[Good intentions]

Did you guys see the picture in the publication, of the hernia? The hernia that the guy was “comfortable” with for five years was huge. You can see how the person running the scanner might have questions. It’s interesting how different cultures have different values. I can’t imagine anybody I know living with a hernia that large.

I don’t know that the relatively small hernias discussed on this forum would show up on an airport scanner.

[Good intentions]

Follow to the post above – Dr. Grischkan is an expert witness in the case.

“…
October 31, 2023: Plaintiff rested his case yesterday.

October 27, 2023: We said Dr. Grischkan was a key witness. All day yesterday was spend on his continued testimony.

October 26, 2023: Today is Day 9 of the Stinson trial. Yesterday, the plaintiff and David Grischkan provided testiomony. Dr. Grischkan is a board certified general surgeon who specializes in the repair of abdominal wall and inguinal hernias. He is a key plaintiff’s expert on specific causation.

Let’s take a second and recap the allegation in Stinson. The main argument from the Plaintiff is that Bard was aware of the risks associated with its PerFix Plug device but still promoted and sold it without properly warning doctors and patients.

What was the problem? Plaintiff design defect claim contends that the PerFix Plug breaks down after being implanted, leading to a prolonged inflammatory reaction in the body. So instead of putting a warning on the product giving doctors the information they need to do a risk/benefit analysis, Bard minimized the potential complications of the device, patients at an undue risk of severe and lasting harm.

Plaintiff’s lawyers also argue that this inflammatory reaction is exacerbated by poor design choices in the device’s shape, weight, and the size of its pores.

October 17, 2023: The size of the Bard hernia mesh MDL actually decreased over the last month from 20,405 to 20,369 pending cases. This is the first time ever that this class action MDL has posted a monthly decrease in pending cases. What does this mean? It is difficult to say until we see if the trend continues, but this could be a sign that we are running out of possible plaintiffs.
…”

https://www.millerandzois.com/products-liability/hernia-mesh-case-value/

[Good intentions]

It appears that BD (Bard) is going to fight these cases all the way to judgment or settlement. The lawyers assumed that they would settle but it looks like they’re taking it to court. Weird how the decision coincides with the release of the Updated Guidelines which recommend mesh for the majority of patients. Just odd.

“…
October 31, 2023 Update
The plaintiff concluded his case yesterday. The defendant began their defense, calling BJ J Pomerants, MD, who testifies that the plaintiff’s pre-implant injuries and conditions “affected the manner in which he perceives pain in his groin both before and after the implant surgery.” This is Bard’s classic defense of looking for someone or something to blame other than its product.

October 26, 2023 Update
Our prediction that Bard would come to its senses and settle Stinson did not come to pass. We are now in Day 9 of trial and we can expect the plaintiff to close his case this week.

What are the facts in Stinson? The plaintiff had a right inguinal hernia repair using the Extra-Large PerFix Plug mesh made by the Defendants.

Two years later, due to persistent pain in his right groin, Plaintiff had another surgery to see if the hernia had returned or if there was nerve damage.

During this surgery, his doctor discovered a significant amount of scarring and found a “large ball” about 2.5 cm in diameter of mesh that had bundled up next to a specific bone area. Removing this mesh was challenging for his surgeon due to the extensive scarring. After removing it, her used another Bard product – the Bard Marlex Mesh – to fix the hernia.

October 2, 2023 Update
September was a very slow month for the CR Bard hernia mesh MDL docket. The only entry on the docket for the entire month was an Order from the MDL Judge giving the parties seven additional days to resolve a discovery dispute before the Court got involved. Meanwhile, the upcoming bellwether test trial appears to still be one for October 16th, however, and there has been a flurry of pretrial motions filed in that case.
…”

https://www.lawsuit-information-center.com/bard-hernia-mesh-lawsuits.html

[Good intentions]

Surgeons do worry about “billowing” of the mesh in to the hernia if it is large. It is one reason that fixation might be used where otherwise it would not be. The mesh gets pushed in to the hernia before “incorporation” happens. It could also be that the mesh moved before the body tissue infiltrated it.

I assume that Dr. Muschaweck will leave the existing mesh in place and just open you up from the front to do the minimal repair, on top of the posterior mesh. I would take her advice if it was me. She has seen thousands of situations, many with professional athletes, and knows what works. Why would you second-guess her expertise?

