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Ethicon Media Monitoring 10/6/2017
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Doctors blame media for scaring patients off vaginal mesh implants
Oct 5, 2017 | The Guardian
By Melissa Davey
Surgeon says reports claiming mesh is unsafe and unproven are ‘not true’ and people who need abdominal wall hernia repair are now fearful of procedure -
Patients 'terrified of mesh' driving fear of hernia surgery
Oct 6, 2017 | Radio New Zealand
Patients are turning down the best surgery treatment for hernias out of fear of the use of surgical mesh, a Christchurch Hospital surgeon says. -
Using surgical mesh for hernias 'safe and effective', surgeon says video
Oct 6, 2017 | The Dominion Post
By Cate Broughton
A Christchurch general surgeon says public debate about surgical mesh complications has frightened off hernia patients who would benefit from it.
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Doctors blame media for scaring patients off vaginal mesh implants
Oct 5, 2017 | The Guardian
By Melissa Davey
Surgeon says reports claiming mesh is unsafe and unproven are ‘not true’ and people who need abdominal wall hernia repair are now fearful of procedure
Inaccurate media reporting about vaginal mesh implants and the lawsuits associated with them has caused patients to become fearful of mesh procedures that may be essential to improving their health, New Zealand general surgeon Dr Steven Kelly says.
In a piece published in the New Zealand Medical Journal on Friday, Kelly said the media “have over previous years done great harm to the reputation of mesh abdominal wall and groin hernia repair”.
Concerns have been escalating after thousands of women around the world reported chronic pain, mesh cutting through tissue and being left unable to walk or have sex after having mesh surgery to repair urinary incontinence and prolapse – conditions often caused by childbirth.
US pharmaceutical company Johnson & Johnson, a major manufacturer of mesh implants, is fighting class actions in Australia and the US, and could face legal proceedings in the UK.
But the media had “published multiple articles claiming that mesh is unsafe and unproven”, Kelly said. “That is simply not true,” he wrote. “Patients whom require abdominal wall hernia repair are now fearful of mesh. New Zealand general surgeons are well trained in modern hernia surgery and the management of complications.”
Most short-term clinical trials have found high efficacy and low complication rates for the most common mesh implants used to treat incontinence and hernias. But there is a growing body of evidence that efficacy is lower and complication rates are higher when the mesh, also known as transvaginal mesh, is used to treat pelvic organ prolapse.
“It is very important for the public to understand that transvaginal mesh repair has a different risk profile compared to abdominal wall mesh repair [to treat hernia],” Kelly wrote.
“Transvaginal mesh is placed into the vaginal wall in an attempt to treat pelvic organ prolapse. It was initially presumed to be as safe as abdominal wall hernia mesh repair. However, over time there were increasing reports of significant problems with this mesh technique, including mesh erosion, chronic pain, mesh infection and dyspareunia [painful intercourse].”
While many of the problematic meshes have been removed from the market, controversy remains among experts about the risk profile of contemporary meshes and how they should be utilised to treat prolapse. But Kelly said it was essential to also reassure people that the complication rate for abdominal wall hernia repair using mesh was low.
The president of the Australian Medical Association, Dr Michael Gannon, said even in the case of mesh used to treat prolapse, “a minority of women having these kinds of operations have been damaged”.
“One in eight women who have delivered vaginally will need an operation for either prolapse or incontinence, and using surgical tape or mesh may be a part of their legitimate care,” Gannon said.
“We seem to have forgotten how many women have been helped by these operations over the journey in acknowledging that some may have been harmed by it.”
Gannon, who is an obstetrician, said he had been involved in the treatment of women who had been harmed by the meshes. Like Kelly, he said the media had been guilty of misrepresenting the scale of the problem.
“I have a lot of sympathy for the minority of women injured by gynaecological mesh operations; they have chronic pain and a lot of cases are very hard to fix,” he said.
“Stories like theirs are highly charged, emotional stories that make for good copy and its inevitable the media would report them. It’s less interesting to talk to a woman who had an operation five years ago and their lives have been made a whole lot better.”
More than 100,000 transvaginal mesh lawsuits have been filed in the US, while more than 700 women comprise the Australian class action. NHS records have revealed that thousands of women have undergone surgery to have vaginal mesh implants removed during the past decade in the UK due to traumatic complications linked to the devices.
The CEO of the Health Issues Centre in Australia, Danny Vadasz, said pointing out that the majority of women to undergo mesh procedures had not been harmed was an attempt to deflect attention away from the medical profession.
He used the example of the drug Thalidomide, prescribed to women to treat insomnia and morning sickness and which was subsequently found to have caused severe deformities in babies born to women on the drug.
“No one said, ‘Oh yes, but hundreds of thousands of women got a good night’s sleep on the drug, and that outweighs the harm’,” Vadasz said.
Vadasz said while it may be the case that complication rates were much lower among those who had mesh procedures to treat hernia, “patronising” comments from doctors were not helpful.
“Doctors need to stop taking this patronising ‘we are the experts why aren’t you listening to us’ approach,” he said.
“My frustration is that I’m on various reference groups and government committees dealing with the mesh issue and this narrative of ‘we made mistakes in the past and its fine now’ keeps emerging. But it’s not fine.
“To me it’s a part of this larger, poor attitude towards women and not listening to women when they say something is wrong, and not explaining the risks to them so they can give informed consent to procedures.”
https://www.theguardian.com/australia-news/2017/oct/06/doctors-blame-media-for-scaring-patients-off-vaginal-mesh-implants
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Patients 'terrified of mesh' driving fear of hernia surgery
Oct 6, 2017 | Radio New Zealand
Patients are turning down the best surgery treatment for hernias out of fear of the use of surgical mesh, a Christchurch Hospital surgeon says.
