This information goes against the orthodoxy but we feel that a patient that has not considered this prior to hernia surgery is poorly informed. You do not want to learn about this after hernia surgery.
In the past 50 years the recurrence rate of hernia repairs has not changed despite the nearly universal adoption of mesh repair as the Standard of Care. The world wide recurrence rate is 14%. Recent studies in the United States examining 600,000 repairs show that 12% of repairs are for recurrence. High volume expert hernia surgeons have recurrence rates of about 3% with or without mesh. Take into consideration the problem of chronic pain which affects 20% of patients with mesh and 1% of patients without mesh then the choice is pretty clear. Pure tissue repair in the hands of an experienced surgeon is the superior repair.
Tension causing hernia recurrences is a myth promoted by manufacturers of mesh to sell their product. Tension is physiological and it is not the problem. It exists everywhere in the human abdominal wall. The problem is tension mismatches which leads to mechanical stress. Mechanical stress leads to mechanical failure and also chronic pain. The abdominal wall is a multi layer composite structure which is much more complex than generally appreciated even by or especially by surgeons. There are multiple layers of muscle and fascia stacked on top of each other that have properties of contractility, elasticity and compliance which are anisotropic, each layer bearing tension and torsion in a way that allows the human torso to twist, turn and pivot around the axis of the spine without causing pain or shearing injury. It is a remarkable mechanism that has not been replaced or improved by medical science. Anything that interferes with normal abdominal movement physiology may cause movement restriction and chronic pain.
The idea of a non-mesh hernia repair is to restore normal anatomy and physiology. The idea of mesh completely ignores normal anatomy and physiology. The properties of mesh do not match normal tissue.
Technique does not matter, at least not as much as the skill of an individual surgeon. It has been shown over and over again in the medical literature that results of hernia surgery vary widely for any given named technique.
Most surgery does not have a technique name. When a technique name is used by a surgeon usually it is used as shorthand for description of a complicated procedure. The details may only loosely bear resemblance to the original named technique. There may be a component of the named technique that characterizes it and distinguishes it from other named techniques.
Dr. Petersen does not endorse a particular named hernia repair technique. He is familiar with all of the techniques described in the medical literature and relies on principles that have been proven over generations of surgeons and in decades of his own experience.
The manufactures themselves admit this in filings with the Federal Drug Administration. The FDA releases new mesh products to the market through a process known as 501(K). By this process manufactures show that their new product is substantially the same as another product already on the market. Based on this the FDA does no further testing and releases the product to the market.
When mesh is put into the human body during surgery stress is being born by the native abdominal wall. The mesh is essentially floating. After healing it is a different story. The mesh becomes stuck to the surrounding tissue and encased in scar tissue and in essence turns into a sheet of stone. It does not bear torsion and tension with properties of compliance and elasticity that matches the surrounding tissue. This creates excessive mechanical stress and shearing forces which is one of the mechanisms by which mesh causes pain and recurrences. Also, scar tissue contracts which causes more stress and pain.
Patients naturally and erroneously think that if you strengthen the abdominal wall this will prevent hernias. A hernia is an injury to fascia causing a defect in fascia which allows intestine to poke through the abdominal wall. Muscle does not hold in your intestines. It is your fascia and there is nothing you can do to strengthen your fascia.
There are known technical mistakes that should be avoided when using mesh. Avoidance of nerves is the primary concern but it is impossible to avoid all nerves and avoid pain. You can mostly avoid large named nerve trunks which are visible. The branches for these trunks are microscopic and cannot be avoided.
Traditional non-mesh hernia repair can be done with a low recurrence rate avoiding the potential complications of mesh.
At this stage of your research you might be thoroughly confused. The easiest and fastest way to clear this up is to speak directly to Dr. Petersen. Do our online consultation then you will be offered a free telephone consultation with the doctor. To start your consultation click here.
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"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News