[Good intentions]

Thanks for following up Herminius. It’s useful to know who is still out there solving these problems. Good to see that Dr. Muschaweck is still active.

I looked up one of your original threads to fill in the story and linked it below. Could you describe how you ended up with what looks like bilateral mesh implantation after suffering what was apparently a common sports injury? Was the surgeon that implanted the mesh a common general surgeon or a member of a hernia repair specialist organization? This urge to use mesh as a fix-all for any type of groin pain seems to be an epidemic.

Also, if you have the time and patience maybe you could describe what Dr. Muschaweck found. You have traveled an interesting path that could be important to any of us that are physically active and trusting the medical community to have the right solution ready for common injuries. In today’s world it’s up to the individual to find the right solution. Ironically, “Dr. Google” is a necessity today.

https://herniatalk.com/forums/topic/last-minute-advice/#post-36549

Last Minute Advice

[Good intentions]

Here is the full review from the Trustpilot site.

There are many good reviews also, including mesh removal.

It looks like Dr. Koch worked in the area of a nerve, on which mesh was impinging. The symptoms suggest that the nerve was damaged more during the removal. Maybe neurectomy is the solution after all.

“Rated 1 out of 5 stars
Oct 3, 2023
Constant pain following partial mesh removal
I had irritation to a nerve and was booked in to have a neurectomy (left side only). I approached Biohernia and Dr Koch for a second opinion. Dr Koch explained that he could remove some of the mesh from a previous hernia operation and release pressure from the nerve and avoid a neurectomy being needed.
I flew over the Germany from the UK and met with Nahom (Biohernia) and went to the pre consultation with Dr Koch, the day before the surgery. I was shocked when I saw that the operation was to be carried out using an open technique, as my mesh was placed laparoscopically. I had emails from other experienced surgeons explaining that laparoscopic mesh should only be removed laparoscopically as it is less invasive and an open removal could leave me in debilitating pain. I had messages from Dr Sheen, Dr Kangs secretary and Sharin Towfi (all highly respected individuals in the industry) all advising that laparoscopic mesh should be removed laparoscopically. I showed these messages to Nahom and was visibly distressed and in shock after finding out Dr Koch plans to do an open procedure. Nahom explained said ‘IT WAS THE BEST WAY, DR KOCH ONLY CUTS THROUGH CONNECTIVE TISSUE’. I went into the pre consultation room and Dr Koch repeated ‘IT WAS THE BEST WAY, DON’T WORRY I HAVE DONE THIS HUNDREDS OF TIMES’. Still in shock, I returned to the hotel and was numb. I frantically looked through all the reviews and had a sleepless night.
The following morning, I decided that I couldn’t go through with the operation. I messaged Nahom early (06.30) and asked him to meet me in the lobby in the hotel. He didn’t respond to my message. As I had already paid for the operation (a significant amount) I thought it was best I went to hospital and explain myself to Dr Koch and ask for a refund. On arrival I repeated that I was uncomfortable with the procedure and again attempted to show him the messages. Dr Koch put his arm on my shoulder and said ‘I WOULD DO THIS TECHNIQUE FOR MY FAMILY, I HAVE BEEN TO COUNTLESS CONFERENCES AND IT’S THE BEST WAY’. When I heard these words (especially about family), I thought he must be right, and sat on the bed I would be going into theatre in. When I sat down, I froze, couldn’t move and said to the nurse that I’m not comfortable with this (I was a rabbit in headlights, even though I’ve had previous hernia surgeries and never hesitated once). Suddenly Nahom appeared as he was viewing operations and asked me what was wrong. I repeated what I said the previous day, that I was not comfortable with the operation as the technique he was going to use was wrong in my opinion. At this point or any other point over the previous day, Nahom and Dr Koch both failed to listen to me. I believe anyone with compassion would say ‘if you’re not comfortable then we are not comfortable, your needs come first’. Nahom just repeated ‘IT’S THE BEST WAY. DR KOCH GETS A BETTER VIEW DOING THE OPERATION USING AN OPEN TECHNIQUE’. I folded to the pressure and went ahead with the surgery.
Waking up after the operation I was told by Dr Koch and Nahom that the mesh had bulged and entrapped the nerve. The surgery was a success and I would be free to return to normal activities after four weeks.
Following the surgery, I have been in EXTREME PAIN which is constant (pre surgery I only had mild symptoms after doing sporting activities) and have never experienced anything like it. Constant pain in the left testicle and a new constant stabbing pain in the lower abdomen (feels like I have been stabbed with a knife). There is no relief and it’s been MONTHS since the operation. I have a 2-year-old and a 6-year-old. I am no longer able to play games with them, take them swimming or take part in a little kick around like I could before the operation. My daughter keeps asking me when I’m going to get better, which kills me inside. Unfortunately, my love ones suffer the most as the procedure has changed me. I also had to give up the idea of pursuing a new career (which was arranged for September 2023). I had a consultation six weeks post op and was advised by Dr Koch to take herbal medication. Safe to say I don’t feel enthusiastic about getting in touch with him again.
I have recently been to see a local specialist in the UK and he was shocked by the open approach used to remove laparoscopically placed mesh. He said if the mesh had bulged it would have shown up on my scans. He has been a specialist for years and has never known anyone do this procedure this way. I’m not sure where I go from here and I’m not sure I will make any kind of recovery. My mental health has plummeted alongside my physical health. I struggled to concentrate on anything other than the pain.
I have never left a negative review before but if I can just prevent one person making the same mistake I have, then it will be worth it.

