Good intentions
Forum Replies Created
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quote Brady:So it sounds like they sometimes do it for precaution since they’re already doing a surgery, but is it necessary or does it increase risk for the other side? Sounds like it’s open for opinion?I should add that “already doing a surgery” is a term used for laparoscopic hernia repair. Once they have the abdominal cavity opened up.
An open repair would involve two separate procedures, one for each side, maintaining the undamaged tissue in between the two groins.
Another example of how laparoscopy is indirectly contributing to the mesh problem. It’s just so easy to keep going and add more mesh.
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Hello Brady. I think that you’ll find a wide range of opinions, many contradictory, sometimes from the same person. Not too long ago “watchful waiting” was recommended for small hernias. Surgery itself was considered to add risk so it was better for the patient to wait and see if it got worse.
Now, today, you’ll find many surgeons who will place mesh on asymptomatic hernias. That can only be found during surgery. No pain, no bump, no external sign that a hernia exists. Many will routinely cover as much abdominal area as they can, if they find just a small sign of a defect. It’s just the reality of today’s “standard of care”.
I can say, from experience, that the precautionary approach sounds like a good idea, before surgery. Because the surgeons that suggest it, indirectly, make it sound so easy. “We’ll take a look and if we see anything we’ll “fix” it.” But if the mesh causes a reaction then all of that area that was not a problem before, becomes a big problem.
So that’s your decision – trading one risk for another. Trading one fairly well understood small risk, the chance that the painless small hernia will get larger, for one poorly understood and substantially damaging risk, that you’ll have a mesh reaction.
Try to find a doctor that can defend their method with actual long-term follow-up results, by survey or direct contact with former patients. Somebody that knows how many of their patients have had problems, and why they had problems. If they say “I haven’t heard anything” that just means they don’t know, not that their method is good. There is nothing stopping any individual surgeon from staying in touch with their patients.
Good luck. Be careful.
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Good luck kevin b. Sorry for the distraction with my long posts.
Your description doesn’t read like a run-of-the-mill “sports hernia”, it looks more like an abdominal muscle tear, with an incidental hernia. I’m not a doctor though.
Still, and always, a good idea to get a copy of your medical records. The surgery report is probably interesting reading.
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Implantation and removal might be getting mixed up here. It’s difficult to remove mesh via TEP. TEP basically means keeping the peritoneum intact during the procedure, entering at a single point and splitting the peritoneum from the fascia to create a space to work in. Dr. Towfigh has said in past posts that sometimes she is able to do a TEP removal. TEP is important because by keeping the peritoneum intact the chance of adhesions is almost zero.
TAPP was used to remove my TEP-implanted mesh. The abdominal cavity is entered and the intestines moved out of the way leaving the back of the peritoneum exposed. The mesh is located through the peritoneum and the peritoneum is cut to gain access to the mesh. It is then split away from its attachment points and removed. Then the peritoneum is closed up. Side effects are adhesions, apparently.
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quote DrBrown:I wish it was not true, but some doctors think more about money than the patient.
Bill Brown MDIt might be that the effect of the device makers pushing their products as truly better for the patient is most significant. There are too many surgeons involved, I think, to believe that they all became mesh proponents for the money. I have worked in some very large corporations and I can see the hand of the executives focusing on market share and sales. From their perch they don’t see people, they see consumers. They have spun this web and captured a whole generation of surgeons.
I posted a link to some Ethicon videos and one of them has Dr. Kercher suggesting that surgeons who learned anatomy over 10 years ago don’t really understand where the significant structures are to do a proper laparoscopic surgery. Indirectly implying that older surgeons are behind the times.
And laparoscopy is tailor made to promote mesh usage, with less scarring, and faster short-term healing. Also making the mesh harder to remove by implanting it over more difficult to access area. .
Add in the failure of the FDA and other organizations to regulate the industry and it really is a master plan for market dominance. There is no business incentive to acknowledge that a suture repair might be better than a mesh repair. Much more money is made on a piece of mesh than a few feet of suture. The medical device makers control the industry now and don’t really have to do anything to keep it.
https://www.cbsnews.com/news/opioid-epidemic-did-the-fda-ignite-the-crisis-60-minutes/
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Another video from the past, with some of the bigger names in the field, with a question about choosing from the huge assortment of meshes. 2011. The chaos and confusion is incredible.
