Desarda vs Grischkan’s two-layer Shouldice, etc…

[Casimir]

@ddot14
About your comment about follow up, I only speak from my experience, but Dr Grischkan has been very diligent regarding followup. The exact opposite of what the experience was with Dr Tomas and that entire organization.

In fact, I recently emailed Dr Grischkan on a Saturday night. I didn’t expect a response for a couple of days, at least. But I got a call a little later that Saturday night. I missed the call but got the voicemail, and I thought wow that is great, and thought that would be that. Then the next day, Sunday between flights, he called again to make sure I received the voicemail. This time we spoke about the subject, and he went into greater detail. That was pretty great, and I really appreciated it.

[Casimir]

I feel I need to add to this.

Dr Grischkan is not impressed with the Desarda, I gathered from my interaction with him. Something about it can easily be done too tightly at the ring, as I recall, and that it is perhaps more prone to failure, and does a lot of moving of things around. He’s had to “fix” a share of them is my understanding.

As I had both the Desarda (for an indirect, and a small, hernia which was a mistake right there as I understand it, and that I am going to flatly say I feel a doctor of let’s just call it a different mindset would not want to allow happen, and a tailored approach would preclude) and Dr Grischkan fixed it after it failed and then some. My post on it is elsewhere.

To be clear, in my view seems obvious failure itself is not something that can be or should ever be expected guaranteed to not happen. Would never expect anyone to offer a guarantee. Maybe some are more prone. Seems like any can fail. Seems like it’s just one of those things. But you need to accept it can happen at least. Surely all doctors accept it can happen…

…which is why I am more than a little upset that Dr. Tomas literally used the word, and guaranteed me, that mine had not failed in a phone call, and this is after I got their attention with issues I was having. Without seeing me. In the couple weeks or so time after that call as I was getting things wrapped up to go down, I got in such bad shape it wasn’t possible for me to go there anymore.

So, that happened. Fun times.

Tailored approach makes so much sense even to a layman like me, seems to be critical. I’d add, from my personal experience, it seems the surgeon and way a practice operates is often as important as the approach chosen. Just my 2¢.

[saro]

quote Ddot14:

First attempt to post this was flagged as spam after attempt to edit, so will try again…

No, I still haven’t been able to get my inguinal hernia dealt with – family medical issues have gotten in the way. The good thing about that is that I’ve had additional time to research and ponder options. The bad thing about that is that I’ve had additional time to research and ponder options. 🙂

Definitely still wanting a no-mesh repair. Shouldice seems overly invasive and I’ve read multiple patient reports of lack of understanding and support by Shouldice Hospital with post-surgery complications. I’ve been seriously considering Desarda repair with Dr. Tomas in Florida or Dr. Parvez in New Mexico and have been In contact with both offices. Have talked on the phone with Dr. Parvez directly, but Dr. Tomas charges $ to talk directly to him on the phone so I’ve only talked with his staff at this point. I’m now also looking into Dr. Grischkan’s 2-layer Shouldice repair, but haven’t found any data or studies about it regarding practicality, reliability, long term results, chronic pain, etc. His website says that he’s done over 25,000 hernia repairs, but it doesn’t say how many were his 2-layer Shouldice (no mesh) and how many were his modified Shouldice (using gore-tex mesh) repair, or if the chronic pain or recurrence percentages are different between the two methods.

His website describes his 2-layer Shouldice this way:

“With the appropriate layers opened as prescribed in the Shouldice Method and hernia tissue reduced, the Transverses Abdominis Arch and lateral edge of the Transversals Fascia are approximated in a continuous manner to reduce tension. No wire suture is used as is called for in the pure Shouldice Method, but instead a flexible polybutester suture is inserted to accommodate athletic movements. A second layer incorporating the Inguinal Ligament and Transverses Abdomens Arch is then placed to reinforce the first layer in a similar manner.”

I have no idea if the above method is sound or not, but it definitely trims some steps from the original Shouldice technique. The website also says:

“The modified Shouldice hernia repair takes less than 20 minutes and patients can be discharged within one to two hours following the shouldice surgery. