Reply To: Desarda vs Grischkan’s two-layer Shouldice, etc…

[Tino_7]

quote DrBrown:

Each hernia repair needs to be tailored to the patient’s anatomy. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a very good choice, especially if the floor of the inguinal canal is just weak and not fully torn. But there may more tension on the repair than the other techniques. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch to cover the inguinal floor. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. The Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is very strong. But it does rely on an intact inguinal ligament and good tissue in the inguinal floor. Thus, there will be times when the Shouldice may not be possible.

Regards.
Bill Brown MD

Very helpful, Dr. Brown!

I’m meeting with a surgeon who does open and robotic mesh, but was trained in tissue repair as well (Bassini).

I have an indirect inguinal – my second one. My prior was repaired at RUSH University in Chicago (Millikan Modified repair, after Dr. Keith Millikan) two decades ago with mesh + plug. It’s held up well with no issues whatsoever.

I’d prefer an open repair under twilight sedation because of BPH and voiding difficulty. My concern: post op urinary retention and Foley catheter if general anesthesia is used (since I am at risk).

Dr. Grischkan offers a modified, two-layer Shouldice under twilight sedation.

If not for BPH I’d opt for the less invasive laproscopic so I could bounce back faster.

It truly comes to a trade off of potential risks-benefits, doesn’t it?

I’m early 60s, BMI = 25, reasonably good shape but certainly no longer have hard abdominals, thus expecting a longer recovery than my first open repair.

Overwhelmed trying to plan two surgeries close together – praying and asking God for guidance/wisdom.

Thank you.