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It seems that inflammation weakens surrounding tissue. So, somewhat ironically, the use of mesh would most likely increase the probability of another hernia in surrounding tissue, just by the mechanism of its function. Induced inflammation. I’m not sure that anybody can argue against that. Inflammation weakens tissue, weak tissue is prone to herniation.
If you get a TEP implantation of mesh, the dissection process exposes both sides. That’s why they say that they can “take a look” for another hernia. When I consulted with my surgeon about my obvious right side direct hernia he asked probing questions about any sensations on the left side. I said that I felt an occasional twinge. So after surgery, I ended up with full coverage mesh, bilateral, about as much mesh as a patient could receive. He was evasive on what he actually found on the left side, a lipoma maybe.
Learn about the various “states” of the “art”. Many surgeons will implant as much mesh as they can. There is usually no consideration of how the patient’s physiology will respond to the mesh material.
Kent Kercher used to have a video on the Ethicon site where he recommended placing mesh even for asymptomatic hernias. Meaning that there are no symptoms, no pain, no bulges. But it looks like they have removed the video. Dr. Kercher is a paid consultant for Ethicon.
The videos are at the bottom. Just click through as a professional.
https://jnjinstitute.com/online-profed-resources/resources/hernia/inguinal
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From 2012 recommending lightweight mesh for chronic pain reduction.
https://www.premiersurgical.com/06/study-recommends-lightweight-mesh-for-hernia-repair/
Here’s Ethicon’s, using their own “International” hernia registry results to market light weight mesh.
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- In the same study, patients reported improvement in pain and movement limitations from baseline at 1 year postsurgery2*
* Data from a prospective, longitudinal study of 470 patients receiving laparoscopic, mostly inguinal, hernia repair with ULTRAPRO®Flat Mesh from the IHMR. Most complications reported: hematoma 1.3% and seroma 3.6%.
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quote bmul100:a complex 2 layer mesh inside that is next to impossible to remove.
Your description sounds like the Prolene Hernia System. I don’t think that it is impossible to remove. It might actually be easier than removing a full coverage TEP mesh placement, since it’s localized to the groin and inguinal canal.
Just posting so that you can add it to your list of options.
I saw your description in another topic of what seems like an allergic reaction. I know of at least one person who had that type of reaction from a second mesh placement, years after a successful mesh repair. He battled it for years.
It helps to be aware of all of your options so that you can make good decisions. You might start contacting surgeons who have removed mesh just to see if they recognize your symptoms.
Also, get the details of your surgery, including type of material, with lot numbers. Occasionally, bad materials are produced, even counterfeit. There is no guarantee that anyone will contact you if a recall happens. Best to keep your own records. Good luck.
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Hello BobbyO. I think that Dr. Brown is looking for as much detail as you can supply. You haven’t said if the open repair used mesh or if it was a “pure tissue” repair. You didn’t describe how much mesh was used, if it was, or what type. No details on what was done for the second operation. Did they cut some nerves, or just take a look? The answer is in the details, I think.
If you don’t know, you should get your medical records quickly. There are hundreds of different ways to repair a hernia.
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Hello kevin b. I recommend getting a copy of your surgery notes so that you know more about the details and can pass them on to any doctors you might choose to talk to in the future. You said that a hernia was found but did not say what type. “Inguinal” covers several.
Was the clot related to the “hernia” surgery? That might be a clue. Also, “sports hernias” are not real hernias. You might have had a misdiagnosis from the start.
Also, to be cynical, remember that his partners will also be somewhat liable for any errors that your surgeon made, if any are found. Did they explain how you got a blood clot? If they do not have immediate answers, consider getting a second opinion, using your surgery notes. You need those notes anyway, for the future. Many facilities only keep them for a few years.
My last bit of cynicism – If you used insurance to pay for your procedure the clinic will not get reimbursed until the complications are resolved. So there is incentive to make you feel “right” quickly. I think that the reimbursement period is measured in a term of a few months.
Good luck.
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More, from the original link.
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Here is a telling quote from the article I linked above. Apparently, more people just see “being a doctor” as another high-paying profession. Mesh over-usage seems to be just a symptom of a larger societal problem.
“Younger physicians may have less faith in the Hippocratic Oath, which has a patient focus, because they feel it no longer holds in today’s healthcare environment in which many needs compete for their attention. According to the poll, only 12 percent of physicians under age 34 said they were always able to put patients first, compared to 40 percent of physicians age 65 and older. Many younger physicians also indicated they felt the oath’s patient focus added to burnout. Forty-seven percent of physicians ages 34 and under felt the oath contributes to burnout compared to 27 percent of those over age 65, according to the report.”
