Good intentions
​​​​​​​Thank you for keeping everyone updated.
I agree that it is crazy to use mesh for small umbilical hernias. And even more stupid to put the mesh in the abdomen where the intestines can scar to the mesh.
The video also said that 20% of surgeons wanted to repair the hernia with the laparoscope. I wish that there was some common sense in the world.
Regards. ​​​​​​​Bill Brown MD

Thank you for the acknowledgement Dr. Brown. I have thought more about the doctor in the video and realized that she was asked to make a video and to say some good things about mesh. It seems also that Dr.. Towfigh's video was sort of an "equal time" video showing that non-mesh is being considered.

There was really no intellectual value to the first doctor's video. No references or timelines mentioned so that people could learn about these new guidelines. Just some comforting words supporting the use of mesh everywhere possible. No need to think about it, all umbilical hernias should be repaired with "a mesh". I still feel embarrassed for her.

Good intentions
Unfortunately, money and not patient care make many of the decisions.
Regards.
Bill Brown MD

Allow me to provide some background and context to this.

The surgeon being interviewed is well known and respected for her hernia research, which is mostly based on population databases. She is a resident in training. She’s reporting on what data was presented based on her population based research. As you know, the Danish and Swedish hernia databases provide us with robust and longterm patient data that we really don’t have anywhere else.

Note that these databases are government based and objective. They are not influenced by industry or company sponsors.

Most data show superiority in outcome for umbilical hernias when mesh is used, no matter the size of the umbilical hernia. It also shows laparoscopic to provide better outcomes than open, again regardless of the size of the hernia. Outcomes are mostly based on her i recurrence, but also include pain and infection risks , etc.

But that’s not the full story. My belief and that of some others is that we are overusing mesh. That is, the benefit of mesh placement is not as high for smaller umbilical hernias. It is more beneficial for larger hernias.

My analogy to this is driving a car (aka using mesh) Vs walking (aka nonmesh repair). Driving somewhere will always be faster than walking there. But there are risks with Driving (Ie, mesh), such as pollution, car accident, cost of gas. And when needing to visit a neighbor a few houses away (Ie, small umbilical hernia), the Lee really is no need to drive there. Walking (Ie, non mesh repair) is just as good and without the risks of driving, though driving will still be faster to get to your destination.

DrBrown I agree with him because we need to add some logic in interpreting the data. This is one of the problems of database research. It doesn’t account for tailoring to the needs of the individual patient.

Again with the driving analogy: for some people (eg, broken leg, wheelchair-bound) (Ie, patient with high risk factors for recurrence, such as smoker, obese, chronic cough), perhaps the drive for 1 block away (ie, small umbilical hernia) is still better than walking (ie suture only repair).