Reply To: Excellent discussion with hernia genius JF–Watchful bryant pinto..mike m
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“Is there a way to just sew these hernias closed without opening the inguinal floor and putting a bazillion layers of suturing in???”
This is what Dr. B did for me. Used absorbable sutures and determined that the inguinal floor did not need to be opened, and used a modified Bassini technique to tighten things up. That may largely be because my hernia was indirect. And it remains to be seen what my long-term prospects are, so I can’t say if it worked or not. Two months out and still have some discomfort and no clue if hernia was totally fixed. But I had some pre-existing discomfort since the first mesh surgery and then removal, and it may always be impossible for me to say what the source of any of my issues truly are. I am not currently in much pain per se. It’s more discomfort and mild soreness and weakness. Feeling tightness in the groin and like a heavy knot is just kind of sitting in that spot and tugging and pulling on things. The next few months will probably be instructive. And perhaps even a year or two as the tissue remodels.
At any rate, another reason I chose him (besides the fact that he’s an expert on hernias and abdominal wall reconstruction and knows the anatomy inside and out) is that he took a very conservative approach. His surgical notes carefully detailed his sewing technique to provide a strong repair but one that wouldn’t be too tight, and how he made an effort to avoid all critical nerves and other important structures. He’s no tissue guru, but he’s a bona fide expert, a nice guy, honest and practical and keeps it real, and he’s cheap and close by.
Dr. Kang also commented here how he also wasn’t sure why so many surgeons found it necessary to always open the inguinal floor when in many cases it’s just not needed.
Lastly, I do think with some of the techniques, even with permanent sutures the amount of permanent material is pretty negligible considering how thin the sutures are. Shouldice obviously will have more. I asked Dr. B what he recommended for me and I told him I was open to permanent, but he thought given my history it might be best to go with absorbable so there’s no question down the road about whether or not some permanent material is causing ongoing issues. He may have suggested that partially for his own protection, but he seemed to think a younger healthy person should be able to form enough scar tissue over several months to hold an indirect hernia tightly. And as I mentioned before, he did some extra work to strengthen the direct space.