Chronic pain the data?

[Chuck]

Our friend watchful based his surgical decision in part on chronic pain risk…..he says something i have not heard…that tissue repairs had an order of magnitude less risk of pain…1 percent vs 12 percent…I am not sure where he is getting these figures but in a large study cited by Dr Towfigh, the chronic pain rate for open surgery at 3 months was 15 percent….and it was the same whether mesh was used or tissue. Mesh caused the pain or nerve damage caused it. Dr T goes on to say Lap risk of pain is lower…a finding confirmed by Dr Voeller in his infamous debate with Dr, Bendavid. This is the reason i selected Lap surgery—and there were other studies online supporting lower risk of chronic pain with lap. So not sure where the esteemed watchful came up with 1 percent chronic pain rate for tissue. Even netto at shouldice says shouldice chronic pain rates are certainly higher…maybe even 5 percent…then there is the study i found which found shouldice at a 36 percent chronic pain rate. I hate mesh. But I wonder whether all the tissue repair is less painful propaganda stands up. Bryant—which way are you leaning for your repair. I alwasys ask you because you are a keen student and you have to make a decision. I am still stumped…and i have the additional issue of having to do a repair over mesh removal tissue

[Watchful]

Chuck,

I said that this has been the impression here (at least in the past) – that chronic pain is much lower with tissue repair than mesh. If not, why even bother with tissue repair? It certainly doesn’t win on the recurrence front, and it’s extremely hard to find a surgeon for it. I also said that it appears that this impression about chronic pain of tissue vs mesh may be wrong. For example, if you look at the data from Dr. Kang.

The “official” chronic pain number from Shouldice has been 1%. They now sometimes say 2%. The reality is that they haven’t studied it. They are studying it now, but with a very lacking methodology because they aren’t following up with patients like Dr. Kang did.

I think their past recurrence rates of 1-2% were substantiated properly in a study that’s fairly old now, but chronic pain is a different story.

Dr. Lorenz says 1-3% chronic pain for Shouldice. Dr. Conze says no chronic pain other than maybe one or two cases. Dr. Muschaweck said no chronic pain during her interview with Dr. Towfigh. Strange…

[Chuck]

And yet i found a guy who claimed he was destroyed by Muschaweck….i dont think any of these quoted statistics mean a thing.

[Chuck]

And i wonder how they are defining chronic pain…I think kang would say 1-2 percent if asked…but he is talking about the worst chronic pain category. Just curious…you were so enamored with Conze and probably rightly so. What caused you to go to shouldice? I have read the shouldice facilites are antiquated and run down…whereas everyone raves about Conze facility and kang’s facility.

[Chuck]

Also the chronic pain data always seems to favor lap mesh repair….didnt you find that to be the case. I didnt want to use plastic mesh but everything I read and every doctor I talked to said lap mesh was the lowest risk for chronic pain. My friends really screwed me…they both had no issue with lap mesh. They said why would you want to do this the “old way”….they said our friend did that and he nearly passed out when he woke from surgery due to the pain. Same for another friend who had a tissue repair in the 80s…most pain he ever had in his life on waking up –you yourself experienced horrible pain. I just don’t know where all this tissue repairs are safer and better comes from. In my experience the folks with the least issues had open mesh. And these were the folks that did the least research….when i tell them about the risks they faced they didnt even know about them at all

[Watchful]

I agree that these statistics quoted by the surgeons don’t mean much, although this wasn’t so clear to me in the past. These stats should be ignored unless the surgeon has done a proper study with proper follow-up and with transparency on the definition of chronic pain. I don’t know of anyone who has done that other than Dr. Kang who actually did it recently, and he certainly deserves appreciation for doing it and sharing the results while other surgeons are too reluctant (or lazy) to do it.

I went to Shouldice because that’s basically the “Mecca” of this procedure, and they have the most experience with it. I thought Dr. Conze was great, but didn’t see a compelling reason to go all the way to Germany when the Shouldice Hospital is close. A lot of the issues that I’m now aware of with the Shouldice Hospital and how things evolved there were not all that clear to me before I went there.

Even with hindsight, things are not all that clear. For example, I don’t think Dr. Conze would have ultimately done Shouldice on me. I think he would have ended up using mesh. That would have probably been a good thing, but maybe not. Who knows with these things. It’s a mess.

[Chuck]

thanks watchful….just found this review on conze….there are no sure things with hernia surgery ….now i have a hydrocele on the side where i didnt even have a hernia and was double meshed for cash….every single study i saw said lap mesh was lowest risk for surgical pain and chronic pain….it beats open repairs by a mile…but very deceptive

4 days agoNEW
No trust big lier Dr Conze. He destroyed my life at all .
1

[Watchful]

This person has been leaving this kind of review for Dr. Conze on Google for almost a year now. He posts it, and then removes it, and then posts it again at some point later on – very weird.

[William Bryant]

Chuck, I’m not really sure. It’s a difficult choice. I still intend to have tissue repair as once mesh is in, it can be difficult to remove if a problem arises.

Which tissue method and surgeon I’m not so sure about.

Dr Kang
Dr Lorenz
Dr Conze

Would be my possibles. Dr Kang of he was nearer or I to him, I’d be there.

Its worrying that chronic pain seems a risk with all.

I’ve recently read about a study on chronic pain and things that I remember are

Pain before surgery can indicate pain after.

Pain less likely in older patients!

Not sure if this is consensus or just that papers.

Up until now I hadn’t paid much attention to collagen but wondering if it could be an issue ad I had a burn that took ages to heal. My doctor’s nurse didn’t say it was an issue but I had to go to urgent care at one stage and the triage nurse said “why is your skin so fragile”?

Recently I’ve had areas on my face that have bled. Asked pharmacist and they just said rash and maybe bite or ingrowing hair. I’ll see how I go but maybe ask doctor about collagen.

[Chuck]

Yes Bryant its a mindfield as you have said many times. Watchful said that tissue reapirs had a chronic pain rate of 1 percent…compared to 12 percent with mesh. I never saw that data. Everything i read said lap was the lowest risk of chronic pain. and lowest risk of post surgical pain…and mesh has a lower risk of recurrance….and lap mesh had few complications as compared to an open repair. I got the info that destroyed me from the Towfigh -Yunis interview and the Voeller Bendavid debate —i think most would agree that Towfigh and Yunis are probably two of the top surgeons in the US —and both were saying that lap mesh was the superior surgery in terms of recurrance and chronic pain. Watchful was insightful enough to see through this…I looked at open surgeries as painful…short term certainly and a good risk for chronic pain given all the cutting and sewing I never saw or read anywhere that open tissue repair were less painful…in fact that one study said shoulidce has a 36 percent chronic pain rate. I still have zero clarity on the least risky procedure…but I think Conze due to his experience and his abiity to do several different repairs. is the choice…I feel like i looked at this to death —yet somehow missed those 1 percent pain rates for tissue. EVery doc I went to made it sound like tissue and open mesh were old school…lap mesh was the gold standard…even my friends asked why i would want to do it the old way and wake up with massive pain….

[Author]

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