh is any different from any other. The only fairly strong opinion you might see is that some doctors recommend against the plug.
I think that your first decision is mesh or no mesh. Then the type of repair. “Kugel” mesh is a Bard trade name, for a mesh that has a ring of of more sold material around its perimeter, to stop the mesh from folding, in principle, or to let it spring open to the desired flat shape after pushing through the incison. But, many people have mesh problems with mesh that is perfectly fine, no folds or creases. I had two pieces of Bard Soft Mesh implanted and one had a fold and the other didn’t. But they both were inflamed and surrounded by edema (fluids) when they were removed.
The Kugel method is a method to implant mesh, and the Kugel mesh is a mesh design meant to work well with the Kugel method. But, in the end, you still have mesh in your abdomen. That is the key. It’s just another polypropylene mesh in the end.
https://akinglobal.com.tr/uploads/subdir-182-4/BARD_catalogue.pdf
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quote Spanish:In Holland, the most corrupted country in the EU and having one of the most underdevolped health system, I am offered to have a laparoscopy in weeks by the expert in hernias in the hospital, i.e. a student. Go figure.
Thanks again for the help!!
That is disturbing that you think that.
The HerniaSurge group is based in Holland, and they are behind the big push to promote a new set of “International Guidelines for Groin Hernia Management”. There is some question abut how they decided to designate themselves as the global authority on hernia repair but they have a growing following. Odd that they would come from the situation you describe..
If I were in your situation I would go to Germany. I almost flew over there myself when I was having problems.
Good luck.