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All good points, Good Intentions.
The problem is partly that patients and surgeons look at the same problem differently and perhaps there is some loss in translation.
When I mention the importance of listening by the surgeon, you validate my point because it frustrates you when your surgeon barely hears your words. Also, listening and learning from the patient allows the surgeon to tailor the operative plan to each patient’s needs.
Recurrence is not the only outcome by which we measure hernia repair success. That was proven to us in the mesh era, when recurrence became a much lower problem (as compared to non-mesh tissue repairs), and chronic pain raised as a more important outcome of measurements. Almost all modern studies, including outcomes databases such as the AHSQC, include short term and long term quality of life parameters as a measure of outcome, and therefore success, of hernia repairs. That said, hernia recurrence can significantly affect quality of life, so it should not be discounted as one of many outcomes factors. Europeans are much more advanced in tracking population data than in the US.
There are a few surgeons, Dr. Ramshaw being one of them, where research is being performed with the goal of helping predict the best plan of care/surgical technique/mesh implant, etc., for each patient characteristic. It is quite a complex system of analysis. To date, there is no science that can predict the best surgeon/technique/implant for each individual patient. Each surgeon can only apply his/her best knowledge and experience to help determine that on an individual basis.