13 Questions to Ask Before Inguinal Hernia Shouldice Repair
Hernia Discussion › Forums › Hernia Discussion › 13 Questions to Ask Before Inguinal Hernia Shouldice Repair
Tagged: preop questions, Shouldice, Yunis
- This topic has 46 replies, 9 voices, and was last updated 10 months, 1 week ago by
Monika.
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AuthorPosts
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11/10/2020 at 5:20 pm #28202
Thunder Rose
ParticipantI am 3 weeks out from my Shouldice repair from Dr. Yunis in Sarasota, Florida. I have had an extraordinarily smooth recovery and I am very happy with my repair.
I talked to a large number of surgeons while watchful waiting for 5 years. By the time I met Dr. Yunis I had prepared a rather intense written cross-examination. I think I gave the impression of being very nervous, but the result of having all my questions answered in advance was that I felt very relaxed on the day of surgery and confident in my choice of surgeon.
Here is my slightly revised list of questions for those considering an Inguinal Hernia Repair, along with roughly what I wanted in response.
Questions for Surgeons Prior to INGUINAL Hernia SHOULDICE Repair
1. Will it be an option to choose local anesthesia with I.V. Conscious Sedation instead of General Anesthesia?
— I had to specifically request it at the surgical center, but I did receive I.V.C.S. It was not my surgeon’s preference but the anesthesiologists were more than happy to do it and told me it would reduce my post-operative nausea. I asked about General Anesthesia being safer for monitoring the airway and was told that this would only be a factor to consider if I were 200 pounds heavier (I have BMI ~23-24).
2. Do you routinely transect any of the three nerves (genital branch of the genitofemoral nerve, ilioinguinal nerve, or iliohypogastric nerve)? For what reason(s) would you transect any of these?
— The answer should be that they never routinely cut any of the nerves. I liked Yunis’s response — roughly, ‘no one does that any more!’ — which while untrue conveys that he’s not going to transect any nerves without reason.
3. Do you routinely ligate and resect the hernia sac? Under what circumstances would you do this?
— Answer should at least show awareness that there’s research correlating this with post-operative pain. I accepted that the sac would be ligated and resected depending on the gestalt.
4. What type of suture material would you use for the reconstruction portion of the Shouldice repair?
— I wanted Prolene. I believe this is the material used for Shouldice repairs by Towfigh, Muschaweck, Yunis, and Wiese. My understanding is that Brown uses silk, Sbayi and Shouldice Hospital use stainless steel 32 or 34 gauge, and Grischkan uses Polybutester.
5. Is there potential that during a planned tissue repair you would need to use mesh? What type of mesh would you use under those circumstances?
— I agreed to a Nyhus-type posterior placement from an open repair flat polypropylene mesh if my hernia turned out to be femoral. I had been assured by another surgeon that it was definitely not femoral so I felt the risk of this was low. I felt this approach and type of mesh was safer than a laparoscopic posterior mesh which would have been contoured and larger (Bard 3D).
6. Females only: Do you routinely transect the round ligament? I am aware that most surgeons consider it vestigial.
— I decided to accept this being transected, but I think it’s good to ask. Patients with high risk of uterine prolapse might want to make the case for it to be saved.
7. For the reconstruction portion of your Shouldice repair, how many lines of sutures do you run over the posterior wall of the inguinal canal? Are you running 4 lines formed by two sutures as in the Shouldice repair described in Glassow (1973: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941165/pdf/canmedaj01661-0043.pdf) and Bendavid (1997: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952996/) or are you running two lines formed by one suture on the posterior wall as in various modified 2-layer Shouldice repairs?
— Answer I wanted: 4 lines formed by two sutures.
8. For your first two lines on the posterior wall, which structures are being sutured? Do you double-breast the transversalis fascia, or is the remaining flap of transversalis fascia not included in the second line?— Answer I wanted: that the transversalis fascia is sutured first to the back side of the superior wall (conjoint tendon) and then to the inferior wall at the inguinal ligament. The terminology varies by surgeon so it can be hard to parse.
