Good intentions
Forum Replies Created
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quote DrBrown:Dear Jnomesh .
When I used the term weakness, I usually mean that the inguinal floor is very thin and if it gets much thinner a direct hernia will result. This is also a very common finding in athletes with sports hernias. Athletes with sports hernia also have injuries to the medial attachment of the inguinal ligament, injuries to the origin of the adductor longus, and osteitis pubis.
Weakness of the inguinal floor often feels just like a direct hernia. Pain and weakness with exercise. Minimal symptoms at rest. But usually no bulge.Hello Dr. Brown. Your response makes me wonder if the damage from mesh implantation and its removal could also lead to a weakened inguinal floor. I’m finding, a year and four months since having two large pieces of TEP implanted Bard Soft Mesh removed that, after rigorous activity or exercise, I still get irritation around the canal, with a feeling of fluid buildup, the feeling of material moving through the bowel, pain and irritation, swelling and pressure. It resolves after a few days of rest but seems to have the signs of a hernia. I had the mesh inside for three active and painful years.
On my hopeful days I convince myself that it’s damaged tissue restructuring and it will slowly get better.
On my most objective and realistic days I think that both inguinal canals are damaged now and that it will never get better and will eventually get worse.
I am still not back to being able to go for a simple run or a gym workout without having pain afterward. I can work, sitting or physical activity, at a reasonable level but I feel like I could be much better off if my abdomen and groins were more healthy.
What is your experience with people that you’ve removed mesh from? I wonder what an exploratory surgery would find, and if it could be improved.
Thank you for sharing your experience.
[USER=”2580″]DrBrown[/USER]
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Dr. Towfigh, could you share your presentation? Or suggest a way to see the other presentations? Chaunce1234 was right, the topics are very interesting. [USER=”935″]drtowfigh[/USER] [USER=”1916″]Chaunce1234[/USER]
Session 5: The Great Debate: Mesh, Litigation, Petrochemicals and the Patient (Panel Session) Moderators: Michael Rosen, MD & Sharon Bachman, MD
Perceptions of Mesh Use in Hernia Repair Shirin Towfigh, MD
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Sorry Chaunce1234 I got carried away in studying how one of these organizations work.
To your original question – it seems like the AHS would make their presentations open to the public so that patients can be well-informed and up to date. jnomesh just posted a topic about “why patients ask for non-mesh repairs”. The AHS should be an educational resource for patients, since they are the ones who sign the informed consent forms. If the research supports the use of mesh for the patients long-term benefit, let it out where people can see it.
They can’t be the world wide authority unless their work is known. Shine a light on the problems.
“The vision of the Americas Hernia Society is to be the world wide authority on hernia.”
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And finally, the American Hernia Society is also a not-for-profit corporation. Interesting to see the three branches defined like they are.
https://americanherniasociety.org/uploads/files/AHS_Bylaws_Amended_and_Restated_2018.pdf
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And here is the Corporate Alliance statement. Similar.
“The Americas Hernia Society (AHS) Corporate Alliance (CA) is a group of manufacturers who provide service and/or materials to assist professionals in the diagnosis or treatment of disorders of the abdominal wall. The Corporate Alliance is committed to supporting scientific programs of the organization.”
The corporations must have influence. And the device maker corporations are not going to be supporting tissue-based repairs. As opposed to government funded research, which focuses on cures, the device makers are looking for consumers and market share. It’s like training a fox to guard the hen house. They are what they are, corporations with a responsibility to share holders to maximize return on investment.
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Sorry, it’s difficult to see the distinction on the web page. The headings stay the same no matter what page you’re on.
Here is the AHS statement. It looks similar.
“Our Mission & Vision
The mission of the Americas Hernia Society is to advance the science and treatment of hernia. The vision of the Americas Hernia Society is to be the world wide authority on hernia.
AHS fulfills its mission and vision by, among other things:
a) hosting periodic meetings for open presentation and discussion of scientific material concerning subjects of common interest,
b) cooperating in educational endeavors with groups of similar interest throughout the world,
c) initiating and cooperating in the publication of a journal and/or newsletter on the subject or hernia/abdominal wall abnormalities, and
d) undertaking projects of scientific interest to seek information and otherwise serve the mission of the organization.” -
I think that I have figured out how to avoid “Unapproved”. “Paste as plain text”.
And the corporations.
Corporate Alliance Members include:
Bard Davol
Cook Medical
Ethicon
General Surgery News
Getinge Group
Gore & Associates
Insightra Medical, Inc
Allergan
Medtronic
RTI SurgicalCorporate Alliance Fees:
$25,000 initial joining fee
$15,000 3-year renewal fee -
Too many odd formats in the text, apparently. “Unapproved”. Here is the bare facts part.
