pinto
Forum Replies Created
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Perhaps but the respondents were presumably in close proximity even sitting next to each other. Then again they also may have assumed a higher chance of incarceration, encouraging them to favor early surgery. They are also likely to be enthusiastic about lap by virtue of their conference attendance, so their choice of personally getting lap isn’t surprising. In this regard it doesn’t necessarily show lap superiority if some readers might conclude so. Polling/surveying isn’t always what it appears.
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[USER=”2029″]Good intentions[/USER], could you elaborate about this: “Be careful what you describe to your doctors, certain words will not be accepted as standard for “hernia repair”. You can get deflected down wasteful paths, both time and money.”
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Very interesting to see the survey among surgeons. We need to remember that all the respondents were lap surgeons and the hypothetical condition was a minimally symptomatic hernia. Yet if memory serves me, those choosing surgery all chose lap. Very curious! Not only they would not wait but they would rush to have lap. How was the survey conducted? Within a conference of lap surgery or within the privacy of one’s home? Even hernia surgeons are not immune from social influences, so the survey results are only as good as the method employed. [Game changer: meaning of “minimally symptomatic hernia.” If that translates to small hernia hole, then absolutely immediate surgery would be called for, as small herniae have much higher chance of incarceration. Again another concern about method.]
GoodIntentions makes a worthwhile point: some surgeons oversell surgery. I echo his report: surgeons I spoke with pushed rushing to surgery while at least one internist told me I need not fear incarceration, that I was not in a dangerous condition.
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@ HoleintheWall, thanks for the posting. My take is that the Dr. essentially claims that post-op pain is relatively the same between methods and that mesh has less recurrence than non-mesh. However, his presentation appears flawed because of inconsistency and unclarity about his method of comparison.
Non-mesh is not consistently part of his comparisons of method, so he cannot claim that post-op pain favors no particular approach. And when non-mesh is included, he does not specify how really more or less the data favors mesh. Because the related literature is uneven about determining actual pain as he states, implying that unreliability of some pain reporting, it becomes necessary to know how he chose which research results to include, their categorizing, and ultimate matching between the surgery methods. Without such information, we cannot accept his conclusions.
Some things though we can reasonably take: he reports that less post-op pain will be reported the less pre-op pain felt and the older the patient is. Presumably such was found across the research literature regardless of methodology employed.
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@ DrBrown, Fascinating! Thank you.
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@ DrBrown Thank you for clarifying. Quite interesting. I never expected that reason–pain. I don’t recall pain being a feature considered in comparative readings about hernia repair methods. Some will say certain methods allow quicker recovery. Maybe that’s a euphemism for pain?
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I stand corrected, Dr. T. Thank you. I would really like to hear more about it. I never seen anywhere a statement that the hole can be reduced by lifestyle changes. And presumably if so, then theoretically cure could be reached. With all due respect, isn’t there some intellectual tension among surgeons about these points of actually lessening the severity of an IH through exercises and lifestyle?
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I agree especially with your point about unrecognized herniae–they are so unobtrusive that for all practical purposes they can go without surgical treatment. The rest, I refer you to the title of the topic–Can hernias heal without surgery? According to the OED
heal means “to become healthy again.”My understanding is that by definition, hernia is literally a hole in the abdominal wall through which bodily matter protrude. Granted I am a simple layperson but the many many doctors I have read all say that hole–that hernia–cannot heal naturally. It can only do so by surgery. Surely after surgery or as a preventative, strengthening the core seems wise but for the watchful waiting patient, highly risky.
And the point of the discussion concerns the website named “My Natural Cure.” The name speaks for itself–it challenges the entire medical profession by claiming a non-surgery cure. Again, I am confident that you will find no legitimate medical doctor who would say that the hernia hole can be closed by physical exercise.
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Please correct me if I am wrong but “reduct[ion of] the clinical symptoms” does not mean cure. A person is still left with a hernia. If a person does not leave his bed, then he really does not have symptoms (assuming a reducible hernia) . I have yet to find a doctor anywhere who says that hernia can be naturally cured.
I agree however symptoms possibly can be reduced, such that a person might find less debilitation. For example, properly wearing trusses can help when previously misapplied. Exercise is another matter. I have yet to find any published data showing exercise led to appreciable reduction of an IH.
I myself would like to do such exercise but yet to find well illustrated exercises borne from evidence-based data. My local IH surgeon told me to cut out the physical training (very moderate and excludes the abdomen) I do. Perhaps the gentlemen’s website to which you refer has exercises well documented for improving IH conditions, but at the website I find no references to any clinical studies in support.
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My understanding is that across the medical profession there is absolute certainty that an IH cannot heal naturally. And in fact, the gentleman behind
https://mynaturalherniacure.com/hernia-exercises/
sells his own truss belt. Surely belief in natural cure will forestall surgery, thereby increasing the potential for truss sales. Seems like nothing more than snake oil selling. -
Indeed great as in a short time it interconnects a suffering patient, mesh and non-mesh doctors, and a researcher of medical device use. First, notably, this is in Australia, showing the hernia mesh backlash is not limited to the U.S.