9. If you’re placing a 3rd and 4th line on the posterior wall, which structures are sutured? (Only in general terms. I realize that the structures on the superior wall vary over the length. I am most interested here in the inferior wall as I find it curious that in Bendavid’s reconstruction (cited above) his third and fourth line are to the external oblique aponeurosis just above the inguinal ligament while Glassow and other descriptions I’ve encountered suture to the inguinal ligament itself.)
— Answer I wanted: confirmation that the 3rd and 4th lines are part of the reconstruction and that the surgeon understood the question.
10. For the closing of the external oblique aponeurosis on the anterior wall do you use an absorbable suture?— Answer I wanted: confirmation that they’re not going to add a Desarda repair on top! I wanted to know that this would be an absorbable suture. Answer I got was short term vicryl.
11. What type of incision do you make? What type of skin closure?— I wanted an oblique incision and running subcuticular skin closure.
12. Does your Shouldice repair include “two sutures to close the gap between the transverse muscle and the femoral ligament”? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235020/pdf/annsurg00046-0039.pdf)— Answer I got and don’t really understand: Rarely-because of the risk of femoral vein compression.
13. Men should ask about partial vs. complete loss of the Cremaster muscle.
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11/10/2020 at 5:31 pm #28203Participant
I found the six-sided box model to be very helpful for gaining a rough understanding of the inguinal canal:
https://en.wikipedia.org/wiki/Inguinal_canal#Walls
I also found watching YouTube videos of Shouldice Repairs to be very helpful for visualizing the surgery:
a more recent 2-layer Shouldice:
an older 4-layer Shouldice:
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This reply was modified 2 years, 4 months ago by
Thunder Rose. Reason: tweaked a line break to improve URL appearance
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This reply was modified 2 years, 4 months ago by
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11/12/2020 at 12:27 pm #28210
Eu
ParticipantGreat posts, just in time for me as I am scheduled to talk to Dr Yunis later this month. Thank you! How big was your incision? How long have you experienced post-op pain and what meds did you use for it? If you experienced nausea and bloating prior to the surgery (I have a low-grade nausea and bloating over the last month or so), do you still have it?
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11/12/2020 at 1:27 pm #28211Participant
Hi Eu, Answering your questions one by one:
1. How big was your incision?
— Yunis told me ahead of time it would be larger, but it’s only 6 cm (just under 2.5 inches). I am extremely fine-boned so my best guess is he adjusted the incision to my frame.
2. How long have you experienced post-op pain and what meds did you use for it?
— I did not fill my prescription for pain meds (I think it was a codeine with acetaminophen). I used the maximum dose of over the counter Tylenol and Ibuprofen for about a week, and then a lower dose for another week. I walked two miles the evening after my surgery and two to three miles including uphill hiking every day after that. I had some bloating after the surgery and some swelling with a healing ridge. Superficially I only had one small bruise about an inch across and then a second one-inch bruise appeared three days post-op.
We stayed 8 days in Florida for a bit of vacation so I had an in-person follow-up and they did comment that many patients have much worse bruising and swelling, and larger incisions, than what I experienced.
I have been doing some light jogging starting at 2.5 weeks post-operatively. I think everyone’s pain tolerance is different, and my bulge had grown so large and bothersome that the nuisance of a healing surgical wound was immediately an improvement for me over the hernia.
3. If you experienced nausea and bloating prior to the surgery (I have a low-grade nausea and bloating over the last month or so), do you still have it?
I didn’t have nausea, but I did have a feeling of needing to lie down to reduce the bulge and my ascending colon would feel bloated and gassy. Every digestive complaint I had before the operation (mainly sluggishness) has been resolved. My bulge had grown to roughly tennis-ball sized and my defect turned out to be direct.
For me, the decision to go to Yunis was predicated on confirmation I would only receive a Shouldice repair, not a Desarda, independent of my defect type (direct vs. indirect).
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11/12/2020 at 2:22 pm #28213Participant
TBH my husband did all the cooking, cleaning, and managing kids for a week. Walking, hiking, even getting in and out of a car repeatedly for hours while going birding at a state park was fine but I didn’t want the kids bumping me (I have very active 7-year-old twin boys). I was doing computer work (designing catalog layouts) (while on vacation) starting the day after my operation, but only in bursts of thirty minutes on, thirty minutes off, and against doctor’s orders to wait until day three to return to office work.
