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Possible explanation for mesh problems (from a product standpoint)

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  • Possible explanation for mesh problems (from a product standpoint)

    I work in marketing, constantly evaluating the problem-solving potential of different products and helping position them in the marketplace. So I might be seeing these things from a slightly different angle, but here goes, my hypothesis about why mesh products sound great in theory, but have so many problems in practice:

    Mesh theoretically serves two purposes, it acts as a prosthesis and promotes healing through tissue ingrowth. The problem is, it hasn't been OPTIMIZED for either purpose. From a product standpoint, that's a huge issue; combining two conflicting, partial solutions is problematic. The same would ostensibly be true for the procedures used to insert that mesh.

    If mesh is supposed to be a prosthetic, then shouldn't it mimic the form and function of the tissue it replaces? Rather than something that shrinks and hardens, shouldn't it be flexible and expandable, serving the purpose of damaged fascia?

    On the other hand, if the purpose is a healing aide, then it should be thought of like a splint or bandage, right? That is, something that isn't meant to be there forever. Since removal would be more invasive surgery, absorbable would seem to be the answer, but that only works if the procedure for insertion addresses the actual tear (per one of Dr. Kang's primary operating principles). Otherwise, it would be like bandaging a deep laceration without closing it.

    From this perspective, it's easier to see the shortcomings of mesh from a product development standpoint. I'd be very interested to hear the opinions of experts in terms of optimizing a product to serve its intended purpose (instead of serving two somewhat conflicting purposes).

  • #2
    UhOh!
    Mesh is not as flexible nor as elastic as your normal tissues.
    It always elicites a foreign body reactions.
    It shrinks with time.
    It easily becomes infected.
    What could go wrong?
    Bill Brown MD

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    • #3
      Originally posted by DrBrown View Post
      UhOh!
      Mesh is not as flexible nor as elastic as your normal tissues.
      It always elicites a foreign body reactions.
      It shrinks with time.
      It easily becomes infected.
      What could go wrong?
      Bill Brown MD
      Yes, exactly. It sounds like it was engineered (or chosen, from a pile of "stuff") because it checked some boxes in terms of serving a dual purpose (prosthetic; healing aid) without anyone ever thinking about optimizing it for either purpose.

      Huge failing from a product development standpoint (true whether it's a medical product, or meant for any other industry requiring precision).

      What do you think the results of "mesh" repairs would look like if, either:

      1. A fully absorbable mesh were used in conjunction with tissue repair techniques, to promote healing, and then go away (like a splint, cast or bandage)

      or

      2. A true prosthetic, meant to mimic the form and function of the damaged tissue, had been developed (along with the right technique for integration)?

      Do you think that it would have led to better overall results, instead of new problems (chronic pain vs. recurrence)?

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      • #4
        I think that your logic is on target. Of course you know, that business is not really about making the best product, it's about maximizing shareholder value. It's the major flaw of free market economics. The business model is not for the benefit of the consumer it's for the benefit of the business owners, the shareholders. Unfortunately, in this case, maximum shareholder value comes at about a 15% chronic pain rate for the consumer.

        You can see this in Johnson & Johnson. They are actually buying companies that have been shown to harm consumers, and are paying the settlement costs. But the business is still profitable and worth owning, for the shareholders.

        Free market economics are based on the principle that everything has a monetary value. That it's possible to quantify a ruined life in dollar terms.

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        • #5
          A pure tissue repair with a absorbable mesh is something I’ve been pondering and asking about on these forums. If “perfected” it seems for a certain population it could be a great solution.
          For inguinal repairs it could start with the premise that a non mesh repair repair will be the first line of defense for small hernias and strong surrounding tissue. If upon surgical exploration it is determined that the hernia is to big or that surrounding tissue is also weak in addition to the hernia defect a natural repair with a onlay of absorbable mesh could be the protocol.
          The absorbable mesh could also be a additional safeguard should the surgeon not bring an expert in non mesh repairs with the absorbable mesh being an extra layer of defense.
          Bridging the two methods tissue repair and absorbable mesh seems to have as a idea promise
          Ofcourse we know very little about absorbable meshes: do they really completely absorb 100% and what are some of the risks inherent to this kind of device. And ofcourse as good intentions mentioned we can’t trust the manufacturer to really have the patients best health interests in mind when developing this product .

          Comment

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