2: The patient is so debilitated that he must use a wheelchair and reports that according to the many specialists seen, he cannot be helped. Moreover, he reports that the original surgeon gave him a completely rosy picture without mention of the risks. (I received the same from the two, albeit general surgeons doing IH surgeries, I met with recently.) 3 The doctors agree that something is amiss with mesh. 4 The non-mesh doctor reports that mesh and non-mesh recurrence rates are relatively the same (but unclear his source information).
5 The researcher in a limited survey of various medical device use, IH use has had the most complaints, something seemingly was a surprise to him. (We don’t know if his data was proportional, but his impression is that IH mesh is indeed a problem.) 6 The mesh doctor points out that causation is difficult to pinpoint among the various factors involved. Whatever, the program asserts that the medical profession hasn’t been on top of it as it should have. The patient says that surgeons generally shift responsibility onto patients, telling them that patients need to more patient or to stiffen up. 7 Anyway, Australia is mobilizing (probably starting by govt. agency) to have more oversight by developing a tracking system for hernia mesh.
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@ Chaunce1234
Would you mind expounding on this: “….complex anatomy which differs per patient“?
Really, how much do people differ anatomically, such that it complicates surgery? I am assuming “normal” structures, nothing congenital or diseased. -
Informative article! Thank you, GoodIntentions. Author, Kavic, distinguished surgeon, professor, and editor, writes as recently as 2016:
“The evidence is mounting that mesh, which was generally thought—and promoted—to be inert, now appears not to be so.”
Reading the article, a valuable overview of the history of IH methods, one gets the sense that this history is purely of trial and error. Each step along the way, a feeling of advancement yet eventual recognition of new problems. Ladies and gentlemen, that is not the impression I got after talking with two IH surgeons or reading what other surgeons have written.Reread what Kavic, a heavyweight in medical science said: mesh might not be what it was cranked up to be. Further he highlights a serious overlooked problem: long-term post-operative pain, which apparently has been underestimated. When you couple this with the fact that apparently also doctors presume success if patients do not come back with complaints, then the image that surgeons have given me of a highly developed field is hokum. As Kavic suggests, present-day pain complaints may be just the tip of the iceberg. Patients must undergo far more risk than I had previously been led to believe. Fifty years from now present methods might be looked upon as primitive.
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Jnomesh, I agree but did not intend to support the great hold that mesh has had on IH medical practice. As Dr. Kang mentioned elsewhere how mesh popularity came as a simplified method for most surgeons. The same happens in any field: simplicity yet effective practice enables wide application by practitioners. Unfortunately mesh has not yet been fully perfected, but it can be a functional option. It is not a new idea but I believe was entertained by some surgeons in the 19th century. My purpose was to try to add a little balance to the debate about mesh and even mesh makers: Doubtless mesh is absolutely necessary in some cases–it may be the only option. I fully recognize also certain medical practice and faulty design of mesh have tragically victimized some patients. Such of course demands pure tissue repair but as you pinpoint non-mesh approaches are getting pushed aside by the dominance of mesh in medical practice.
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Collectively, the approach appears abandoned. It might be worthwhile to consider a key point claimed at
that Guarnieri’site: “considered “tension free” even in cases where the mesh is not used.”
I am unable to evaluate it, but know that if valid, then the approach would have to be exemplary. -
Another way of looking at this is by necessity. Some herniae are so large that mesh might be the only option for treatment. My understanding is that pure tissue repair surgeons resort to mesh for such extreme cases. So mesh is life-saving in this regard, and the mesh makers would be making great contributions to society for funding such research.
But looking more broadly, mesh seems to have a spotty history because clearly some mesh have been failures, even the mesh makers would agree. So the quest is to find the golden mesh. Due to known failures, GoodIntentions rightfully questions medical practice and as well research funded by the mesh makers. I myself was disappointed to see this financial tie-up, but then again the extreme cases occur and the research must be done. Unfortunately, mainstream science is biased toward mainstream approaches. This likely stunts the growth of pure tissue repair. -
Dr. Towfigh,
Thank you. When you say, “sensitivity,” would this practically mean “clarity,” in that MRI might produce clearer visuals than the CT? (I personally for a non-hernia issue, “proved” to my doctor that MRI was just as good as CT by happening to have an MRI done by a brand new machine. He remarked how clear the picture was when we both looked at it. He had pushed for a CT scan but I was reluctant. Since then I wondered if in fact MRI generally produces clearer visuals than CT.)
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Dr. Brown,
You are great to us in your sharing about Dog’s case and so on. So I hate to ask you to indulge me, but could you tell me what is a large hernia unable for tissue repair? Would the gap be, say, 4 inches or more? (Again thank you for your exceptional kindness by your commentary about Dog’s case.)
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Did you understand your friend saying, “…so it’s a matter of pain tolerance.” He’s saying that once having the operation you must live with the subsequent pain; or that the pain is temporary until you have completely healed”?
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Dr. Brown,
Thank you for your kind answer. Two doctors told me I am not in immediate danger but urged me to do the operation. I feel in a bind because realistically I cannot get an operation yet. I need to sort a lot things out. However, I am concerned that in time, the IH gap is likely to get larger and so, harder to fix. That seems especially for tissue repair. Thus my question, what range of size is most amenable for repair (or watchful waiting).