tal allergen or something else. That seems to be one of the factors that
leads to less-than-ideal outcomes. The raw material in synthetic mesh is
petroleum plastic. That's bound to create sensitivity issues in some
patients.
Does that mean biologic mesh, which is derived from either animals
or humans, is a better option? Some subpopulations seem to react bet-
ter to biologic mesh, but the problem with biologics is that no matter
how thoroughly treated and sterilized they are, if you use them, you're
putting a complex biologic form of material inside a complex biologic
person. We shouldn't be surprised that just as we've seen with synthet-
ic meshes, we've also seen tremendous variability in results with bio-
logic mesh.
Looking for data
With hernia repair in general, and mesh in particular, we're trying to
understand the differences among many subpopulations — to pin-
point the factors and combination of factors that can be identified to
predict what approaches will produce the best outcomes.
One surprising thing we've discovered through data and analytics is
that the patient's pre-operative emotional state can be a major con-
tributing factor. There's a neuro-physiologic interaction with the
immune system, hormonal system and inflammatory state of the
patient. So, a patient who's especially anxious — who expects a bad
outcome, may be more likely to have one.
What other factors are we seeing as predictors of success? It
appears that patients with lower BMIs may be more susceptible to
pain. There are also indications that prior traumatic experiences, such
as sexual abuse, could be a factor. Undoubtedly, there's predictive
data contained in other genetic, environmental and demographic fac-
tors.
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