BACKGROUND: Hernia mesh removal is growing in demand. Meanwhile, there is no standard for handling the mesh specimen or any consensus on the clinical value of the surgical pathology findings. STUDY DESIGN: All hernia mesh specimens gathered from 2013 to 2018 were analyzed. Patients were categorized based on indication for mesh removal. The "mesh reaction" group included those with clinical reaction deemed to be related to the mesh material. The "mesh nonreaction" group included patients who had mesh removed for a clinical indication unrelated to the mesh material. RESULTS: One hundred and one patients had 115 mesh specimens that were microscopically evaluated. Patients with clinical diagnosis of mesh reaction were significantly younger (39 vs 56 years; p ¼ 0.023) and more likely to be female (71% vs 39%; p < 0.001) than those without mesh reaction. Although the clinical symptoms were significantly different, the pathology findings were quite similar. CONCLUSIONS: There is no clinical value in submitting mesh specimens for microscopic surgical pathology evaluation, regardless of clinical indication for the mesh removal. Also, no clinical claims can be made based on pathology findings from explanted mesh. In addition, microscopic evaluation does incur additional costs to the consumer. We recommend explanted mesh be submitted for gross examination only for documentation purposes in the medical records.
Social media can influence public perception in health care. By 2016, social media discussion against the use of transvaginal mesh influenced changes in Food and Drug Administration (FDA) regulations. We propose that the fate of hernia mesh will follow that of transvaginal mesh. Thus, we compare the trend of social media discussion of hernia and transvaginal mesh. Posts on Twitter and public Facebook groups were tracked for keywords “hernia,” “hernia mesh,” and “pelvic/vaginal mesh.” Posts were categorized based on sentiment. On Facebook, 16 public groups with 14 526 members expressed negative sentiments in 95% of their 750 daily posts. Meanwhile, of the 1.1 million tweets on Twitter, those about hernia mesh were more negative (36.5%) than those about pelvic/vaginal mesh (29.2%). Three of the 5 top tweeters about hernia mesh and pelvic/vaginal mesh were linked to law firms involved in mesh-based lawsuits. The negative sentiments and steering of social media discussion by lawyers may directly affect surgical care. As surgeons, we may adapt our informed consent to acknowledge our patients’ apprehensions about mesh. We may also be more involved in social media discussions ourselves. Meanwhile, we await FDA decisions in the regulation and availability of hernia mesh.
Background Currently, over half of drug overdose deaths are due to opioids. Opioid alternatives may be prescribed to help curb the opioid epidemic. However, little is known about their efficacy for acute postoperative pain. Methods We studied patients who underwent low-risk outpatient surgery. Perioperatively, all patients were started on an anti-inflammatory bundle consisting of multimodal pain remedies. Opioids were available to the patients postoperatively. Pain scores and opioid use were recorded. Results Over 18 months, 120 patients underwent low-risk outpatient surgery and all used the anti-inflammatory bundle. All patients had a significant decrease in postoperative pain scores (p = 0.001). There was no significant difference in postoperative pain scores between those who followed the anti-inflammatory bundle alone and those who also used opioids (mean 2.2 vs 3.1/10). Twenty-five (21%) patients were using opioids preoperatively and 50 (42%) postoperatively. Of those using opioids preoperatively, six (24%) patients used the anti-inflammatory bundle alone and avoided opioids postoperatively. Conclusions For 58% of our patients, an anti-inflammatory bundle alone provided adequate pain control after a low-risk outpatient operation, such as hernia repair. Our practice uses the anti-inflammatory bundle for all patients. Our goal is to reduce both the need for opioids and the surgeon’s contribution to the opioid epidemic.
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