Date of experience: June 14, 2023”

[Good intentions]

I think that lifting belts are more for the back and to help maintain form. Not preventing hernias.

Have you ever thought about the design of the typical “jock strap”. Aka athletics supporter. They have some of the elements of a truss, with the wide band across the area of the inguinal canal. It might be that the design is a result of trial and hernia but I’m pretty sure that the purpose is hernia avoidance. p.s. be careful searching for “jock strap” on the internet. Use the term “athletic supporter” instead.

I think that wearing a truss or at least a supporter is not a bad idea in the months after hernia repair surgery. Unfortunately, as I’ve noted before, surgeons today do not really think much about the healing process. They put the mesh in, wait the two to three weeks, and set their patients free. If they do think about healing time, they seem to use the typical “percentage of final strength” curves that you can find here and there, and apparently assume that 80% or whatever at some short time frame is close enough. The goal is to get people back to work as quickly as possible. If a recurrence happens they’ll just start over.

Here’s a paper from 2020 that is pretty good. I see that the authors still think of the mesh as maintaining its physical properties after the pores are filled with new tissue. They don’t seem to understand how fiber-reinforced composites work. It doesn’t have the properties of human tissue or mesh after “incorporation”.

Anyway, this might give some ideas. I pulled out a small part about tissue strength but the whole thing is worth reading. Fixation might be more important than it’s thought if the whole healing process is considered.

https://www.sciencedirect.com/science/article/pii/S2666138120300025

Engineered Regeneration
Volume 1, 2020, Pages 19-33
Engineered Regeneration
Hernia Mesh and Hernia Repair: A Review
Carmine Wang See, Tiffany Kim, Donghui Zhu

“…
4.2. Mesh Reinforcement in Tissue
The purpose of using a mesh is to provide a platform for native tissue to colonize through fibrotic reactions in the tissue [52,53]. A strong mesh aponeurosis scar tissue (MAST) complex reinforces the weakened abdominal tissue when implanted. MAST formation happens when connective tissue is deposited onto the mesh pores and filament (Fig. 5) [38,44]. The newly formed MAST tissue takes about 6 months to attain 70-80% of mechanical strength of native tissue [44].
…”

[Good intentions]

There are different types of “open” mesh removal, just like there are different types of open repair. For example, I think that Dr. Meyers also performs open removal. But I think that they go in through the muscle, like a TREPP repair, rather than through the canal itself, like a Lichtenstein open. It would be good to learn more details about Dr. Koch’s removal method.

I found the review. I don’t see that the person has contacted Biohernia or Dr. Koch for resolution of the problem, after a six week follow-up. Not sure what to make of it. Not sure why he had the mesh removed since it was only causing mild pain.

