Good intentions
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Dr. Ponsky presented at the recent SAGES meeting, in the “Perfect Repair” session.
Laparoscopic inguinal hernia repair (Based on Patkowski’s technique – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Todd Ponsky during the The Great Video Debate: Perfect Inguina… -
Here is a video titled “Inguinal hernia-Open mesh repair” in the “Perfect Inguinal Hernia Repair” sub-category. It’s really just a collection of “state-of-the-art” techniques, I believe. No actual measurement of “perfection”.
It doesn’t really instill confidence. The presenter makes an off-hand comment that if the patient has a non-painful hernia when they come in that they will certainly not have pain afterward. “They’ll be fine” at 4:00. He cites a one year study. This does not fit with many stories on this forum and around the internet. People who got their hernia repaired to be safe, and ended up with more pain afterward. Anecdotal, of course. The pain discussion starts at 2:50.
Inguinal hernia-Open mesh repair – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Matthew I Goldblatt during the The Great Video Debate: Perfect… -
Here is a link to the whole 2018 “playlist”. There are a few more hernia, and mesh, presentations.
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quote Good intentions:Dr. Bruce Ramshaw even can’t resist defending what’s happening and seems in denial. His statement from the article is surprising. I can’t see a reason for making such a blunt statement except to defend the industry.
“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”
That’s the same logic as “the fall doesn’t kill you, it’s the sudden stop at the end”.
I wrote the comment above then went back over what I knew about Dr. Ramshaw. He seems to undecided about the whole “mesh” situation. He has written quite a bit about post-repair pain, and does remove mesh. But sometimes he seems to imply that the problem is psychological. It’s hard to tell what to think about his comment, it might be one of those Freudian slips, from wishful thinking. I don’t know.
Here is a link to his UT page, and a recent video from the last SAGES meeting. He seems like a guy you would want repairing your hernia.
https://www.youtube.com/watch?v=Pffj-GAEMRs
Bruce Ramshaw, MD, FACS | The Department of Surgery
http://gsm.utmck.edu
The University of Tennessee, Graduate School of Medicine is located in Knoxville at the University of Tennessee Medical Center. The Graduate School of Medicine is part of the University of Tennessee Health Science Center and offers residency programs, fellowships, and opportunities for medical students. -
The American College of Surgeons does pretty well but still implies that chronic pain is a short-term issue, “pain one year after surgery”, not really exploring what happens after that. But they do give a value of 10-12% and address it directly. More promising. They also show that the recurrence rate is higher for laparoscopic than open, which is surprising. Overall, they seem to have compiled current study results and are facing them directly. Just not going far enough with chronic pain. “Pain” is the original reason for going to the doctor. It should be of the highest priority.
https://www.facs.org/~/media/files/education/patient%20ed/groin_hernia.ashx
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The US FDA tries to address the issue but still falls back on the lack of understanding, thereby perpetuating the problem. Blaming chronic pain on previously recalled products. Still making very vague statements, “many complications”, and taking no action. At least they’re getting closer.
“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. ”
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These two links illustrate the huge disconnect between some hernia repair surgeons and general surgeons, at least in Great Britain. Even though supposedly they are the same type of surgeon, and hernia repair is a skill within general surgery skills, somehow the hernia specialists in Great Britain are on a completely separate page from the rest of the surgical community. I say apparently, I haven’t read the whole article, it’s a pay-per-view article.
It seems that the hernia mesh repair surgeons in Great Britain, or at least their representative, are using the “no firm relationship” view to keep on doing what they do. It’s shocking to see it in print. The first article is about caring for your patients, the second one is about caring for your business. Some of these surgeons must know each other, it’s hard to see how they can coexist. And this is after many years of published studies showing that there is a correlation between mesh hernia repair and chronic pain, higher than pure tissue repairs, where chronic pain was so low that it was not an issue. The chronic pain issue has developed in step with mesh repair.
Hate to be so negative but these are recent results. Strange how the industry seems to be paralleling American politics.
From the article – “Around 570 0000 hernia mesh operations have taken place in England over the past six years, figures from NHS Digital show. Leading surgeons think that the complication rate is between 12% and 30%, meaning that between 68 000 and 170 000 patients could have been adversely affected in this period.”