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quote drtowfigh:The majority of patients fortunately do not clinically react to the mesh.
Those that do react must get their needs addressed by a specialist, as it’s an uncommon problem and specialists are the ones who see this problem more often and have an algorithm to address how to manage it (including need for surgery).
Hello Dr. Towfigh. Is using words like “majority” and “manage” really appropriate for this situation? It seems to be justifying the use of mesh, even though there are other hernia repair methods available that seem to give better results. 51% is a majority. That leaves 49% that do have a bad reaction.
What is the fundamental reason that mesh is used for hernia repair? It doesn’t seem to be that it’s best for the patients, on average. The results of a mesh reaction are terrible and tortuous. If you factor that in the situation is even worse. It seems that the industry is trying to save their “investment” in this new technology, forcing patients to “pay” with their own well-being. It’s counter to the reason that people become doctors, to help people, taking the Hippocratic oath at the end of their training. I can’t comprehend what is happening.
If the community of surgeons could start using real numbers, and accepting the fact that mesh might not be the wonder material that it seemed to be in the early days, or that maybe people have gone too far with mesh and need to pull back, there might be fewer patients needing to have their surgeon-caused problem to be managed. There is no mystery.
I really appreciate this forum and how you’re keeping it going. But we need to start using real numbers so that people understand the magnitude of the problem. Planning to manage problems that were created by the use of mesh seems unconscionable, especially when it is used on people that were otherwise very healthy.
If the industry is going to handle the situation by increasing “informed consent’ then the use of real numbers is even more important. Tell people the odds, that there’s a one in six chance that they might wish that they had chosen a non-mesh repair. They might have to have the mesh removed and there’s a chance that they will still feel discomfort and/or pain, for years afterward. That would be true informed consent.
Maybe I just don’t understand what it means to be a physician. Apparently, times are changing, see link below. No offense intended, I mean that sincerely, I know that it’s a difficult field with much happening these days. All the more reason though, to clearly expose these things before they grow.
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quote drtowfigh:The majority of patients fortunately do not clinically react to the mesh.
Those that do react must get their needs addressed by a specialist, as it’s an uncommon problem and specialists are the ones who see this problem more often and have an algorithm to address how to manage it (including need for surgery).
Hello Dr. Towfigh. Is using words like “majority” and “manage” really appropriate for this situation? It seems to be justifying the use of mesh, even though there are other hernia repair methods available that seem to give better results. 51% is a majority. That leaves 49% that do have a bad reaction.
What is the fundamental reason that mesh is used for hernia repair? It doesn’t seem to be that it’s best for the patients, on average. The results of a mesh reaction are terrible and tortuous. If you factor that in the situation is even worse. It seems that the industry is trying to save their “investment” in this new technology, forcing patients to “pay” with their own well-being. It’s counter to the reason that people become doctors, to help people, taking the Hippocratic oath at the end of their training. I can’t comprehend what is happening.
If the community of surgeons could start using real numbers, and accepting the fact that mesh might not be the wonder material that it seemed to be in the early days, or that maybe people have gone too far with mesh and need to pull back, there might be fewer patients needing to have their surgeon-caused problem to be managed. There is no mystery.
I really appreciate this forum and how you’re keeping it going. But we need to start using real numbers so that people understand the magnitude of the problem. Planning to manage problems that were created by the use of mesh seems unconscionable, especially when it is used on people that were otherwise very healthy.
If the industry is going to handle the situation by increasing “informed consent’ then the use of real numbers is even more important. Tell people the odds, that there’s a one in six chance that they might wish that they had chosen a non-mesh repair. They might have to have the mesh removed and there’s a chance that they will still feel discomfort and/or pain, for years afterward. That would be true informed consent.
Maybe I just don’t understand what it means to be a physician. Apparently, times are changing, see link below. No offense intended, I mean that sincerely, I know that it’s a difficult field with much happening these days. All the more reason though, to clearly expose these things before they grow.
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quote drtowfigh:The majority of patients fortunately do not clinically react to the mesh.
Those that do react must get their needs addressed by a specialist, as it’s an uncommon problem and specialists are the ones who see this problem more often and have an algorithm to address how to manage it (including need for surgery).
