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Dr. Bachman discusses more people inquiring about no mesh repairs


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  • Dr. Bachman discusses more people inquiring about no mesh repairs

    All this is from a year ago it is good to see some surgeons bringing to light that more patients are inquiring about non mesh repairs or alternatives to mesh repairs. Dr. Bachman is a surgeon that I know removes hernia mesh. And although this footage is a tiny step in the right direction I see a lot of troubling things that are evident in this talk.
    1) again the main discussion between mesh and non mesh repairs is % of recurrence between the two type of methods. No mention of chronic pain between the two methods and even more specifically all the different types of pain mesh can cause.
    Its this focus that is at the center of the mesh issues and misinformation. It isnít hard to extrapolate from her talk that if a patient came to her asking for a non mesh repair that she woukd most likely focus on recurrence rated-not chronic pain and all the risks associated with mesh as well as it being a permanent implant.
    what feeds off of this mindset is that when patients go back to their primary implanting surgeon with pain symptoms this is what the surgeon focuses on-is there a hernia recurrence or not to validate the patients pain symptoms.

    2) She confesses that even though she is a skilled surgeon understanding how to do a textbook tissue repair is very challenging for even the most skilled surgeon of this isnít their speciality.
    she noted when you look at the textbook diagrams they are very different from what the patients insides look like when she actually gets in there

    3) she also confesses-which is quite logical-that even if she was confident in doing a native tissue repair the fact she just doesnít do many-99% are lapro mesh repairs-so itís not her specialty and the quality of the non mesh repair will reflect that.
    She said people are good at what they do the most of.
    This is again one of the problems for the patient when seeking a non mesh repair-except for a few surgeons just either donít do them, and if they do they donít do a lot of them-which automatically reduces the quality of the repair. Not every surgery is textbook. You need to do many to see the unusual cases and no how best to repair it.
    She acknowledges one of the reason the Shouldice Hospital is so proficient is Bc thatís all they do-shouldice residents have to do many (I think she said 200) surgeries and supervised surgeries of this type of repair before they can indeledntly operate.
    So again a US resident has to travel to Toronto, Florida or CA or Korea to find a hospital and two surgeons who specialize in a pure tissue repair.
    A big burden is placed on the patient if they want a non mesh hernia repair that they can feel confident will be successful long term.
    below is the link

  • #2
    That is a great presentation to watch for someone who wants to see how to convince yourself that what you're doing is right. She seems very conscientious and gives a nice presentation but she never even got close to answering her primary question. "Why are more patients asking their surgeons for non-mesh repairs?".

    She, instead, suggested that some of the most intelligent people in the world, scientists working at some of the best research organizations in the world, were being swayed by law firm web sites on Google searches. Overall, actually, a poor presentation, whose actual result was to personalize the use of mesh, with the story of the young woman, but avoid answering the real question of why we ask for non-mesh repairs. She asked the right question then diverted to supporting the use of mesh as the core of the presentation. It might even be subconscious, she might think that she actually addressed the question.

    It is actually a fairly standard boiler-plate mesh-use support presentation. Not patient-centered, but surgical practice centered. Justifying past and present behavior.

    And, as everyone seems to do, she balled all of the different types of mesh and different repair methods in to "mesh". She was aware of the differences but still referred to everything as "mesh" versus non-mesh.

    Very discouraging that this is a "Masters Hernia" presentation in July of 2018. Not even a year ago. Thanks for posting that link.


    • #3
      Here is an example of what a person might find on the internet if they search "chronic groin pain mesh". Dr. Bachman may have overlooked also that a person who works for NIH might have direct access to these papers through an internal database search. No need for Google. Most professionals would use Google Scholar anyway. Still surprised that she discounted the opinions of the very educated people she mentioned at the beginning of her presentation.


      • #4
        And, a review by an impartial professional is typically a great starting point for any research.

        Professor Emeritus at a top medical school and editor of Journal of the Society of Laparoendscopic Surgeons seems good.

        Sorry jnomesh I might be overdoing my response. That video is frustrating to watch. So recent.


        • #5
          Totally understand and totally agree. And what makes it even more frustrating is that Iíve seen her name pop up form other people who have had their mesh removed by her which means she knows first hand what this stuff can do to some people. I have a feeling she mostly removed o it infected mesh as that is known th be easier to remove and can be used as a excuse of why mesh needs to be removed when there are so many other reasons.
          The Salt on the wound is that she is basically also saying that she doesnít really do non mesh repairs Bc she doesnít really doesnt do many non mesh repairs and because of this itís ok to tell the patient no if you donít feel comfortable doing one.
          Just so frustrating and pre-k logic.


          • #6
            Without practicing the non-mesh repair, those who do not know how to perform a non-mesh repair will not know how to perform a non-mesh repair. Sort of a self-fulfilling situation which maintains the status quo, or worse as the skilled non-mesh surgeons continue to retire in the USA. Admittedly, it is complicated and requires a very strong understanding of complex anatomy which differs per patient, but as Shouldice has shown repeatedly, practice makes perfect.

