chronic pain.
And surgeons who fail to grasp the complexity of the challenge may
end up exacerbating the problem when patients report post-surgical
pain. Surgeons may basically just blow them off, telling them their
pain can't be the result of the mesh, and it can't be the result of their
surgical technique. But that kind of reprimand leads to fear and anxi-
ety on the part of the patient. Patients feel abandoned, which might
increase the likelihood that the pain will worsen or they'll develop
chronic pain.
The norm is that many surgeons think they should know what mesh is
right for their patients. Or they may have the decision dictated by their
facilities or by contracts facilities have with mesh companies. If they
don't understand and respect the science behind systems and data, they
may try to force a one-size-fits-all kind of thinking. And if their patients
opt for a second opinion, they may end up with an entirely different
product based on the same kind of thinking.
Hundreds of options
There's no shortage of mesh products. If you include things like the
weave, the type of fiber and the material, we now have hundreds of dif-
ferent mesh options. Inevitably, if you're using only one type of mesh
product, you're going to have variable outcomes.
Surgeons in general need to be better informed. There's still a persist-
ent belief that mesh is inert, that it doesn't have any major interaction
with the body and everything comes down to surgical technique. That's
what I believed 15 years ago, before I actually studied what was hap-
pening. Yes, technique is important, but it's not as dominant a factor as
we all once thought, at least for some patients.
One complication is that a lot of patients are simply more reactive to
various materials, whether the material is plastic, metal, an environmen-
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