Around 5000 hernia repairs are carried out every year in New Zealand but surgeon Steven Kelly said publicity over complications with the use of the mesh in transvaginal surgery meant some patients were avoiding the treatment.
Mr Kelly told Nine to Noon transvaginal mesh was different from the surgical mesh used for the abdominal wall or groin.
He said it was important patients knew the difference and that the risk for chronic pain after hernia repair was only one percent.
"That means 50 people a year in New Zealand are going to be developing disabling pain and they of course are the people that are going to the media.
"It's very important that the argument is balanced and that the vast majority of people who have a hernia repair actually have very good outcomes and are very happy with their operation."
He said there were many factors that influenced the risk of an unsuccessful mesh operation.
"Take for example transvaginal mesh which is very different, that's mesh placed around the vagina, the risk profile is different so when the mesh is taken out transvaginally, 50 percent of women will continue to have pain.
"It was initially thought that mesh placed around the vagina was as safe as mesh placed around in abdominal wall or groin, and it's clearly not turned out to be the case."
He said the majority of patients who underwent a hernia repair had a successful result, while patients who got alternative surgery for hernias had an almost four times higher hernia recurrence rate.
http://www.radionz.co.nz/national/programmes/ninetonoon/audio/201861408/patients-terrified-of-mesh-driving-fear-of-hernia-surgery
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Using surgical mesh for hernias 'safe and effective', surgeon says video
Oct 6, 2017 | The Dominion Post
By Cate Broughton
A Christchurch general surgeon says public debate about surgical mesh complications has frightened off hernia patients who would benefit from it.
Dr Steven Kelly said he was driven to write an opinion piece for this month's New Zealand Medical Journal (NZMJ) defending mesh for hernia surgery because he was fed up with patient fears following media reports of complications.
"It is very important for the public to understand that transvaginal mesh repair has a very different risk profile compared to abdominal wall mesh repair."
His comments come as Auckland woman Karen Randell says she considered suicide to bring an end to the agonising pain she had felt since a hernia surgery in August 2011.
"It's sharp, like an electric shock, it's like stabbing, pulling, stretching, that's what it feels like … it's like something in me is cutting into me."
The pain forced her to quit her job and she relied on a combination of strong medications.
"I wrote a personal letter to ACC and I told them the truth, how it really is for me, my life has been taken away it's reduced to nothing basically."
The 46-year-old mother of four and grandmother said her surgeon would not acknowledge anything was wrong and had refused to remove the mesh.
ACC declined Randell's claim for cover, as pain alone was not considered an injury.
When Randell sought a second opinion from another surgeon, an ultrasound revealed the original hernia had returned, along with two more.
Her experience had left her terrified of surgeons and hospitals.
About once a month, when the medication at home fails to relieve her pain, she gets a pethidine injection from her GP.
On several occasions, Randell had been given intravenous morphine at her local hospital's emergency department.
Two years ago, she suffered two seizures within 10 days.
Doctors said it was a result of using the pain medication tramadol, which she stopped taking. She has continued to have mini-seizures since.
"If I had known that my life was going to end up like it is I would have never got it done, I would have just stayed the way I was."
Kelly estimated about 5000 people had surgery to repair hernias each year in New Zealand.
Hernias happen when the abdominal wall weakens and other organs protrude into the stomach cavity. Repair involves stabilising the abdominal wall with mesh or suturing.
Kelly said the use of mesh in hernia surgery had long been accepted as the international gold standard method, with suture or Shouldice repair producing far higher rates of recurrence.
"It's a bit like suturing wet paper, ultimately it will fail again so that's why we have to reinforce the tissues."
In New Zealand, surgical mesh was used almost exclusively for hernias.
Without the intervention, hernia patients would "either die or will live terrible lives with terrible pain and won't be able to have any quality of life", he said.
"The public needs to be informed that mesh for abdominal wall hernia repair is safe and effective," Kelly wrote in the NZMJ, published on Friday.
He said complications and chronic pain could happen in any type of surgery and hernia repair was no different, even with mesh.
About 1 per cent of all hernia repairs using mesh had complications, Kelly said, though exact figures were hard to gauge due to a lack of reliable data.
The New Zealand Association of General Surgeons said chronic pain could occur in less than 10 per cent of patients.
In the NZMJ article, Kelly said a 2004-14 ACC audit of treatment injury claims for surgical mesh showed the complication rate for hernia repair was 0.6 per cent, compared to 3.3 per cent for transvaginal mesh.
ACC received 265 surgical mesh claims for hernia surgery between 2005 and April this year.
Some New Zealand patients who have suffered life-changing complications from hernia mesh surgery say they would not have had the procedure if they had been told about the potential consequences.
Kelly said some of his patients had suffered complications, but he emphasised it was very rare.
"I see these patients and from my perspective there is a fully informed discussion."
Defining the cause of chronic pain was difficult as some patients developed a chronic pain syndrome that was not related to the surgery.
"Some of those patients they actually may have a chronic pain syndrome where the pain originates in the spinal chord and the brain."
He said a very small number of patients experienced pain as a result of the surgery.
All hernia surgeons should have a fully informed discussion with patients about the risks, he said.
One of the founders of surgical mesh advocacy group Mesh Down Under, Charlotte Korte, said much of the research on the impact of mesh complications did not include "robust quality of life data".
Without it, the "true impact of mesh complications on the patient" and the scale of the problem remained unknown.
Without a full inquiry into surgical mesh the medical sector could not comment on the number of people suffering mesh complications in New Zealand, Korte said.
"It is important for clinicians to take into account the severity of mesh complications and perhaps re-examine the risk ratio of potential harm".
https://www.stuff.co.nz/national/health/97524332/using-surgical-mesh-for-hernias-safe-and-effective-surgeon-says
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