You would have to ask her, but here’s my impression for what it’s worth.

She has a lot of experience with mesh problems and revisional surgery. This enabled her to develop a profile of people who are more likely or less likely to develop problems from mesh. Things like sex, age, body type. Similarly, she has experience with tissue repair, and tissue repair going wrong. Based on her experience, her assessment in my case was that I should be more worried about the risk of recurrence with tissue repair than the risk of trouble from mesh.

The size of my hernia played a part among other factors in her rejection of tissue repair in my case. I wasn’t 100% sure about one thing, though. It wasn’t clear to me how much her concern about Shouldice in my case had to do with what she thought the results might be in her hands specifically. She did say that some other surgeons would do it, but she wouldn’t, and it wasn’t clear to me how to interpret that. Did she mean that others might be able to do it better, or did she mean that others might be less conscientious or less concerned about recurrence? This wasn’t clear.