Thanks for posting. The pressure that they put on him to go through with the operation is concerning.

https://www.trustpilot.com/review/biohernia.com

[Good intentions]

Sorry that you’re stuck in a slow process AJM. I don’t know if it helps to remind you that I had no repairs after mesh removal and I’m coming up on six years since removal and just now feeling like I can do several consecutive very active days without worrying too much about after-effects. And I’m still discovering new ways to make things better, like by buying a different type of belt. My old belt was too stiff and rubbed on the site of the hernia, I think. A softer fabric belt makes a difference.

I never expected to spend so much time focused on a single part of my body, but that’s where I am today.

Don’t get too down. Eight months is still early. The doctors don’t want to tell you that but they know.

[Good intentions]

Thanks for the reply Peter. I was just trying to differentiate him from the vast array of hernia repair surgeons. It’s very interesting that he chose an open mesh repair instead of a laparoscopic repair, especially since he has expertise in laparoscopy apparently. I assume that it was a Lichtenstein method. Did he discuss his reasoning for the method? Sorry to pry but that has become a hot topic on the forum. The best method.

Most surgeons today choose a single method and use it on all of their patients. I have talked to three different surgeons about hernia repair and they all talked about “this is what I do”. None of them even mentioned the possibility of a different type of repair. The big societies have “method battles” at some of their meetings, with surgeons describing why the method that they use is best. It’s pretty fascinating.

There is a lot of pressure today to move to laparoscopic methods (which necessitates the use of mesh), and on to robotic if possible. The medical field has turned in to a tech entrepreneur field, with even the big professional societies like SAGES having tech-oriented inventor focused events.

Anyway, thanks for posting and good luck. I have found Dr. Liang’s article and linked it below. Looks like an email address is required at the least in order to read it.

https://www.uptodate.com/contents/robotic-groin-hernia-repair

[Good intentions]

Are you still running 10 miles per day? I have found that resting is as important as moving. Basically, life becomes a lot more mental than spontaneous. You have to plan a balance between rest and action. You have to give up some of the things you want to do in order to let things heal and adjust.

But I’ve also found that eventually the extensive thought and planning is not as necessary. In my case it took years.

[Good intentions]

Thanks for posting. Can I ask a few questions? One of the major problems in hernia repair is the vast array of possibilities. Different types of hernia, different types of repair even within a category like laparoscopic, different types of mesh, and different types of people.

How long has it been since the surgery? What type of hernia did you have? Are you an active person, like an athlete, or more moderately active, like just coming and going to work every day? What type of mesh did you get? (Dr. Liang’s web site implies that he is a “mesh-first” surgeon). What type of surgery did you get? Open, laparoscopic, robotic?

No offense intended, but the majority of the discussions on the forum are about the odds of success, in the short-term and in the long-term, and the methods and materials used. Without some details there’s no way to differentiate Dr. Laing from any hernia repair surgeon. They all have some wins behind them.

Keep posting as you recover. The real world stories are important.

[Good intentions]

I had wondered about cold water swimming also. For men though I think that there are different issues involved, with the retraction of the testicles and general pulling back of all externalities. I didn’t find any good places to swim, but I did try cold showers directed at the area. But it all warms back up pretty quickly. Not the same.

The type of pain probably matters also. Pain close to the skin versus pain deeper, like at the pubic bone.

Have you had surgery?

[Good intentions]

That is quite a story Mark H, thanks for posting it. I have found that you can only put three web links in a post otherwise the forum software just throws all of your work away and goes back to the main page if you add four or more.

I went through the details and am a bit confused. Did you have both surgeries on the same day? You wrote that September 27 was treatment day and reported a lipoma removed. But then on September 30 you wrote that you had to go “for” surgery. Did you mean that you had a follow-up appointment? It might just be a linguistic issue, like the reversed date code usage.

“Couple of days later I had tracked down the bus company but couldn’t do anything more as I was due to go for surgery.”

Here is a summary, I think, assuming that everything was done on the 27th.

September 26 – first visit to Gibbeum Hospital, extensive diagnostic work performed
September 27 – both sides repaired surgically
September 30 – first follow-up (American term)
October 2 – final follow-up

Long flights from England at beginning and end.

So, it’s been 17 days since surgery. How do you feel now?