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11/12/2020 at 5:49 pm #28214Participant
Thanks for your detailed answers. My understanding is that you had a chance to speak with anesthesiologist re the type of sedation you wanted. At the Shouldice Clinic they use a combo of a 18-hr med. and a short lasting ones. Was it what you’ve got? Did Dr Yunis recommend any physical therapy after the surgery? If mesh had to be used, what options did he give you?
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11/12/2020 at 6:55 pm #28215Participant
Anesthesia: I don’t know the specific meds. At the surgical center I first signed a paper where the two main options were General Anesthesia or Monitored Anesthesia Care (MAC, i.e. IVCS) and I only signed permission for MAC. Then I spoke to the anesthesiologist and finally to the anesthesia nurse. If you want to know the specific meds you could try calling Sarasota Physicians Surgical Center. I shadowed a pulmonologist during an endoscopy under IVCS years ago so I felt like I knew what I was agreeing to. Apparently typical patients are awake but then have amnesia, but they told me afterwards that I was atypical and snored through my procedure.
Yunis did not recommend PT. For the days immediately following the procedure he recommended walking rather than biking (in contrast to Shouldice Hospital). I followed the advice reported in reviews of the German surgeons like Wiese and Koch and tried to do a lot of walking immediately.
Regarding mesh I was pretty confident mine wasn’t femoral so I wasn’t too concerned Yunis would place mesh. His office has separate paperwork to sign allowing a tissue repair and not permitting mesh placement so I think one can go in confident mesh will not be placed unless the patient has given specific permission. My understanding is Yunis does not use polyester mesh like Parietex Progrip and does use Polypropylene mesh (smaller flat for Nyhus, Bard 3D Max for laparoscopic).
Sbayi surprisingly offered lots of different mesh and honors patient request for mesh material– we discussed Ovitex, “thicker biologics”, and Phasix synthetic absorbable. With Sbayi we discussed a “complete blow-out” of the inguinal canal floor and using G.A. or relaxing incision first before turning to mesh. I believe Yunis was more confident indicating he can do a Shouldice for inguinal defect of any size.
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11/12/2020 at 8:00 pm #28216Participant
Has Dr Yunis succeeded sparing all the nerves or some had to be cut?
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11/13/2020 at 10:37 am #28228Participant
My understanding is none of the nerves were cut and I have no reason to think otherwise.
One surgeon who told me he would transect the genital branch nerve told me it would take 6-24 months to grow back and I would have numbness. I have nothing like this. Another surgeon told me he would transect both the genital branch and the ilioinguinal nerves. My understanding is Yunis does not take nerves in a primary repair.
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11/13/2020 at 1:02 am #28220
drtowfighKeymasterThis is a fantastic thread. Thanks for sharing.
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02/26/2022 at 3:03 pm #30801
Debbie
ParticipantSo glad you’re doing well. Wow. Very informative. It seems that you did a tremendous amount of research. Can I ask what your reasons were to use Dr Yunis or dr. Sabyi and others? Thank you
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02/26/2022 at 3:05 pm #30802Participant
Correction. Can I ask what your reasons were to us Dr. Yunis over Dr. Saybi or others? Thanks
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02/27/2022 at 9:00 am #30820Participant
Hi Debbie, Sbayi uses metal sutures and insisted on General Anesthesia. I decided I wanted Prolene and Monitored Anesthesia Care (MAC) / Conscious Sedation. Yunis uses Prolene and offered MAC in an outpatient surgical facility instead of a hospital setting. I could have had the same (Prolene Shouldice repair w/MAC in outpatient facility) from Dr. Wiese in Germany and probably would have gone that route if not for COVID. Yunis was out of network for my insurance but the facility and anesthesia were in-network: it wound up being less money out of pocket even than the flat rate for Wiese, so it worked out in my favor.
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02/27/2022 at 10:32 am #30822
Watchful
ParticipantI’m surprised Dr. Sbayi wanted general anesthesia. Was this because of anything specific to your case? He normally uses local+sedation. Dr. Yunis actually prefers general, but will do local if you insist.
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02/27/2022 at 10:41 am #30823Participant
Watchful: you’re correct: I made an error above. Sbayi uses conscious sedation, though my notes show he told me that he “may introduce general aneasthesia to let muscles relax” although I believe he said that’s rare.
