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That makes sense – while they noted no difference in short-term outcomes between low- and high-complexity recurrence repairs, they suggest that may be at least in part to their allocating the more complex cases to senior surgeons, the in-op consult option for juniors, etc…however, that skill/experience is not available everywhere, so if an ‘easier’ repair option is available (and widely available), it makes sense to consider that option.
That same logic could indeed apply to more complex or higher risk primary repairs, like larger hernias. Patients should be made aware of how THEIR hernia and overall situation relates to various repair options so that they can make a more informed choice. From strictly a recurrence standpoint, I suppose one potential benefit of going with tissue repair, like Shouldice, is that a lap mesh recurrence repair would be considered ‘easy’? Whether the potential benefits of possibly avoiding mesh in the first place are worth any unique risks of complications going with the more complex repair to see if it ‘sticks’ is debatable and we don’t have any good data on that yet, AFAIK.
I share that sense of mystery (a ‘healthy skepticism’, you might say) with Dr. Kang’s perspective. I’m all for whatever works best, so I do hope we see reliable, published data at some point.