Hello Dr. Towfigh. Is using words like “majority” and “manage” really appropriate for this situation? It seems to be justifying the use of mesh, even though there are other hernia repair methods available that seem to give better results. 51% is a majority. That leaves 49% that do have a bad reaction.
What is the fundamental reason that mesh is used for hernia repair? It doesn’t seem to be that it’s best for the patients, on average. The results of a mesh reaction are terrible and tortuous. If you factor that in the situation is even worse. It seems that the industry is trying to save their “investment” in this new technology, forcing patients to “pay” with their own well-being. It’s counter to the reason that people become doctors, to help people, taking the Hippocratic oath at the end of their training. I can’t comprehend what is happening.
If the community of surgeons could start using real numbers, and accepting the fact that mesh might not be the wonder material that it seemed to be in the early days, or that maybe people have gone too far with mesh and need to pull back, there might be fewer patients needing to have their surgeon-caused problem to be managed. There is no mystery.
I really appreciate this forum and how you’re keeping it going. But we need to start using real numbers so that people understand the magnitude of the problem. Planning to manage problems that were created by the use of mesh seems unconscionable, especially when it is used on people that were otherwise very healthy.
If the industry is going to handle the situation by increasing “informed consent’ then the use of real numbers is even more important. Tell people the odds, that there’s a one in six chance that they might wish that they had chosen a non-mesh repair. They might have to have the mesh removed and there’s a chance that they will still feel discomfort and/or pain, for years afterward. That would be true informed consent.
Maybe I just don’t understand what it means to be a physician. Apparently, times are changing, see link below. No offense intended, I mean that sincerely, I know that it’s a difficult field with much happening these days. All the more reason though, to clearly expose these things before they grow.
https://www.beckershospitalreview.co…ernatives.html
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quote saro:Please Good intention, you can check the first link (http://riskcalculator.facs.org/RiskCalculator/), because I can not open it, while for the second everything is fine
Hello saro. I just clicked on the link and it opened. It opens to a page where you need to check two boxes (“I am not a robot” is one) to get to the next page.
If you use Google and search for “ACS NSQIP Surgical Risk Calculator” it should be the first result. Maybe that will work.
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Those studies are over 14 years old. New devices have been produced since then to combat pain and discomfort, like “light weight” meshes. Unfortunately, there is some evidence that they actually make the problem worse. The device makers seem to be guessing at the cause(s) for discomfort and pain while trying to stay within the 510(k) guidelines, for relatively quick and inexpensive new product introduction, in a battle for market share.
I don’t want to make you less hopeful but it’s important to be realistic. The suggestion to take psychiatric treatment drugs for a physical problem does not seem right. Especially since they have their own negative side effects. You might seek a second opinion. Your surgeon has an inherent bias and may not be completely objective.
Good luck.
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Search for Chaunce1234’s previous posts. He often includes a list in his responses. Another term used is “pure tissue repair”, or suture repair, instead of no-mesh.
Dr. Towfigh, the site administrator and founder, is in Beverly Hills and could give you good advice also. She offers online consultations. https://twitter.com/Herniadoc
Good luck.
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quote Chaunce1234:More specifically, I meant to ask you if your experience with feeling pain and discomfort impacted you in any mental or psychological fashion, basically as a side effect of experiencing the pain. For example, did you develop any sort of depression or insomnia due to the pain or discomfort you experienced? Or anything of that nature? And if you had, did you find those psychological side effects of dealing with pain to change again after your second procedure to remove the mesh?
I wrote half a page Chaunce but I’ll try to condense it. Before the mesh I was a very active member of society and family, engaged in many ways. With the mesh, my life slowly shrank down to a daily check of the state of the mesh site, and a plan for how I was going to try to make it better, today. I wouldn’t say that I was clinically depressed but I knew that my life was much worse. I was more frustrated and angry than depressed.
Now, with the mesh gone, I am planning weeks, months, and years ahead. I’m getting better, physically, every day, and that allows me to be healthy, mentally and emotionally.
One important thing for me though was that I had resources, money in the bank, and time, to solve my new mesh problem. So I had hope. The problems that you are describing will be made much worse for people who aren’t as lucky as I am. I had the ability to find a solution. Many people don’t, and their symptoms are denied when they seek help, as has been documented in many stories.
I think that if this situation was a project under a single entity, like a large corporation, it might have been halted already, just based on a comparison of the old way of hernia repair versus the new way. The new way is full of problems that never existed before.