As you say Yunis prefers GA but allows for patients to choose MAC. I was able to choose at a private conversation with the anesthesiologist immediately pre-op at the facility.
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02/26/2022 at 11:20 pm #30816
Monika
ParticipantHi Thunder Rose , I understand you went for Shouldice repair , did you ever consider any other technique like Desarda or Marcy at all. Would you mind telling me what made you go with Shouldice technique?
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02/27/2022 at 9:10 am #30821Participant
Hi Monika, I was interested in a Marcy repair until a surgeon said my hernia was most likely Direct (based on its shape and size). It did turn out to be a Direct Hernia.
Have you found a surgeon who will do a Marcy repair for an adult without reinforcing with Desarda? I suppose Kang does.
Watching YouTube videos of the Desarda repair ended any interest I might have had. It doesn’t make sense to me anatomically, and I think I was influenced by comments Towfigh has made about not doing Desarda repairs and the absence of evidence for the procedure. I only went to Yunis given reassurance that he would honor my choice not to have a Desarda repair.
I haven’t been thinking much about hernia repairs for over a year. I have not been following new research and opinions on these repair options.
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02/27/2022 at 3:00 pm #30825
Jack
ParticipantThis is such a great list, you really did your homework. Obviously only an issue for males, but is resecting the cremasteric muscle, per the Shouldice Hospital technique really a cause of sagging down there? I gather it’s done to give the surgeon a better view of other possible hernias. I wonder what the impact on patient is as it seems like many who modify the a Shouldice technique (like the surgeon you went to) leave this out.
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02/27/2022 at 9:42 pm #30837Participant
I didn’t research this.
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02/27/2022 at 5:57 pm #30826Participant
Hi Thunder Rose ,
Thank you so much for getting back to me . I have noticed you had the surgery way back . I haven’t found any doctors who perform Marcy repairs as yet however I understand that it’s not invasive . I live in Sydney and unfortunately the only surgeon who does tissue repair performs Desarda technique . I know you have done lots of your own research on it and I thought I might ask you for your opinion on a Desarda method and any cons you might have . I am considering going to Florida for Shouldice . I understand you are still happy with the repair ? Again thanks so much for your reply .-
02/27/2022 at 8:52 pm #30832Participant
Yes I’m still happy with my repair. I live in Wyoming and since my repair have done nearly two full ski seasons (Alpine and Nordic) and quite a bit of running, hiking, and biking. I don’t have any pain with exercise.
Very rarely when at rest I get a twinge or brief ache of scar tissue pain at or near the surface of my skin, but I don’t have any pain deeper down at the site of the repair in the inguinal canal.
Sorry, I don’t feel qualified to give more specific critique of the Desarda repair. I suggest watching the YouTube video of Desarda himself demonstrating the technique. My memory is that it gave me the willies watching him pull tissue under the spermatic cord that should have been over it.
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02/27/2022 at 7:44 pm #30827
Chuck
ParticipantThunder Rose…you are the goddess of hernia research…i foolishhly overlooked your killer threads and selected a mesh repair that has me in a world of hurt…really disappointed in myself because i typically do the level of reaserch that you do on all things health related…and this mesh has really tanked my health…do you have any opinion on mesh removal? i Always wondered why you completely passed on kang and peterson…peterson is a jerk for sure ,,,but he does have massive experience at doing a shouldice repair. he has easily done three times the number of repairs that yuhis has done but you never mention him in your analsys…if i could turn back the clock kang would be my pick…i dont think anyone can compare…thanks for all of your great posts
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02/27/2022 at 8:36 pm #30831Participant
I never talked to Peterson. I piggybacked on another HerniaTalk user’s research in ruling him out (that was privately shared with me). The info I received was that he uses individual sutures instead of running lines, and I knew I wanted running lines.
I don’t have informed opinions on mesh removal, but my uninformed opinion is that it’s a more specialized surgery than a tissue repair, and I’d be more willing to spend the money to see someone like Towfigh to have a chance of getting my health back without the solution being worse than the problem.
