Good intentions
Forum Replies Created
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Here is an example of what a person might find on the internet if they search “chronic groin pain mesh”. Dr. Bachman may have overlooked also that a person who works for NIH might have direct access to these papers through an internal database search. No need for Google. Most professionals would use Google Scholar anyway. Still surprised that she discounted the opinions of the very educated people she mentioned at the beginning of her presentation.
https://www.google.com/search?hl=en&authuser=0&ei=jyeZXMrVH4mLr7wPjeuziA0&q=chronic+groin+pain+mesh&oq=chronic+groin+pain+mesh&gs_l=psy-ab.3..33i22i29i30.16781.17798..18192…0.0..0.67.289.5……0….1..gws-wiz…….0i71j0j0i22i30.y-40gGBN-q0
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Here’s the site for the PHS. It’s a lot of mesh.
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quote kevin b:Hey everyone.
I’m 40 years old — 5’8″, 185 lbs. Decent/average shape (at least I was a month ago).
5 weeks ago (2/19/19) I had open hernia surgery on the right side. Surgeon found the following:
- Torn oblique and torn transversalis.
- Entrapped Iliohypogastric Nerve.
- Small direct inguinal hernia
He then repaired it by:
- Removal of section of iliohypogastric. Cauterized ends.
- Repaired the hernia (small bulge of spermatic cord) with medium prolene mesh
- Sutured up the muscles.
I had a lot of post-surgical complications:
Dr. Brown responded to your other post and might have more comments since you’ve added more detail. Are you reciting from memory or notes, or from copies of the surgery notes? I’m not sure that what you described is self-consistent. A direct hernia is a projection of material in to the inguinal canal from the side, not through the spermatic cord. But you mentioned a swelling of the spermatic cord, which implies a lipoma or an indirect hernia. If my understanding is correct. You could have both, of course.
Also, Prolene mesh is used in many different forms, from small patches, to complex two patch systems, connected together. The Prolene Hernia System. It would help to know what was used.
And, Dr. Brown probably has more experience in fixing ruptured muscles since he works on many professional athletes. Suturing them back together and getting them to work correctly are not the same thing, I expect.
As far as “stuff” in the scrotum by the testicles, I also had that experience. It resolved over time. I assume that it was some sort of tissue damage, possibly from the tying back of the penis during surgery.
Good luck. If you don’t have copies of your surgical notes you should get them.
[USER=”2580″]DrBrown[/USER]
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That is a great presentation to watch for someone who wants to see how to convince yourself that what you’re doing is right. She seems very conscientious and gives a nice presentation but she never even got close to answering her primary question. “Why are more patients asking their surgeons for non-mesh repairs?”.
She, instead, suggested that some of the most intelligent people in the world, scientists working at some of the best research organizations in the world, were being swayed by law firm web sites on Google searches. Overall, actually, a poor presentation, whose actual result was to personalize the use of mesh, with the story of the young woman, but avoid answering the real question of why we ask for non-mesh repairs. She asked the right question then diverted to supporting the use of mesh as the core of the presentation. It might even be subconscious, she might think that she actually addressed the question.
It is actually a fairly standard boiler-plate mesh-use support presentation. Not patient-centered, but surgical practice centered. Justifying past and present behavior.
And, as everyone seems to do, she balled all of the different types of mesh and different repair methods in to “mesh”. She was aware of the differences but still referred to everything as “mesh” versus non-mesh.
Very discouraging that this is a “Masters Hernia” presentation in July of 2018. Not even a year ago. Thanks for posting that link.
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[USER=”2814″]Bswilson[/USER] forgot to add a notification.
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Different surgeons use different methods for removal. It is not something that they like to talk about and share, it’s not a popular topic, even though it is more impactful, in a positive way, than a hernia repair, to the patient. I suggested recently that mesh removal should be a major topic at the big surgeons’ meetings but it seems unlikely to happen. And the huge range of materials and methods possible, and combinations, mean that the potential problems cover a wide range.