            As to why patients are seeking non-mesh repairs... I think that is fairly obvious. Not everyone wants a permanent implant in their body, particularly an implant that is associated with known significant risk and is also incredibly difficult to remove if there is a problem with it. How and why patients come to that conclusion varies greatly, but the idea that patients are being misled by legal ads is fantasy and denial.

            Interestingly, I stumbled into a slide from the recent AHS 2019 conference that appeared to be from a talk focused on protecting from lawsuits by disclosing all the possible mesh risks in fine print of consent paperwork before surgery. So liability is the main concern for some. Think of that what you want, but regardless many patients will read that fine print and then ask for a non-mesh repair as a result.

            So for hernia surgeons, I strongly think they should be able to confidently perform both a non-mesh repair and a mesh repair. Then the surgeon and the patient can make a decision together based on their specific case, preference, risk profile, concerns, comfort, etc. One size does not fit all.


            • #7
              @ 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.


              • #8
                Dear Pinto.
                The anatomy does vary from patient to patient. The nerves are often in different places. In heavy patients the muscles are pushed so that they are orientated anterior to posterior rather than superior to inferior. During the repair knowing how far apart to place the sutures. How many knots. What to do to relieve tension. Where are the femoral vessels.
                So it is important that the surgeon does the operation frequently.
                Bill Brown MD


                • #9
                  @ DrBrown, Fascinating! Thank you.


                  • #10
                    Here is another talk that followed. Apparently there is not only nothing wrong with mesh, there is nothing wrong with anything.



                    • #11
                      @ 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.


                      • #12
                        If you review the literature from the 1980's (before mesh), there are no articles about post operative pain following hernia repair. That is strong evidence that when surgeons were trained for pure tissue repairs then pain was not a post operative problem.
                        Also if you have pain after a mesh hernia repair it can be debilitating. If you have pain after a pure tissue repair it resolves with time and it is not debilitating.
                        Bill Brown MD


                        • #13
                          Originally posted by HoleintheWall View Post
                          Here is another talk that followed. Apparently there is not only nothing wrong with mesh, there is nothing wrong with anything.

                          Thanks for posting that. I watched it and, frankly, was embarrassed for him. What he said at 7:00, basically explained what he was doing with his presentation. He said that the data in the meta-analyses can be used to show whatever that surgeon doing the analysis wants. He cherry-picked data from the papers, sometimes showing better or worse comparisons with no number and sometimes showing pain numbers. Whatever was needed to make the point.

                          His overall message was that there's nothing to worry about with "mesh", just work on your skills. I think that any surgeon who was there probably felt like they wasted their time. It was another "mesh" defense. He even mentioned that what he was presenting could be used as "defense against those lawyers". At about 3:10 he talks about "the lawyers". At least he was honest about that part.

                          And, somehow, he didn't even describe his own hernia repair. It was probably Shouldice. Who knows. Seriously, does anyone know how his hernia was repaired? That might be the most honest answer to his presentation.

                          If you search his name on the internet you'll see that he is one of the vocal defenders of mesh, he's a popular speaker. He really should tell people what repair method he chose.


                          • #14
                            That explains some of the inconsistency I perceived in the presentation --but doesn't he state that pain is relatively equivalent or even less than non-mesh repairs? The latter is extraordinary given what you point out about absence of pain reporting in the non-mesh era. How can the claim be made that mesh repair is superior to non-mesh repair? Comparison cannot be made in the absence of hard data.


                            • #15
                              Here is another of Dr. Felix's presentations. You can see how people are pushing for laparoscopic mesh placement to be the state-of-the-art, or "gold standard" as they like to say. Apparently Dr. Felix considers himself to be a spokesperson for lap and mesh. He seems to be on a mission to make it the "gold standard".

                              MIS is short for Minimally Invasive Surgery, even though much more space is invaded than for an open procedure. It's a misnomer carried over from procedures where it actually is minimally invasive. But it's not for hernia repair.

                              The presentation gives a nice short history of mesh development. 5:20 is telling, in that he describes the placement of large pieces of mesh as the goal of laparoscopic methods training today. Lap placement of large pieces of mesh is the future, and the people promoting it still focus on the level of pain, compared to other methods, but don't talk about the difficulty of removing the pain if it occurs.

                              What is fascinating, from a psych perspective, is how he can be so pro-mesh and pro-lap, then a year later give a presentation describing how there is no useful data about chronic pain. He is enthusiastic about forging ahead with new unknown techniques, at the expense of the patient. He doesn't see the correlation with the lawyers that he keeps talking about.

                              These two presentations are both within the last two years. You can really see the army forming. He makes a call-to-action at 11:30. Pretty amazing. He is a "believer", he's really selling it.

                              He does mention his own repair though, at the end. Apparently it was a lap repair with mesh. If you watch his first presentation you'll see that he said that he had "almost no pain", and that old people don't complain (he mentions it above as a reason that younger people seem to have more pain). Who knows. One of thousands.

                              Anyway, this is the future. Good luck to all.



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