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ok i need to know what all of you think including doctors
I have been diagnosed with a direct ingunal hernia…saw to surgeons one wants to do open with plug and mesh( with covidean or ethicicon) under local sedation and the other want to do robotic with a bard 3dmax….both of course sound confident…I need to know the good and bad from your experience….particulary the pros and cons of each… on a side note I am a Canadian citizen residing in the US, therefore I think I could go the Shouldice clinic if I had too…my concern with that is that while the recurrence seems low I cant find any info on wether or not chronic pain is a real issue….please take a moment to advise as I am scared to death….btw I am in the Atlanta area
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13 Replies
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Well written John. As someone whose mesh has failed and cussed me pain for 6 years and was repeatedly brushed off from the medical community for years only to finally find a surgeon who saw my mesh was folded and had to have mesh removal and all the exhausting things that go along with that-I applaud everything you are saying in your post. Two quick tie bits from my own research:
1) you mentioned that non mesh repairs have a higher occurrence rate than mesh repairs-I think this is inaccurate-the Shouldice Hospital reports that the recurrent rates are less than 1% and chronic pain less than 1%- both these stats blow away the rates reported with mesh use. these stars are for the Shouldice Hospital only and I’m sure they are much higher for surgeons using this technique that have not been trained at the Shouldice Hospital.
2) regarding your own condition although I think it is suitable to take a wait and see approach if you have a hernia that is Asymptomatic it is also inpotsdnt to remember if the hernia gets bigger that impacts on the success rate of a non mesh repair. Just something to consider. I’ve heard many surgeons say if the hernia is bigger than X (not sure if exact size criteria) they will use mesh instead of a pure tissue repair. Of course I think the shouldice Hospital handles bigger hernias Bc they are suited to.
3) As I mentioned in another post dr. Robert Tomas has been trained by the founder of the Desarda repair and he is in Florida so no need to travel outside of the US for that repair.
4) the only thing that concerns me about the shouldice repair is that they cut the cremester muscle which they say helps to prevent future hernias. Not sure if one would miss this muscle but it kind of makes me a little nervous. However that wouldn’t sway me to mesh-only debate more between the desarda or shouldice repair. I’ve also been told that the desarda is a better repair for a direct hernia and not a indirect one and that a Marcy, bassini, and shouldice repair is the way to go for a indirect hernia. -
I am in my 30s now and I got my inguinal hernia in my 20s. I have had it for about 8 years now. You might be thinking why I have not fixed it yet. I am holding out for a record. Just kidding! Even I know I will have to fix this thing one way or another. But I really resent this idea of fixating a plastic mesh inside my body. It is such a sensitive and active area of the body. It’s incredible how complex this seemingly simple problem is, despite falling into the category of “general surgery” and despite the fact that over 20 million people worldwide have a hernia surgery every year, most of which are inguinal hernias.
Hernia repairs without the use of a mesh is not the commonplace. You have to use a lantern to seek out clinics and doctors that perform mesh-free repairs. Some of them have sought refuge in Canada where you find the Shouldice clinic, the last stronghold of the skilled masters of the art of mash-free repairs, where mash-free believers travel to like pilgrims every year. Thankfully, like any good Karate school, they have sent out their scholars to all corners of the world to preach their mash-free believes. But you will still find that most places in the world perform mesh repairs using polyethylene (PE) or polypropylene (PP) material. The stuff that Coca Cola bottles are made of. It allows ordinary and inexperienced surgeons to perform hernia surgeries. It’s no big deal they say, it’s one of the most common type of surgeries they say. But you should not take any type of surgery lightly.
I understand the challenges that bioengineers face when trying to engineer that perfect mesh material. But they have tried and failed again and again. That is not to say they should stop trying. But there has been very little progress since the earliest plastic meshes were introduced some decades ago, from the horrific products from leaders in this “market” (it is a billion dollar business) to the latest “laced” and “dual layer” meshes and even absorbable meshes that supposedly promote neogeneration of supporting tissue through means of mechanical forces and tissue in-growth, and subsequent absorption of the mesh material. I have had the time to read all about it. It’s an area of active research for a great number of applications, not just meshes for hernia repairs.
I strongly believe in the body’s ability to heal itself. So instead of trying to invent biocompatible synthetic meshes, we should look at how nature does it, how our own bodies do this. If the body cannot heal these defects on its own, we have to give it a push. Not by putting in foreign objects in it. Come on! We are living in the 21 century. How about tissue engineering? I mean growing required tissues in a lab using stem cells and stuff like that. It’s technically possible. But it may not be economically feasible or of interest to all parties involved, especially not mesh makers.