In principle, the body is “rejecting” the mesh forever. It never gets “incorporated” in to the body although that phraseology is used all the time to support its use. It gets encapsulated at a fiber level with low inflammation if a patient is lucky. Maybe your surgeon(s) mean that they need to give the body tissues time to restrengthen before continuing? So that the strong tissue can be distinguished from the damaged tissue. The tissue around mesh can be full of fluids from the damage of the mesh.
Can you give more details about your situation? The type of defect repaired, type of mesh, method used? And the method being used to remove it? Some surgeons that use an open method to remove mesh can get more done in a shorter time than a surgeon using laparoscopy. Either way, I think that it is a very tedious time-consuming process, and the internal parts of the abdomen can only be exposed for so long before damage occurs. Tissues dry out and the possibility of adhesions increases. If you have mesh entangled with important structures they might be taking their time to save those structures.
Good luck.
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This seems like something that it would be very reasonable for the community of surgeons to get behind. A lever to use for reform or rehabilitation of the FDA. Smoking is one of the worst things for healing, but the FDA’s efforts to minimize the number of smokers produced by big tobacco marketing efforts is at risk.
More smokers means more weak tissue, more disease, poorer healing, more need for mesh implantation and more mesh failures, both recurrence and chronic pain. Staying focused on only the few hours of surgery isn’t enough, if the goal is to produce a healthy patient. “I did my job” isn’t enough.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html
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quote kls007:I was wondering everyone, can a hernia or nerve entrapment cause the cremaster muscle to not work properly or over work? It feels that that my scrotum and penis pull into my body even when I’m not cold or its not cold outside?
I still get that response occasionally after mesh removal, after more rigorous activities. I think it’s just the bodies response to damage. Is yours always that way or is it better after rest, like in the morning?
I don’t know that trying to figure out the exact mechanism of the response is going to get you to a solution. Probably any damage in that region could cause the response. Athletic pubalgia, hernia, muscle strains.
If you’ve been seeing mostly general practitioners maybe try to find a doctor with expertise in abdominal injuries, like a “sports hernia” doctor. Athletes tend to have a wide variety of “core” injuries.
[USER=”2580″]DrBrown[/USER]
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If you use these words to search the internet you’ll find another very good article by the Guardian. I’d post the link but I get constant “Unapproved” rejections.
[h=1]Don’t pin the opioid crisis just on Purdue. The guilt runs wide[/h] -
Another article from the Guardian. Considering the recent tragedies with the Boeing 737, you can see that the big institutions are like giant machines, focused on keeping the business alive.
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I know somebody that works in venture capital and they said that all of the device makers are waiting to see where the litigation ends up. Their research budgets are small, they’ll just make the money that they can while they can.
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I’ve been blocked.
[USER=”935″]drtowfigh[/USER]
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Hello Casey. Dr. Towfigh would probably know the answer to that.
I’m posting here to notify her, but also to see if I can post anything on the site. Good luck.
[USER=”935″]drtowfigh[/USER]
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He does not like plugs, as in the plug and patch method of hernia repair. He commented on Dr. Towfigh’s tweet.
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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Another fairly recent article about changing the 510(k) process. It’s not really clear who will benefit though. Seems to be more short-term based.
https://www.cnbc.com/2018/11/26/fda-to-overhaul-510k-medical-device-approval-process.html
And it looks like the head of the FDA has been pushed out. Wants more family time after just two years.
https://spinalnewsinternational.com/scott-gottlieb-resigns-fda/
This is why we can’t depend on the FDA to save us. If they can help, that’s great. But nobody should expect the help.
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About one year ago there was an effort to increase the dialogue between the FDA and the affected parties. Not clear what ever came of it.
https://www.herniatalk.com/6583-dear-patient-advocates-seeking-feedback
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quote DrBrown:Dear Good Intentions.
Your comments and information in this forum are a start, but I agree it would be very helpful if the FDA would acknowledge the problem. Many surgeons that use mesh do not realize that their patients have serious problems with mesh, because the patient goes to another surgeon to have the mesh removed (i.e. Myself and Dr Towfigh)
I appreciate your effort to keep attention focused on Mesh.
