News Feed Discussions Excellent discussion with hernia genius JF–Watchful bryant pinto..mike m Reply To: Excellent discussion with hernia genius JF–Watchful bryant pinto..mike m

  • Watchful

    Member
    April 19, 2023 at 7:04 pm

    Lichtenstein isn’t so great. Remember the hard bacon pictures of removed open mesh with adhered nerves posted by Dr. Brown? He was doing many of these removals, and said that this was the procedure that caused him to lose the most sleep.

    As I mentioned a couple of times before, one of the general surgeons with whom I consulted needed a nurectomy after a Lichtenstein procedure he had for his own hernia. Now he normally cuts the ilioinguinal nerve in his patients (just like VA surgeon from the Hernia journal letter).

    With inguinal hernia surgery, all you can do is pick your poison, and who will give it to you. It does turn out ok in most cases regardless of the choice of technique, but at least some level of chronic issues is too common for comfort.

    Lap mesh does seem scary, but surprisingly it actually has the best results overall in most studies that I’ve seen – faster recovery, lower rates of chronic pain, and similar recurrence rates. The risk of causing nerve issues is higher with open mesh and tissue repairs than lap mesh.