05 Jul Despite Variety of Products and Techniques, Surgeons Still Searching For Ideal Mesh For Hernia Repair

MedicalResearch.com Interview with:

Dr. Stephen Ferzoco

Stephen Ferzoco, MD, FACS
Chief of General Surgery
Atrius Health in Boston

MedicalResearch.com Editor’s Note:  Dr. Stephen Ferzoco, a prominent active, academic surgeon, discusses the complexities of surgery for hernia repair.

MedicalResearch.com: What is the background for this surgery? How many patients are affected by clinically significant hernias?

Response: A hernia is a common condition where soft tissue breaches a weak spot in the abdominal wall. Hernias can affect the abdomen (ventral) or the groin (inguinal). In the U.S. there are about 350,000 ventral hernia procedures each year; these hernia patients present a range of complexity to the surgeon, with some of these procedures being among the most difficult cases for surgeons to manage. Inguinal hernias are even more common, with about 750,000 total procedures performed in the U.S. each year.

MedicalResearch.com: What are the issues surrounding the various types of mesh used to surgically repair hernias? Are there particular benefits/adverse effects of each type of mesh? Do they require different surgical techniques?

Response: Surgical meshes are used to support the weakened abdominal tissues and minimize the rate of hernia recurrence following the procedure. While there are many meshes on the market today, they are offered in two main categories: biologic meshes (derived from a tissue source) or synthetic meshes (polymer-based).

Biologic materials are intended to remodel into a patient’s own tissue, but are costly materials with mixed outcomes on long-term strength.

Synthetic materials are associated with lower recurrence rates over time and are cheaper, but their long-term presence and prolonged fibrotic response can result in potential infectious complications downstream.

In short, surgeons are still looking for the ideal hernia mesh. Hospitals have a wide variety in stock because no single product has separated itself as the gold standard of care. Without an ideal mesh, surgeons have moved to more complex techniques to try to maximize outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: Whether it’s onlay, inlay, or underlay, open laparoscopic versus robotic, TAR or component separation… more surgeons are entering mini-fellowships to learn new hernia techniques to compensate for disappointing mesh products. And cost is an issue. Some feel a more complicated technique can lead to better results with cheaper mesh.
Surgeons need to recognize their own limitations. When it comes down to it, general surgeons should be able to handle 90% of hernia repairs with a simple technique and a robust mesh product. The ideal situation would be to use a more effective mesh with a simple technique.

MedicalResearch.com: Is there anything else you would like to add?

Response: Technologies that combine the strength advantages of synthetics with the remodeling characteristics of a biologic material are starting to hit the market. Surgeons need to be ready to quickly adopt new technology that can offer the best of both worlds and help achieve successful patient outcomes with simple techniques.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Stephen Ferzoco, MD received his undergraduate degree from Tufts University, graduating Magna Cum Laude. He attended Yale University School of Medicine where he was named a Farr Scholar. Upon completing his medical degree, he did his surgical training in Boston at Brigham and Women’s Hospital, a Harvard Medical School teaching program. A clinical fellow at Harvard Medical School, he joined the faculty at Brigham and Women’s as an associate surgeon in the division of general and gastrointestinal surgery. During his tenure, he was the Assistant Director of Trauma and the inaugural chief of the Emergency General Surgery Service. As an Assistant Professor of Surgery at Harvard Medical School as well as the Assistant Program Director in the Department of Surgery at Brigham and Women’s Hospital, he was charged with the training of the next generation of surgeons. He currently acts as the Chief of General Surgery at Atrius Health in Boston. He has been named a Top Doctor by U.S. News & World Report as well as a Best Doctor since 2007.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on July 5, 2016 by Marie Benz MD FAAD