And, besides the lipoma, did you learn any more details about what Dr. Kang did? Did he just find two enlarged internal rings and tighten them up? Did he find other weakness that needed work?

Good luck for the long-term. Try to stay in touch with the forum if you have time.

[Good intentions]

I just noticed that in the PerFix case described above that the mesh was removed, “and replaced”. Incredible. The refusal to believe that the mesh alone is the problem is amazing to see. The patient still had pain with the new mesh. I wonder what the plug was replaced with.

“…
For 2 years after the surgery, the plaintiff had chronic pain in the area. In 2017, he underwent exploratory surgery to determine if it was a recurrent hernia or nerve entrapment causing the pain. During this procedure, the surgeon found that the Bard mesh implant had curled up into a ball, causing major scarring on the internal tissue. The mesh was removed and replaced, but the plaintiff continued to have pain.
…”

[Good intentions]

Here is a link to that other thread I had going. Just use “litigation” in the search box if the link is broken. It should be the first or second result.

https://herniatalk.com/forums/topic/big-picture-litigation-perfix-plug/

Big picture – Litigation – Perfix plug

[Good intentions]

When you talk about him or reply to his posts you feed his ego. He might have come to the forum for real problems in the beginning but now he’s just here for entertainment and attention. Each new persona is like a new fishing line in the water. Each response is a bite. I am reasonably certain that there one or two new ones are on the forum now. The same statements and same questions are asked, but replacing normal words with strange ones.

They make software tools to find these types of things. A certain famous writer has just been called out for using a ghost writer and passing the work off as their own. We all have limited vocabularies and use words in certain patterns. So, despite the annoyance of the impersonator, I’ve actually become more aware of some new things.
.
.
.
The typical new persona is strangely well-informed despite being new to the hernia world, and has “heard/read bad things about mesh/tissue repairs”. Which is normal, of course, but normal details are usually missing in their story.

I think that a large warning at the top of the new forum page will help. Trolls have been a part of the internet since forums were created. The new VPN software, as someone noted earlier, just makes it very easy to bypass security measures.

[Good intentions]

P.S. Dr. Towfigh or her website manager should be able to reopen the original Kody’s account and show the original posts. For what it’s worth I thought that he said he was 21 not 22.

And, to be frank, there’s no guarantee that the new KodyH is the original Kody. He gave the information necessary to create a new Kody facsimile in his first posts. Just one of those things that makes you wonder. Chuck might have taken notes.
Besides the fact that Chuck is prolific on Reddit where there might be a Kody. Don’t go over there, it’s not pretty. I made one short visit a while back.

The path to the decision to go to see Dr. Kang is interesting. The immediate recovery, not so much. It’s been discussed many times that it’s the long-term that really matters. Full recovery from any surgery takes month or years.

[Good intentions]

Time will tell. MarkK sounds a lot like the original Chuck. He asked the same questions and made the same vague statements, like Chuck and his personas do. See threads below.

As far as getting offended, I don’t see why a person would. Nobody really knows who anybody is on the internet. No reason to be offended. He’s getting responses to his questions and misstatements. And he starts a new thread when he wants to get some new people involved. It’s all working for him, fake or not.

For the record though, I would not share an email address or phone number with anybody on the internet. If any “chatting” is done, create a new email account that you can throw away if things get weird. Don’t share any personal details. Really, there’s no reason to have a personal “chat”, the open forum is the place to talk.

He just sounds like Chuck. Who knows. Maybe he’s getting tired of creating new personas and will behave for a while.

“…
Would enjoy chatting when you get back to the States. Where are you from?
…”

https://herniatalk.com/forums/topic/kodyh-kang-repair/#post-39692

https://herniatalk.com/forums/topic/opinons-re-shouldice-v-kang-repair/

KodyH Kang Repair

[Good intentions]

I wonder if there is some sort of AI based filtering software that is available. “Chuck” eventually shows through in the phrases and bad information. MarkK seems to be one. He was probably damaged before he ever got a hernia. It’s sad to see.

I suggest that there be warning posts in the new forum platform that let people know that there is this “virus” out there, trolling the site persistently. Tell people not to share any personal information with this person. There should also be a simple blocking function so that people don’t have to see any content, posts or messages, from people that they think are trolls. The blocking function is common across many forum software platforms.