Reply To: Disadvantages of Shouldice repair?

[mst3k]

I have read a little about your experience on this board and unfortunately you are not the only one I’ve seen that had to go through that. Your experience is probably what I would fear most: having to go through removal once it has been incorporated in tissue. I don’t understand what causes the mesh in some people to fold up and get rock hard and that scares me. Cases like yours really weigh on my mind and are why I haven’t done anything for over 4 years.

I had planned for the last several years to go to Shouldice when the time came (before the Dr. in Stony Brook was an option). But since this summer, I really tried to read all I could from different perspectives. I really wanted to understand why almost all Drs. want to use mesh. I read the HerniaSurge international recommendations, the EHS recommendations, and considered their advice on using mesh. I watched the Shouldice repair a few times, and in a small way I “saw the light”. It looks like a complicated surgery just to fix a hernia and there is a lot of blunt dissection and cutting, pretty much down to the floor of the inguinal canal, and then a lot of suturing to recreate it. You lose the cremaster function completely, although one can live without it. Things can and do go wrong in it, and I can see why it would lead to chronic pain also. The results and the tightness of the fascia afterwards are all in the hands of the surgeon. In fact I was sufficiently scared of a Shouldice too. It can make Laparoscopic insertion of mesh look attractive again. It’s just a different angle of looking at things.

Also, I started watching the SAGES seminars on youtube, and Dr. Towfigh and many colleagues make presentations concerning chronic pain and complications in hernia repair, so they are aware of it and some very smart and talented surgeons are always working on improving things. If it was as easy as “just do Shouldice”, they would do it. It may be complicated but not beyond their abilities.

I ended up seeing a couple of Docs, and ended up scheduling mesh surgery in three weeks from now, but I’m not done seeing Docs yet. I still have open questions and often consider cancelling the surgery. I’m still trying to understand from all angles.