What’s your hernia like? Is it large? Painful? Is it in the groin? In the scrotum? Does it prevent you from performing certain tasks? Is it reducible? Every hernia case is unique and so is each patient. There are many factors to consider. I am no doctor, but just know that not doing anything about it or putting it on “watchful waiting” is another option. This is something you can discuss with your doctors. I have had mine for 8 years and had pretty much zero issues with it. I know I will have to fix it eventually, but I might as well get another 8 good years out of this waiting game. Don’t rush to surgery.
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Open surgery is appropriate for both direct and indirect hernias. The surgeon will be also able to see if there is a indirect hernia present too.
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It’s your experience and others like it, to pause and some research…. being that mine is a direct defect… would open surgery be more complicated because of anatomy in any way
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The Shouldice Hospital reports that they have less than a 1% incident of chronic pain. I would strongly consider having a non mesh repair and their doesn’t seem to be any better then the Shouldice Hospital. There is also dr. Tomas in Florida that does a non mesh repair called the desarda. This is all these guys do and specialize in.
I would also stay away from the 3D maxx mesh-it Gomes up on me and caused years of pain until it was eventually removed in a tough and Long surgery. You can google it and you will see all kid of problems it can cause. It has folded up on other people too. Also understand a lapro mesh repair puts in a very large mesh often 5”x7” or bigger and it is close to all sorts of organs when it is put in lapro.
Again I’d rx you strongly consider the Shouldice Hospital-it’s recurrence rates and chronic pain rates are so much lower than with mesh and no issues of a foreign piece of plastic being inserted to you. My mesh attached to my bladder and had to be peeled off. It also attached to my spermatic cord and other arteries. And it was pressed up against my colon. Terrible stuff. -
I am also from Atlanta and had Laparoscopic TEP with mesh about 4 months ago. I realize its only been 4 months thus most mesh issues dont show up yet Provided Surgeon I used via message to scaredtodeath. Post of my experience is as follows:
https://www.herniatalk.com/6860-post-op-experience-laparoscopic-left-inguinal-surgery
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I hope that you are reading the other topics on the site and considering each. If you decide that you need to stay in a certain area or need to act within a certain amount of time, here is a link to a recent topic, about a surgeon in your area. A message to smurph71904, the author, might get the surgeon’s name if he does not want to publicize it. It’s only been 3 1/2 months for him but a discussion with his surgeon might help you.
The plugs and the 3D products can take time to shrink and crinkle up. Even the flat products can fold over. So months of time is not really long enough to make a well-informed decision but the surgeon might have more information. His early results look promising.
He mentions Geogia pollen in the first post – https://www.herniatalk.com/7096-open-inguinal-hernia-repair-monday
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As far as plug repairs go, a highly regarded hernia specialist recently posted on Twitter – “plugs are evil and should not be extrapolated as all things “mesh”. I know there have been plenty of problems, reported on this forum, related to plug repairs.
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makes a lot of sense….makes me feel that only the names of the docs mentioned on this board are the only ones that will suffice then…sucks because I would have to travel outta state and im sure that adds another layer of concern
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Ultimately you can find good and bad stories about every type of mesh, and every type of hernia repair. That’s just the nature of these type of surgeries.
This is also why many people will recommend seeking out a hernia specialist who does the surgery often and has become an expert in the specific procedure. It’s that whole “practice makes perfect” thing, which is basically the belief of Shouldice too. That’s not to say you can’t end up with a bad outcome from a great surgeon, but it may help to minimize the risk.
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additionally it seems like plug and patch has grown out of favor
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Chaunce, thank you for your feedback…in scanning these threads it seems like there is some positive things to say about Progrip mesh outcome and negative about 3dmax…….if these are common themes please chime in…and that goes for anyone who has something to say about it…thanks in adavnce
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Have you contacted the Shouldice clinic and asked them about their chronic pain rates? I know they are reported to be very low, but it’d be interesting to hear what they say. It’s always a good idea to ask any surgeon about their own experience and outcomes regarding chronic pain and other complications and risks.
Don’t be scared, but do informed. There is plenty to ask, understand, and ultimately you’ll want to make a decision that you are comfortable with.
I personally think chronic pain is the biggest risk of hernia surgery and that it should be the primary outcome determinant. It’s your groin, it is highly innervated and an area that is virtually impossible to ignore if it hurts. Recurrence is a theoretical risk too, but it should be low with any skilled surgeon.
If you’re from Canada, Shouldice clinic is world-renowned as hernia specialists, it’s certainly a well regarded option.
Good luck and keep us updated on your decision making and case.
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