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David M,
Some of the German surgeons are really good with ultrasound. I’m told they’re able to tell with a high level of confidence if mesh is needed (by their criteria) based on that.
I’m not sure what they would have said about my case after exam/ultrasound, but my hernia was way outside their guidelines for Shouldice, so I think there’s a high probability that they would have recommended mesh. Also, my deep anatomy made the surgery even more difficult. My surgery took twice as long as it normally takes, and that was with a surgeon who had done thousands of Shouldice procedures.
You will need to ask me again in a few months. If all is good at that point, then my answer will be different than if I have some lingering issues that can be attributed to the type of repair I had. Of course, I could have had mesh and had issues from that as well.
At this time, it doesn’t look like going with a Shouldice procedure (vs Lichtenstein) messed me up, even with my difficult case, but it’s still early days.