Dr. Robert Bendavid

April 9, 2013 ~ Dr. Robert Bendavid  is a well-known hernia surgeon who in this editorial for the Africa Middle East  Hernia Society discusses surgical mesh.

Past president and a founding father of the American Hernia Society, Dr. Bendavid has performed thousands of procedures and is presently associated with the Shouldice Hospital in Toronto where the natural tissue, mesh-free, tension-free procedure was developed by Dr. Edward Earle Shouldice.

The same polypropylene mesh used in men and women for hernias is also used in women to treat pelvic organ prolapse and incontinence.  Dr. Bendavid tells MDND he was one of the early collaborators with C.R. Bard on the use of polypropylene mesh for the “Umbrella” and “Fletching”, the first devices ever designed for treating difficult femoral and inguinofemoral hernias. Such devices, as the hundreds of subsequent ones, were never meant to be used on every patient.

Today he believes surgical mesh should only rarely be needed to be used on women for inguinal hernia repair, though it may be needed for femoral hernias.  He is about to publish his latest work on the connection between polypropylene and pain that would apply to all aspects of its use.  That information will be released  later this year. 

Here is his editorial from the April newsletter:

Afro Africa Middle East Hernia Society

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Synthetic Hernia Mesh, WikiCommons, author: droftcm

The Wall Street Journal’s Laura Landro writes about hernia repair and the secret patients should understand before undergoing the operation. The secret appears to be that hernia repair, one of the most common surgeries, carries a high risk of chronic pain after surgery – 30% of patients have restricted movement and chronic pain that can last a long time.

A hernia is the bulging of the intestine or fat that pushes its way through a weak area in the abdominal wall. A number of patients choose watchful waiting but that can result in an emergency surgery which carries additional risks if the intestine is strangled after punching through the wall.

The fact that hernia surgery carries a risk of pain and other complications is not news to MDND readers. See MDND Patient Profiles of Jeff Silverman (here) who still suffers the pain from mesh because the removal threatens severe complications.

Patient Hal Samples still suffers nerve pain even after mesh removal. See his story here.

Sheri Ragan suffered complications from two types of mesh, one synthetic, the other a biological mesh that was used off-label. Her story is here.

An MDND story, Hernia from Hell talks about an extreme hernia mass that was treated by a Sarasota, Florida doctor with biologic mesh made from cadavers rather than synthetic polypropylene mesh that can carries a higher risk of infection and can migrate within the body.

The article says there are more than one million hernia surgeries a year, the majority are located in the groin area and are called inguinal hernias. Men and women, even children can be affected, but men are the majority of hernia patients.

One patient profiled in the WSJ story, a 27-year-old from Virginia, couldn’t walk and experienced stabbing pain after his hernia plug and patch technique. He tells the WSJ that the risk of postoperative pain was not discussed. In his case, the mesh plug had partially detached and was producing the pains. He had three surgeries to remove the mesh which was entangled with nerves.

Quoted in the story is Dr. B.Tom Heniford, head of the American Hernia Society, who says patients need to be informed of all the risks versus benefits of synthetic surgical mesh for hernia repair. “This is not a 100% benign procedure,” he says.

Recall

On July 6, 2011 plaintiffs injured by the Composix Kugel Mesh hernia patch made by C. R. Bard received an offer for a $184 million settlement in 2,600 claims, most of those outstanding over the faulty hernia patch. The amount was negotiated with more than 100 law firms around the country representing plaintiffs who had suffered the effects of a broken plastic ring or defective mesh including infection, bowel perforation, fistulas, even death.C.R. Bard subsidiary Davol Inc. is based in Warwick, Rhode Island and manufactured the Kugel.

Patients have Two Choices

LAPAROSCOPIC SURGERY
A small video camera is inserted through small incisions in the abdominal wall. The cavity is inflated with carbon dioxide and the surgeon can pull the hernia back into place securing it with mesh and staples or tacks and glue. Recovery time can be one or two weeks but there is a risk of infection. Because general anesthesia is used the procedure may be more expensive than open surgery.

OPEN SURGERY
After making an incision in the groin by the surgeon, the hernia is pushed back into place and the abdominal muscle wall is stitched together if the muscle is healthy or by sewing in mesh patches if the area is weak. This technique is recommended for children, but without mesh. The infection rate and risk of nerve injury is higher. The procedure can be done with a local anesthesia and sedation.

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