Here is the “Corporate Alliance” side. Probably the sponsors for the Hernia Compact Course.
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Here is the “Corporate Alliance” side. Probably the sponsors for the Hernia Compact Course.
https://americanherniasociety.org/corporate-alliance
“Corporate Alliance
The Americas Hernia Society (AHS) Corporate Alliance (CA) is a group of manufacturers who provide service and/or materials to assist professionals in the diagnosis or treatment of disorders of the abdominal wall. The Corporate Alliance is committed to supporting scientific programs of the organization.”
And the corporations.
Corporate Alliance Members include:
Bard Davol
Cook Medical
Ethicon
General Surgery News
Getinge Group
Gore & Associates
Insightra Medical, Inc
Allergan
Medtronic
RTI SurgicalCorporate Alliance Fees:
$25,000 initial joining fee
$15,000 3-year renewal fee -
quote Chaunce1234:Is it possible for the general public to view the recent American Hernia Society 2019 conference presentations and notes somewhere online?
I saw a few interesting slides from different presentations and it looks like some interesting topics were discussed.
The AHS is a not-for-profit organization. They have a somewhat odd mission statement, with “devotion to the advancement of the diagnosis and treatment of abdominal wall abnormalities and to seek projects of scientific interest to AHS to fulfill this mission.” as the core of it. It looks like corporate funded R&D to get new products to market.
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Odd that they have two names. They must have kept the web site but changed the organization name to be more broad-based.
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I think that you mean the Americas Hernia Society, with an “s”. Interesting topics, many focused on how to keep using mesh. “Managing” pain instead of avoiding it. Just incredible how the device makers are getting their way. There is even have a special Hernia Compact course to teach a new crop of mesh surgeons how to do it. I wonder if the course material includes tissue-based repairs? I would like to see the course material, it will tell where the industry is going, good or bad.
There are still some topics about tissue-based repair and discussion about what’s best, it seems. It will be hard to stop an 8 billion dollar market though. That’s a lot of lobbying money.
https://americanherniasociety.org/uploads/files/2019_AHS_Program_3.6.19_FINAL.pdf
“Hernia Compact
The Americas Hernia Society is pleased to announce the first US “Hernia Compact” Course for young surgeons interested in direct interaction with international leaders and experts in the field teaching the fundamental concepts, anatomy, and techniques of Hernia Repair and Abdominal Wall Reconstruction. The program will be offered as a closed concurrent session during the 2019 AHS Annual Meeting at the Aria Hotel in Las Vegas on March 13, 2019.
Hernia Compact Registrtion if full!”
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Going in for a unilateral procedure and coming out with a bilateral repair is very common. There’s often some small asymptomatic defect on the other side.
I wish I could be a reassuring voice. But the reality is that it’s 99% luck. It really is. There is no known high probability path to fitness after any mesh repair. No professional papers or programs to follow. That’s why the only advice you get is to “listen to your body”. Even the pros, professional runners, have had bad results, with professional trainers. But, like your friend, some people do okay. Sorry, but it really is unclear.
Listen to your surgeon and gradually work your way up. Keep a log of your activities and the effects from those activities and you’ll know what to avoid if there are issues. I had bilateral TEP placement of mesh myself and was a runner and soccer player. But I am much older than you are. I found that sometimes it would take a day or more for effects to show after certain activities. It helps to keep track so that you can see the correlations. Get more details from your friend and compare materials and methods.
Stay in touch with the forum. Your story will be interesting. If you can get your records and share them, and have good results it will be useful to future searchers. Good luck.
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quote DanGom:I just had a laprosopic ingunial hernia repair surgery using mesh almost three weeks ago. I’m 22 and have lived a fairly active lifestyle involving long distance running and weight lifting.
I’ve recently had my follow up and my doctor told me I was healing perfectly and that he felt no need to put me on any further physical restrictions (other than the no heavy weight lifting and strenuous exercises)
I talked to a buddy that had the same surgery as me a few years back, and he told me “After two weeks the scare tissue heals over your mesh keeping it in place so it’s a matter of pain tolerance.”
There are many different types of mesh and they are not the same. Some are pretty strange. And each surgeon will have their own way of doing a repair using mesh. Laparoscopic is either TAPP or TEP and those methods also have their own attributes. Generally, today, the surgeon will place as large a piece of mesh as they can fit, to cover as much area as possible. Plus, apparently, each individual’s body has its own type of reaction to the mesh, whatever type of mesh it might be. So, overall, each individual surgery is a gamble, with the vast majority of the risk on the patient. With about, roughly, the same odds as a “game” of Russian Roulette with a six-shot revolver, as far as chronic pain or discomfort is concerned. There is no way to predict the results of any mesh implantation. All the individual and the surgeon and everyone else involved can do is hope for the best. That’s just the way things are in today’s hernia mesh repair field.
