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No mesh tissue repair surgeons in Washington or Oregon?
When it comes to inguinal hernia repair, tissue-based repairs are certainly becoming a lost art, as Dr. Towfigh already alluded to. Mesh-based tension-free repairs are the norm, at least in the United States. Much of this is due to surgical training in the U.S., with tension-free (Lichtenstein) repairs being taught almost universally, while tissue repairs are rarely taught. While tissue repairs can offer a solid repair, this is best undertaken at a high volume center or with a surgeon with more experience in these types of repairs.
Personally, I do not perform tissue-only repairs in the elective setting. This is due to the fact that I believe that mesh-based repairs are superior in the majority of patients, as well as my limited number of cases in which I perform tissue repairs (namely, only emergent cases where mesh is contraindicated). Additionally, traditional tissue-based repairs are repaired in an open fashion (one bigger incision). Minimally-invasive approaches such as with laparoscopic or robotic-assisted surgery (few small incisions) require mesh placement for reinforcement of the hernia, thus precluding tissue-only repair in the majority of patients.
With regards to the comment that it would be ok to have another repair in 15-20 years, I would argue that doing it right the first time with the most effective repair should be the norm. Re-operative surgery greatly increases risk of subsequent recurrence, chronic pain, and other potential challenges during the re-repair. While no procedure has a 0% recurrence rate, tension-free mesh repairs have been around for many years and have very good long-term outcomes.
Unfortunately, I do not know anyone in the Portland area that routinely performs tissue-based inguinal hernia repairs, but I will keep my ears open and will re-post if I hear something.