GI,

Most indirect hernias are a result of a congenital defect (persistent processus vaginalis), and long-standing indirect hernias are common. They see large long-standing indirect hernias at Shouldice regularly – I was told they operate on such hernias every week.

I don’t think the different environment in the inguinal canal is an issue. Yes, there was a hernia sac there for a long time, and now there isn’t, but that’s par for the course with indirect hernia repair. None of the experts I talked to considered that to be a potential issue.

One problematic aspect was just the way my anatomy was laid out which made doing a Shouldice repair more difficult, but still possible. On top of that, the hernia defect was large, and the tissue quality was decent, but not great. I was pretty far from an ideal candidate for Shouldice, but this is not something that I could tell in advance. The ultrasound that I had gave an incorrect picture. The skill for doing it correctly for an inguinal hernia doesn’t seem to exist in the US (or Canada), and that’s the reason hernia surgeons find it to be useless. I hear they do a much better job of that in Germany, but we’re talking about hernia surgeons who do it themselves after developing specialized expertise.

Anyway, that’s the reason I mentioned that tailoring the repair is important. I think surgeons who do both Shouldice and mesh would have made the intraoperative (or maybe even preoperative) decision to use mesh in my case. I’m not saying that the fact that it was a more challenging repair explains my pain, but it might. On the other hand, I could have ended up with mesh-related trouble, so who knows.

Having said all that, look at Alan’s case of pain after his Kang repair. Different case, different tissue repair procedure, similar issues after surgery.

We’ll see what happens. Things may settle down, and I may end up being a happy camper with no pain, no recurrence, and no mesh. If anyone is curious about how I would do it with the benefit of hindsight, ask me in a few months.