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Indeed, all cases aren’t equal. Weight can be a factor, and so can the size of the hernia, the tissue quality, and the particular anatomy of the individual. Certain tissue repairs (like Shouldice or Desarda) may not be a good fit for some individuals.
The problem is that if you go to Shouldice (and you aren’t overweight), you will get that repair regardless of the difficulty of the surgery in your case (as long as your tissues aren’t disintegrating). A difficult and long surgery is more likely to cause chronic pain and other complications.
If you go to Tomas, you will get Desarda. If you go to a mesh surgeon, you’ll get mesh. There are extremely few surgeons who can tailor the repair, and most of them don’t have a lot of tissue repair volume. I think a few German surgeons are the exception, but even they have their limitations. For example, the ones with a lot of tissue repair experience don’t do lap or robotic mesh, just open mesh.
Things are further complicated by the fact that the surgeon may not be able to tell in advance what the best approach would be in your particular case, and this may become evident only after they cut you open.