MarkT

Yes…and one concern remains the insufficient follow-up time (1yr for pain, 2.5yr for recurrence), which is a common issue across many studies.

Since we know that many post-op complications will materialize beyond those stated timeframes, the pain and recurrence rates here are almost certainly understated.

It would be great for a study like…[Read more]

It is a great question.

Generally speaking…permanent sutures, stainless or Prolene would be fine…maybe very long term resorbable might be fine too.

I too am intrigued by longer term resorbable meshes being developed, but need to learn a lot more about them.

To be quite honest, I don’t know nearly enough about the various options, products,…[Read more]

@Mark T, are you Swedish btw, is that why you’re arguing: “This study is therefore quite relevant to hernia patients in Sweden” (as you stated in a related thread).

Why would you ask if I am Swedish? I said it is quite relevant to hernia patients there, because the sample covers almost 98% of repairs in their country…while you are sugge…[Read more]

Will give this a good look later…but he talks about risk factors, prevention, patient evaluation, and treatment options (medical and surgical) including medication, physical and psychological therapy, nerve injections, ablation, neurectomy, and mesh removal.

One the ‘key points’ states that 90% of surgery patients see an improvement in their…[Read more]

Yes, the 98% figure was from a ’98 study, and the data from the study here is from 2012-2015; however, “Today more than 90 units are members and almost 100% of all hernia repairs performed in Sweden are registered. A database covering more than 200 000 repairs has been assembled.”

Keep in mind that residents all use a national id card to obtain…[Read more]

Of course this study needs to be taken into its proper context…as does every study.

This is science…it is important to ‘quibble about the numbers’ and not make assumptions. There can be a world of difference between two data sets with the same median, depending upon the range of their data and the shape of the distributions. That is simply…[Read more]

The study used data from a national registry that included 98% of all hernia repairs performed in the country during that time period.

It is the opposite of ‘narrow’.

“None of these products have been removed from the market. There has to be a long-term strategy. What could it be?”

This is appalling…and that Bard is still using the design with new products, per Dr. Towfigh’s post, is just deplorable.

It’s sad that regulatory oversight is so lax…and that legal recourse will take years and cost a small…[Read more]

I discussed this study at more length in the other thread.

“Shockingly I found a highly touted medical study of 22,000 cases aimed to provide data for chronic pain etc. was fully based on surgeons with low-volume loads (50 or less a year)”.

It is not correct to assume it was ‘fully based’ on low-volume, 50 or less. The study also needs to be…[Read more]

Pinto, how is that correct?

The median is simply the middle data point…it does not tell us anything about the range of the data or the shape of the distribution. I’ll give examples if you want.

I’m not sure how it is biased since the study includes nearly ALL repair data for the entire country. As I stated (from the paper), the Swedish Hernia…[Read more]

It is not biased or irrelevant, per se…it just is not relevant for our purposes, since we would all go (or have gone) to a high-volume specialist.

Pretty typical in that they ultimately got data from 65% of people (the 75% figure is only the survey response rate) who had repairs over that 2.5 year period…and they report characteristics of…[Read more]

Yes, you are correct…I had meant to edit that to say the 2007 British Journal of Surgery study (not 2007 British Study)

The problem goes much deeper than the setting, though that is a big deal on its own. The total # of patients getting a ‘Shouldice repair’ (modified repair, it seems) at that hopsital is about one third of what ONE full-time…[Read more]

I pulled a copy of the 2007 British study
https://academic.oup.com/bjs/article/94/5/562/6142702

Results (median 52 months follow-up)

Shouldice (74 repairs): six recurrences, eight cases of suprapubic numbness, and one of scrotal numbness.
Lichtenstein (76 repairs): one recurrence, one case of suprapubic numbness, and 10 cases of scrotal…[Read more]

No, you have not. You’ve been in echo chambers on social media groups looking at non-respresentative problem cases.

The 27% study is NOT from Shouldice Hospital, the Germans, or anyone else who is an ‘expert’ with that repair, is it? Then that would be non-representative too.

Even if we granted a 27% pain rate, how does 27% = the “nearly…[Read more]

“It seems like nearly everyone that has a pure tissue repair has some level of chronic pain…”

That is undeniably false, Chuck. Why are you still making irresponsible claims like this? You are doing a disservice to this community.

It would be nice if it were possible to establish some reliable diagnostic criteria, given that most surgeons are not able to perform all types of repairs with the highest degree of skill (rather than have surgeons just impose whichever repair they do best or where individual surgeons tailor repairs to their patient, despite not being the ‘most’…[Read more]

“A difficult and long surgery is more likely to cause chronic pain and other complications.”

While this seems logical, we still need better data to flesh out the details, because that relationship may depend (change) based upon certain factors (as is thought to be the case in this study).

While it is typically much easier to deal with short-term…[Read more]

The study is not ‘inconclusive’…you don’t know what you are talking about.

Yes, recurrence has long been the primary barometer of success, they note…but of course recently chronic pain has become more widely acknowledged, especially the apparent underestimation of its prevalence.

That is disappointing to hear if the follow-up process is so tedious that it is discouraging participation. As it is, most long-term studies…[Read more]

Most importantly, this ‘alleged’ conflation would not appear to alter the results anyway…so terming the research inconclusive seems quite inappropriate.

The first study objective was to look at patterns of recurrences by primary repair type…and both Shouldice and open mesh are implicated as ‘higher difficulty’ on a series of markers, but…[Read more]