Sue Wilson and Harry Cowan had a dilemma.
The couple from Northern California are friends of mine and Sue even included me in her latest film, Broadcast Blues, about the failures of the FCC to regulate broadcasters. But Harry had developed a hernia and it needed to be addressed. She knew I was working on the mesh issue and understood there had to be an alternative. Looking around for answers all they heard was the pro-mesh point of view.
But Sue got to researching, as journalists will do, and found Dr. Zafar Parvez, a board certified general surgeon practicing in Fresno, California, who has brought a mesh-free hernia surgery to the U.S. based on the work of Dr. Desarda in India.
Dr. Parvez studied in Karachi, Pakistan and began his medical residency in Cleveland in 1982. Back then, he says general surgeons were trained how to repair a hernia without mesh. Even though he used mesh as it came into vogue, he tells MDND he didn’t trust that the polypropylene would be inert in the body.
“Mesh is a foreign body forever, it has reactions to the surrounding tissue and it incorporate eventually in the tissue, when it is not placed properly it will be a problem, when it goes too close to any nerves it gets incorporated that’s chronic pain that’s the worst that can happen. What important is the placement how and where it’s placed and infection.”
Dr. Parvez says a hernia can be addressed without mesh in most circumstances unless the tissue is too weak to use for repair or if the patient has a disease and doesn’t heal.
Dr. Donald Ostergard, MD, has had a long distinguished career in urogynecology and reconstructive pelvic surgery and is the past president of the American Urogynecologic Society. He (background story here) has long said mesh is not inert – I asked Dr. Parvez whether he agrees.
“Mesh is not inert,” says Dr. Parvez. “In every mesh, no matter what makers say, it has a contraction rate and it can go in any direction even toward the center of the mesh. So it will ball up. This is the whole thing. Once you secure it, it’s not nails in a hardwood floor because the body is moving.”
Dr. Parvez is no stranger to the properties of mesh. While his practice focuses on gastric bypass surgery with only about 15 percent hernia repair, he always wanted to learn more and so he attended a number of training sessions offered by Ethicon. “They give you a free trip to wherever you want to go, Las Vegas, New Orleans and train you on a new mesh product. They put you up and fly you out,” he says.
While a surgery to repair a hernia with mesh can last as little as 45 minutes, Dr. Parvez began studying alternatives.
Component separation technique (CST) surgery can take as long as two hours but with it surgeons can close large defects in the abdominal wall without using synthetic mesh by using the body’s own structures to rebuild the wall.
Component surgery is ideal for abdominal wall hernias, but Dr. Parvez said he would not use it on groin or inguinal hernias.
An inguinal hernia is what brought patient, Fred Amir all the way from San Jose in the San Francisco Bay area to Fresno to meet with Dr. Parvez.
Amir, is a health consultant and author of “Rapid Recovery from Back and Neck Pain: A Nine-Step Recovery Plan.” His company, Health Solutions, consults with individuals and industry about maximizing the body’s ability to heal.
“My personal mission is to empower people with information, especially when comes to their health,” he says, preferring a natural and holistic approach to health.
Amir too was not convinced about the promises of synthetic mesh. On his website, Rapid Recovery.net he outlines his research into alternatives for hernia repair. He found both Stanford and University of California San Francisco used synthetic mesh for hernia repair.
He writes about his research on his website:
“I was a patient with chronic back pain frustrated with the medical system. After some of the treatments offered to me by the medical-industrial-complex made my condition worse, I realized that if I did not do my own research and ask lots of questions, I could get seriously hurt. Sometimes patients are offered treatments simply because of tradition or what the doctor is comfortable with, and sometimes there is a profit motive. For instance, A US government study revealed that back surgery has a 1% success rate, meaning it fails 99% of the time, yet there are 350-thousand spinal fusions are done every year. There is absolutely no evidence it works. With the hernia I knew I had to take my care into my own hands and do my own research The doctors I met seem to me were mesh salesman masquerading as doctors. I knew I needed to avoid mesh because of the possible complications even if the percentage is not that high, why take a chance?”
His research led him to Dr. Ulrike Muschaweck, a German doctor who had treated a number of U.S. athletes. But her no-mesh approach to hernia repair was available only in Germany. He found no doctor in the U.S. who duplicated her work.
His studies took him to Prof. Dr. Mohan Desarda of Pune, India, who taught a no-mesh method of hernia repair. Dr. Desarda claims his technique of mesh-free, tension-free, quick-recovery repair is so easy that a skilled surgeon can do it. Dr. Parvez said he was very impressed, so after some initial consultations, Dr. Parvez said he could replicate the technique.
“Most doctors don’t want to do anything new,” Amir says. “He could have said traditional repair only.”
“When I did research online coming from his patients, HealthGrades.com, and everything pointed to a wonderful person conscious person really cares about is patients; I said to myself, and I said “This is a gem hidden in Fresno.” When Dr. Parvez said he could do the Desarda technique, here was where trust came in; I had no doubt in his judgment.”
How did the surgery go?
On the first day after surgery, Amir said he did not use any pain killers, Tylenol or Advil. It did hurt to get in and out of bed he said. By 48 hours he went shopping with his wife and now 18 months later he says he does 2 miles of sprinting, a high intensity workout program and weights.
“In any system where profit is involved, we need a system that gives patients more options. When it comes to hernia repair I hope it’s not just Dr. Parvez, but that every surgeon will offer as an option to their patients.”
How is Harry doing today? He tells MDND, “Today is 2.5 weeks since my surgery and we just went for a two mile hike. I feel fine and I have no problems or complaints so far. If you remind me I will keep you posted from time to time. Thanks for your help. I really appreciate your leading us in the right direction.”
His wife says the hardest thing is keeping her husband relatively inactive through the recovery process. #
Mesh/Medical Device News Desk- Dr. Ostergard on Degradation, infection and heat effects on polypropylene mesh
Abdominal Wall Reconstruction- Medscape
Repair of Giant Midline Abdominal Wall Hernias:- PubMed
Rapid Recovery website with video of Dr. Desarda
Dr. Ulrike Muschaweck- Hernia repair, Munich
Dr. Desarda’s Hernia Center- doctors around the world