Regards
Bill Brown MDThank you Dr. Brown. As you can see from the FDA’s own web site they are aware. But they seem to be deflecting any responsibility for action, even suggesting that the problems they list have all been removed from the market, by recalls. Even as the lawsuit ads on the mainstream media channels become more prevalent. It really looks like the device makers have got to them and are running the show. The FDA expects the device makers to recall their own products, seemingly not realizing that self-recall means self-blame which means liability. The FDA does not seem to understand their role.
From the FDA:
“Many complications related to hernia repair with surgical mesh that have been reported to the FDA have been associated with recalled mesh products that are no longer on the market. Pain, infection, recurrence, adhesion, obstruction, and perforation are the most common complications associated with recalled mesh. In the FDA’s analysis of medical adverse event reports to the FDA, recalled mesh products were the main cause of bowel perforation and obstruction complications.”
They put all of the responsibility on the surgeon, and the patient. Surgeons make fun of “Dr. Google” but Dr. Google seems to be necessary.
“The FDA wants to help patients make informed decisions about their health care and to facilitate a discussion between patients and their surgeons.”
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Thanks for posting this. I found the link to the full review, it’s free for viewing, below. It looks very comprehensive, it will take some time to work through.
Download choices are in a column on the left.
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Thank you for the reply Dr. Towfigh.
Of course, I meant an open forum with presentations, at one or more of the national meetings, similar to the presentations about how to implant mesh. As the patient becomes more responsible for the decision about how to repair their hernia, the patient needs good information. The closed door meetings between surgeons and others don’t help the patient learn anything. They actually make the patient more suspicious that something is being hidden. In the long run, the closed door meetings might even be making the participants of the meetings more liable for future problems.
It would be so much better to just have an official acknowledgement of the problem, with some level of quantification, and some shared information about how to deal with it. My surgeon delayed and denied for almost a year and finally said that he was going to seek outside help. He should have had an answer immediately and recognized the symptoms. He was fully up to speed on how to implant mesh, training and certifying people in laparoscopic techniques, but apparently clueless about mesh removal. He was either pretending, or he really did not know what to do. Both are bad.
Unfortunately, there is a growing gap between what the doctor needs to do for their profession, and what the patient needs to do to heal and get back to a full life. I think that this also plays in to the burnout and depression among doctors that mentioned in my other topic. The doctors need patients to push back, for the health of all involved. Expose the bad side of hernia repair so that people can be ready to deal with the failures.
I think that in today’s world it is inevitable that mesh removal will eventually be fully exposed. Better to be ready for it and ahead of it. It would make a great 60 minutes story.
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I got Unapproved, Green-screened again, above. I wrote quite a bit of stuff. [USER=”935″]drtowfigh[/USER]
Well, in the meantime, notice that Tela Bio (I called them TelaLab above, my subconscious…), is doing exactly what a panel of surgeons said was one of the major problems in the hernia repair field. Placing short-term priorities over long-term patient benefits. I’ve excerpted a few items from a white paper they published, from a panel of surgeons they pulled together.
Also notice that they call out ease of reoperation for recurrence as a benefit. So, we’re back to suture repairs as a comparisons. The whole point of synthetic mesh has been sold as a reduction in recurrence rate.
Finally, how could lifelong safety NOT be the priority? What premise have they been working from?
It’s an interesting paper but, of course, they published it to show potential for Ovitec. It is fairly objective though.
http://www.telabio.com/assets/download/White-Paper-Mesh-Performance.pdf
SUMMARY: SURGEONS’ CONSENSUS STATEMENTS
• There is a growing concern among surgeons that short-term product priorities outweigh lifelong patient benefits
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• Recurrence rates and long-term performance of biologics do not justify their high cost. However, if the cost were more manageable, recurrences arising from use of biologics would be significantly easier to re-operate on in the long run than reoperations of complications arising from failed synthetic meshes
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• There is growing evidence that lifelong safety of implanted mesh is becoming the priority