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02/27/2022 at 7:46 pm #30828Participant
And why wiese over koch…if i had been plugged into your thread when i was doing my reaserch no telling the suffering i would have avoided
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02/27/2022 at 8:24 pm #30829Participant
Hey Chuck: Wiese vs. Koch: I know that Wiese uses Prolene for his Shouldice repairs because of this thread: https://herniatalk.com/forums/topic/my-meshless-hernia-repair-in-germany/ I’m not clear if Koch uses Prolene or Stainless.
I almost went to Wiese because I had to make a family trip to Ulm in spring 2020. I was going to have my hernia surgery before flying home from Frankfurt. Then COVID hit and I cancelled my surgery. My hernia became much worse in Summer 2020 and that’s when I found HerniaTalk and did a lot more research.
So there’s some random geographical bias in my mentioning Wiese. I sent BioHernia better-informed questions in fall 2020 for both Koch and Wiese but I didn’t get any answers, just a response from Nahom that he realized I still couldn’t get into Germany at that time on a US passport. These are the questions I sent Nahom, copied from my email:
…is it possible to ask Dr. Wiese or Dr. Koch some questions about the particulars of their repairs? I’ve come to understand that not all Shouldice repairs are equivalent. For instance,
1. Do you transect the genital branch of the genitofemoral nerve routinely? Do you identify and protect the ilioinguinal nerve or is it transected?
2. Do you transect the round ligament routinely?
3. Do you ligate and resect the hernia sac routinely? In what circumstances would you do so?
4. Does your Shouldice repair always include 4 lines of sutures on the posterior wall (2 sutures each reversed to make 4 lines total) or do you place 2 lines on the posterior wall? Which structures are being sutured together in the reconstruction on the posterior wall?
5. What kind of suture material do you use for the posterior wall reconstruction? For the closing of the external oblique aponeurosis? For the skin closure?Also, is it possible to request a Shouldice and not a Desarda repair, or is it up to the surgeon to select the repair type during the operation?
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02/27/2022 at 9:03 pm #30833Participant
Hi Thunder Rose,
The information in your thread has been very helpful. It looks like you got a great result from your surgery with Dr. Yunis – a good repair without issues. I wish more people reported their experience and results here.
One question is why you wanted to avoid steel sutures. I think you mentioned somewhere that you were afraid that they would break. Was there a reason to expect this, or to be concerned about this? The suture material is one of those aspects of the surgery where it’s not clear if the Shouldice Hospital is doing things just because of historical reasons (why mess with a winning formula?), or whether it’s indeed the best way of doing things. I think in terms of sensitivity or allergies, there are rare cases of Prolene reactions, and there are rare cases of reactions to metals in steel. I don’t know if one is better than the other, if steel elicits less inflammatory response, etc.
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02/27/2022 at 9:33 pm #30836Participant
I love that I’m getting called out for personal biases. I made crafts a few years ago with my kids using a similar gauge of stainless steel to what they use at Shouldice Hospital (32 or 34 gauge): tiny posable beaded animals using seed beads. Here’s a link that’s very similar https://stuwahacreations.com/2014/08/20/how-to-make-tiny-beaded-geckos/. They lasted a few weeks and my kids played with them and eventually that wire snapped with not much bending back forth. So I have an image of those tiny bifurcated gecko bodies with tiny sharp metal points jabbing out their middles that I cannot forget.
I also think Grischkan made a comment to me about the stainless steel sutures snapping as a reason why he uses polyester sutures despite having close ties to Shouldice Hospital.
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02/27/2022 at 10:04 pm #30839Participant
That’s a reasonable concern, at least in theory – thanks. Whether it happens in practice or not, who knows… Since the advantages of steel when compared to Prolene aren’t clear either, I can see why going with Prolene can seem more reasonable.
On the other hand, there’s all this fear of foreign body reaction with Prolene mesh, and I’m not sure why the same wouldn’t happen with Prolene stitches. The amount isn’t the same, of course, but there’s still a significant amount of material even with the stitches.
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02/28/2022 at 7:10 am #30853Participant
I was influenced by the idea that for the majority of people it’s not reaction to the mesh itself but badly placed mesh that causes the problems, hence mesh plugs and system meshes causing issues with such frequency. I extended that thinking to even the flat meshes bunching/migrating over time: perhaps there’s no such thing as well-placed mesh. It’s the quick, easy, literally band-aid-like solution, but not a good choice for an enduring pain-free repair.
