Reply To: Excellent discussion with hernia genius JF–Watchful bryant pinto..mike m
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Even my surgeon at Shouldice told me that the technique that’s least likely to cause chronic pain is lap mesh. He said even that procedure can cause it unfortunately, but the incidence is lower than with Shouldice and open mesh. He was pretty direct about the chronic pain issue saying that they encounter new bad cases on a weekly basis among their patients, and it’s sometimes debilitating. He told me all that before the surgery in response to my questions on this topic.
I decided to go ahead with it anyway since this wasn’t a surprise to me. The thing that got me was that I had a pretty huge hernia. There was no mention of that as being a problem before the surgery even though the surgeon examined me, and I asked him if this would be a good procedure for my case. After the surgery, it was mentioned as a reason for the difficult and long surgery. Also, he told me he still managed to fix the hernia well in spite of its large size. I then asked him if mesh would have been difficult as well, and he said no. I have no recurrence so far, so that’s good, but the surgery caused way too much trauma to the area, and persisting issues.
It goes even further than that… I chatted with him quite a bit after surgery about the tissue repair vs mesh choice that I made, coming there for it, etc. There was zero indication that he thought this was a better approach than others, which surprised me. He viewed it as one of the modalities that could be used, and that’s pretty much as far as it went – no particular enthusiasm for it vs others. This wasn’t even just in the context of my case, but part of a general discussion.
When I asked what to do if there was a recurrence, he said that this was unlikely to happen, but lap mesh would likely be the best choice.
I really think they should follow some guidelines on hernia size and maybe other anatomical aspects, just like they do with the weight. They obsess a lot about the weight, and not at all about the hernia size. The Germans do factor the hernia size into their decision, with a hernia defect size limit. The Germans also do a careful ultrasound as part of the process of figuring out the best treatment for the particular anatomy. They can also make the decision that mesh is more appropriate during surgery, which Shouldice does only in extreme cases. You probably don’t want Shouldice to do mesh on you actually because they don’t get much experience with it…