Hernia mesh complications may have affected up to 170 000 patients, investigation finds
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k4104 (Published 27 September 2018)https://www.bmj.com/content/362/bmj.k4104.full
From the British Hernia Society – “Some patients can develop chronic pain after surgery. There is no firm relationship with the use of mesh and chronic pain, and non-mesh repairs can equally result in this problem.”
Mesh and your Hernia Repair “helping you to make an informed choice”
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HIPPA might be a concern but maybe dog gave permission to Dr. Brown to talk about his surgery, or at least he could say that dog was there, or pass along our well-wishes to dog.
dog had a second procedure scheduled in Florida, apparently, that required a lengthy stay. Treatment two times per day, for multiple days. He mentioned it in his “recovery” topic. It might be harder to recover from than the hernia repair. Inner ear problems can cause vertigo also, I think. He might not be up to posting. Good luck to him.
[USER=”2580″]DrBrown[/USER]
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A few thoughts…
You didn’t distinguish between open or lap, I think that the results can be different, so you might want to specify. Another one of those cases where anything mesh gets lumped in to one word, mesh. I think that open mesh surgery might also be following pure tissue repair in to the past, with everyone converting to laparoscopy, so you might have to request open repair if you want it.
Dr. Towfigh typically recommends checking the American Hernia Society page, if I recall right. It might be a good start. https://americanherniasociety.org/find-a-surgeon/
I know of someone who had a mesh hernia repair in the 80’s and had no problems. He had a second mesh repair about 15 years later and had major problems from the beginning, eventually having it removed after living with the torture for many many years. Again, all he knows is that both were “mesh”. He assumed, like you, that because the first worked that the second would too. Not to scare you, just passing on a true story. Apparently, there are different effects from different meshes, or the repair itself can be either good or bad, with the same material. He is one of the living experiments, that a registry might clarify if one existed.
In short, I’m suggesting that you be extra careful. Good luck.
p.s. I don’t know what you meant by “bark” at your physician, but it doesn’t have a good look. I don’t think that doctors like being barked at. Maybe it was humor?
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There is also Dr. Petersen in Las Vegas. He is known more for mesh removal but he also does hernia repair, among other procedures. His group can put together a whole travel and stay package. He does non-mesh repair.
https://www.noinsurancesurgery.com/about-us.htm
I’m not sure but I think that Dr. Brown’s group can also help with travel and boarding. dog just had his hernia repaired by Dr. Brown. Search for dog’s posts and you will find a lot about Dr. Brown.
https://www.sportshernia.com/sports-hernia-specialist/
And, of course, Dr. Towfigh’s practice might also have advice for a short stay. Ironically, because she is the administrator of the site, we don’t talk much about what happens there. [USER=”935″]drtowfigh[/USER]
http://www.beverlyhillsherniacenter.com/#
Good luck. Put the time, effort, and money in to it as if you wanted it to last for 50 years.
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There were some posts recently about a surgeon in Scottsdale. You would probably be better off to choose the best surgeon for your problem, and to stay in a hotel or BnB after traveling for the surgery, even paying to have a friend or relative stay with you. Pick the best surgeon, I would say, and arrange around them. I tried to compromise for convenience and to stay in my insurance plan when I had my hernia repair and it was a big mistake. I should have done what my research told me was the best surgery option for me, not tried to put a whole project together. The surgeon and the surgery is the most important part.
Here are the links about the Scottsdale surgeon, if you just have to go to that region to get it done. Post #5 is a copy from some correspondence that dog had with Dr. Repta.
https://www.herniatalk.com/9614-open-mesh-removal-and-non-mesh-hernia-repair-dr-remus-repta
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The NIH should be one of the organizations involved in solving the hernia repair mesh problem.
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Here’s a story I came across a while ago, similar but a bit different. It’s from last year. Our government really seems prone to corruption. These people don’t seem to understand their purpose.
https://www.nytimes.com/2018/03/17/health/nih-alcohol-study-liquor-industry.html
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Welcome Dr. Brown. These are interesting times for hernia repair.
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Good luck Dog. You’ve been very persistent and thorough in your research. Thanks for sharing what you’ve found along the way. I’m sure you made one of the best possible choices.