Yes, there’s a large body of material in my Shouldice repair’s four lines of running sutures. Prolene sutures are used internally throughout medicine without the level of issues we see with Polypropylene mesh, which leads me to think the problems primarily arise from the form (mesh) not the material (polypro).
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02/27/2022 at 9:16 pm #30834Participant
Hi Thunder ,
That’s really great to hear that your repair is doing so well . Thank you for sharing with us all of your research, it has been super helpful . I’ll definitely look at the YouTube . -
02/27/2022 at 10:20 pm #30840Participant
Hi Thunder Rose,
First, I wanted to thank you for all the research you’d done and then shared with the forum and for your detailed responses to my questions. This info became the basis for my research and decision making. I had a Shouldice repair by Yunis 4 days ago. The day of surgery I walked 3 miles and the next day started driving. I want to wait for two full weeks to see if there are any significant side effects to share with the forum. As of now, I am happy with the results. I believe Yunis is an exceptionally good surgeon, who is deeply passionate about what he does. I hope to share more soon. -
02/28/2022 at 12:10 am #30843
William Bryant
ParticipantPlease EU, do keep us updated as it means a lot to those considering surgery to hear from the really good, successful ones.
And thanks to Thunder Rose for posting 2 years later! Appreciated
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02/28/2022 at 12:13 am #30844Participant
Hi Eu,
Great to hear your op went so well with Dr Yunis . Please do come on hernia talk again and share with us your experience. It seems like everyone on hernia talk really has great experience with dr Yunis . I was actually considering going to Germany for the surgery however now I am seriously considering dr Yunis -
02/28/2022 at 2:15 am #30848Participant
Monika, who in German were you thinking of? I’ve considered Drs Koch/Weis/Lorenz. And also Dr Kang and Prod Desarda.
Still not chosen!!!Like Dr Kang and the German Drs there are a couple of less than positive reviews for Dr Yunis.
Not sure it is possible to find a surgeon with 100 percent good reviews!
So difficult to decide.
Then there’s cost!!!
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02/28/2022 at 2:19 am #30849Participant
Thunder Rose, could I just ask ref Desarda… Why didn’t it make sense anatomically? Is it because it cuts good tissue?
I’m not as good with the biology/anatomy as you and other posters.
I understand Desarda repair cuts a piece of good tissue?
However isn’t it an easier repair? Shouldice is very complex?
I’m not denigrating either or any but at some point, like everyone, I have to choose
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02/28/2022 at 7:34 am #30854Participant
William, I suggest watching the surgical videos for both Desarda and Shouldice on YouTube and considering the 6-sided-box model of the inguinal canal. Being able to visualize the repairs helps a lot. The Posterior and Anterior (back and front) walls are opposite each other, the Inferior and Superior (floor and roof) walls are opposite each other.
The hernia sac comes through a defect or enlarged ring on the Posterior Wall – the back wall. In Shouldice the faulty Posterior wall is first cut and then rebuilt using the structures on either side of the Posterior Wall (from the Inferior and Superior walls, the floor and roof of the box, where they are adjacent to the Posterior wall) to create the “double-breasting” like a fancy jacket.
The Desarda Repair takes the Anterior wall, that is the FRONT wall or opposite side of the box, the External Oblique Aponeurosis, cuts it into a giant flap and pulls it underneath the Spermatic cord and everything else that passes through the canal, and then stitches that to the BACK wall to make a flap that functions like a flat mesh would.
I believe surgeons like Desarda repairs for the same reason they like mesh: it’s a big flap that is easy to fix in place and cover a defect. It’s an easy to teach repair.
Yes, both repairs cut into healthy tissue. Shouldice is a clever bit of double breasting using structures immediately adjacent to the defect. Desarda is borrowing tissue from the top of the box and tacking it onto the bottom of the box, creating a mesh-like tissue repair.