The best that you can do, probably, hopefully, is to work your way back to the level of activity at which you want to be. If you’re lucky you’ll be able to get there with no, or minor, setbacks. You might find that you have to choose between discomfort and/or pain, and being physically fit. You won’t know until you try. And the tissue around the mesh will continue to restructure so things could change over months or years.
Do you have any details on the type of mesh and the extent of the mesh placement? Plus the type of hernia that was repaired? There might be some specific knowledge here related to those facts. If you did not use the same surgeon as your friend then you probably had a somewhat different repair method than he did. You should get a copy of your surgery notes so that you know what was done, for future reference too.
Good luck.
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My post had a link in it. Maybe why it was unapproved. Here it is without it.
And here is another paper which addresses the definition of “chronic pain”. Easy to shrink the numbers down if you choose an extreme definition, like “debilitating”. Disingenuous.
It’s pay-per-view but the abstract is pretty good. They also mention the wide range of mesh types. >160.
https://www.ncbi.nlm.nih.gov/pubmed/26567717
[h=1]Chronic pain after open inguinal hernia repair.[/h] Nikkol C., Lepner U. [h=3]Abstract[/h]
Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient’s quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. [h=4]KEYWORDS:[/h]
Inguinal hernia; Lichtenstein hernioplasty; chronic pain; lightweight mesh; pore size; self-gripping mesh -
And here is another paper which addresses the definition of “chronic pain”. Easy to shrink the numbers down if you choose an extreme definition, like “debilitating”. Disingenuous.
It’s pay-per-view but the abstract is pretty good. They also mention the wide range of mesh types. >160.
https://www.ncbi.nlm.nih.gov/pubmed/26567717
[h=1]Chronic pain after open inguinal hernia repair.[/h] Nikkolo C1, Lepner U1. [h=3]Author information[/h] [h=3]Abstract[/h]
Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient’s quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. [h=4]KEYWORDS:[/h]
Inguinal hernia; Lichtenstein hernioplasty; chronic pain; lightweight mesh; pore size; self-gripping mesh -
Dang. Unapproved. Anyway, here is an interesting response to Dr. Kavics presentation on the same topic.
Look up the definition of debilitate.
https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543
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Here is an article about the response to Dr. Kavic’s presentation. Dr. Voeller defends the use of mesh and chooses the low chronic pain numbers of 4-6%, plus adds “debilitating” to the description. Implying that the bar for defining success is debilitation. If the patient who came in to fix a small problem with their hernia, get it “taken care of”, ends up non-“debilitated” that is a success, apparently. Somehow, surviving surgery and being still able to function, with or without enjoyment of life, is the criteria for success. This is why the patient has to be very careful.
https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543
““The number of people with chronic debilitating pain is around [4%] to 6% so I don’t think this qualifies as an epidemic,” said Guy Voeller, MD, a professor of surgery at the University of Tennessee Health Science Center, in Memphis. ”
https://dictionary.cambridge.org/us/dictionary/english/debilitate [h=2]debilitate[/h] verb [ T ]
UK /dɪˈbɪl.ɪ.teɪt/ US /dɪˈbɪl.ə.teɪt/ formal
to make someone or something physically weak:Chemotherapy exhausted and debilitated him.
Synonyms
drain
enfeebleformal -
Chaunce1234, your list is very similar to one that Dr. Kavic, Professor Emeritus at Northeast Ohio Medical University and editor of the Journal of the Society of Laparoendscopic Surgeons, produced back in 2016, in his review paper.
Of course, he said “mesh”, but a more proper word might be device or prosthetic. The word “mesh” brings up an image of a net-like material, but that might not be necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
“Most would agree that the ideal mesh characteristics for repair of inguinal hernia include the following and not include symptoms resulting from use of mesh itself:
- Not be modified by tissue fluids,
- Be chemically inert,
- Not excite an inflammatory or foreign body reaction,
- Be noncarcinogenic,
- Not produce an allergic or hypersensitivity reaction,
- Resist mechanical strain,
- Be capable of being fabricated in the form required,
- Be capable of being sterilized,
- Resist infection,
- Provide a barrier to adhesions,
- Respond in vivo like autologous tissue.17
A 12th characteristic might be that the mesh be easily removed whenever a problem such as pain or infection develops.”
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And, a review by an impartial professional is typically a great starting point for any research.
Professor Emeritus at a top medical school and editor of Journal of the Society of Laparoendscopic Surgeons seems good.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
Sorry jnomesh I might be overdoing my response. That video is frustrating to watch. So recent.