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Dr. Todd Heniford, on the other hand, is the type of leader that needs to be supported.
“Surgeons have to ask: Are we protecting patients or are we protecting industry? Are we protecting ourselves?”
There are several other doctors quoted who seem rational and focused on patient welfare. Overall the article shows that at least the discussion is continuing. Let’s hope they can make some progress.
Thanks again Jnomesh for posting it.
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That is promising. Thanks for posting this. I pulled two of the linked articles out, below, the British Hernia Society’s response to a BBC report, and the FDA’s press release.
The BHS response is very disappointing and focused on protecting their image, it seems. The response is surprisingly unprofessional, tone deaf, and uninformed, considering the BHS’s role in guiding the efforts of their membership. Hard to believe that it’s part of an official response. They seem to be defending the industry instead of the patients.
An actual quote, with exclamation mark, from the BHS – “One of the patients developed groin pain many years after the mesh hernia repair – yet the mesh was still blamed for the problem! “
https://mailchi.mp/23a275fbe343/j114lk1gnu
The FDA press release looks good, but it’s an extension of something that started six years ago, in 2012. The government works very slowly. Lots of talk but little action.
https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm626286.htm
Dr. Bruce Ramshaw even can’t resist defending what’s happening and seems in denial. His statement from the article is surprising. I can’t see a reason for making such a blunt statement except to defend the industry.
“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”
That’s the same logic as “the fall doesn’t kill you, it’s the sudden stop at the end”. It’s like he is completely unaware of the people who have been cured of their pain by having the mesh removed. And did not have pain before the mesh was implanted. The cause-effect relationship seems clear. I wish that he did not have such a high profile in the situation, he seems to be hindering more than helping. I think that his comment also minimizes the effect of constant low level pain and discomfort. He shifts the focus to extreme disabling pain, avoiding the issue of degradation of quality of life.
He is also at the University of Tennessee, where Dr. Voeller teaches, who is also of the opinion that the problem is too big to measure, and that’s why nothing can be done. They seem to be protecting the status quo, despite the evidence. And teaching a close-minded sort of approach to surgery. It doesn’t seem right that they are both professors, and both very vocal in their opinions. I wonder if the device makers are big contributors to the department.
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Posting again to make sure people also see the other story that is linked in Chaunce’s first link. By hiding from the problem the medical device makers might be about to lose all of the mesh market in Scotland, when they probably could have kept the good products. A focus on revenue and seeing patients as profit centers might finally be catching up to them.
Published November 12, 2018.
From the article:
“Scotland was the first in the world to suspend the use of transvaginal mesh implants. The whole of the UK has followed suit.
But concern is now growing over hernia meshes, many of which are made from the same or similar material as transvaginal mesh, which has seen manufacturers pay over £3 billion compensation in the US.
A Sunday Post investigation into mesh revealed manufacturers knew 21 years ago of safety concerns but they went ahead.
Thousands of US hernia mesh cases will begin next year.”
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quote Chaunce1234:[USER=”2029″]Good intentions[/USER] by any chance did you report your case to the FDA as an adverse event?
https://www.fda.gov/MedicalDevices/P…/ucm317444.htm
I have been through that form but have not submitted one. I need to contact Dr. Billing and see if he filled out the Health Professional form. I know that he is aware of the FDA’s ability to accept reports and hoped/assumed that he reported mine but have not confirmed it.
I have everything I need to report it. Frankly, I don’t have much faith in the FDA, but will add to their database anyway, in case they get new leadership and get back to their mission. Here is a more direct link to the forms.
https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home
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It’s very unsettling how common the descriptions of the problem are, around the globe and over many years. From the effects of the mesh to the responses of the surgeons. The more stories you see the more you realize that the device makers must be coaching or training the doctors, directly, or indirectly through influencing the various surgical societies, about how to get the patient to accept the operation and how to respond when there are problems. How can the stories be so similar? These stories from Scotland, published just a couple of months ago, are almost identical to my story from here in the United States, three years ago, and similar to many stories from other patients. How long can it go on? How can physicians ignore these stories and keep doing the same things that are obviously the cause? Without telling us that we might be “unlucky”?
Thanks for posting that link. It is well written.