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02/28/2022 at 3:29 am #30850Participant
Hi William,
I was thinking about Dr Conze from hernia clinic in Munich . I’ve seen very positive reviews of him on hernia talk . He dose Shouldice repair and Desarda . I will email him with some question . It’s super hard to make a decision when it comes to the technique or doctor . I really like the way Yunis seems to listen to patient wishes. I am in a super fortunate position where the money is not an issue and to be honest I just want to get this done really well and minimise risk of any complications ect. Are you thinking of going somewhere outside of Uk ? -
02/28/2022 at 4:07 am #30851Participant
Yes I am thinking of outside UK possibly, Monika. Even though I’m not a good traveller.
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02/28/2022 at 6:30 am #30852Participant
I think what some people don’t like about Desarda is that a flap is cut from an unrelated muscle (external oblique aponeurosis) and used in the repair. However, tissue is cut in the Shouldice procedure as well – flaps from the transversalis fascia. It involves pretty extensive dissection. Also, the cremaster and its nerve in men (in the unmodified procedure), and the round ligament in women.
I’m also considering Dr. Yunis among others. He seems very capable and has a few Shouldice success stories here. On the other hand, he does primarily mesh, and relatively few Shouldice and Desarda. My impression has been that he actually prefers Desarda to Shouldice due to its relative simplicity.
I’m surprised that there are no reports here of surgeries with Dr. Sbayi who has done more Shouldice procedures.
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02/28/2022 at 8:18 am #30855Participant
The external oblique aponeurosis (EOA) is cut in both Shouldice and Desarda. It’s the anterior wall of the canal: it is cut to gain access to the inguinal canal in both repairs. See my response to William above for why I’m against the Desarda repair.
Unlike a general surgeon, Yunis is only doing hernia repair: “relatively few” Shouldice and Desarda is still a high raw number of tissue repairs annually.
I had to practice cognitive flexibility to accept that Yunis preferred Desarda repairs. I was focussed on achieving the end result — an out-patient, conscious-sedation, Prolene 4-line 2-running-suture Shouldice repair — that I wanted, and ultimately determined that with Yunis I could have my desired outcome.
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02/28/2022 at 9:46 am #30856Participant
Sometimes there is even an additional step in Shouldice which is a relaxing incision with the goal (I believe) of bringing closer together tissues that need to be stitched and reducing the tension. I don’t know the details. I guess this would depend on the quality of the tissues and the size of the defect. Shouldice is not a simple technique.
A big problem with hernia surgery is that insurance companies don’t pay much for it, and this leads to preferring simpler and faster procedures which can be higher volume.
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This reply was modified 1 year ago by
Watchful.
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This reply was modified 1 year ago by
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03/01/2022 at 5:11 am #30873Participant
Just as Dr Yunis was sounding like good option I’ve found a bad review sadly so like Dr Kang, the Germans, Shouldice etc. Not 100 percent. This person had to have osteomy bag after bowel damaged and still has hernia.
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03/01/2022 at 6:42 pm #30880Participant
Hi William ,
Where did you find this review? I guess no one will have perfect reviews. You could always try consider the surgeon in the Uk Dr Bailey or one of the surgeon in Germany as it very short flight away . One of the reason I struggle to fly far away for the op is that something might go wrong and it would be better to have the doctor close by . -
03/01/2022 at 8:22 pm #30882Participant
Monika, Ive re-read it, and it relates to a mesh repair.
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03/01/2022 at 8:58 pm #30883Participant
Thanks William . Did you think about contacting Dr Bailey in Uk ?
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03/01/2022 at 11:49 pm #30884Participant
I have Monika but I can’t find any reviews about his tissue repairs and I believe he cuts cremaster etc.
He did do one of the strictly dancing celebs “hernia” but suspect it was sports hernia. I only found that in a local paper online.
Apart from that cant find much about him
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05/26/2022 at 5:22 am #31648Participant
Hi Thunder Rose,
Sorry to bother you again however I am in a bit of emergency situation as on top of my inguinal and umbilical hernia they now found a famoral hernia as well! I have been looking for any info on famoral hernia but can’t find much . I know you were preparing for eventuality of your hernia being famoral hernia. Did you ever consider tissue repair if your inguinal hernia was actually famoral hernia? If not could you please tell me why not? And what sort of repair were you prepared to have if it was famoral hernia. I really don’t want to go with mesh .
Would really appreciate any feedback you may have .
Monika
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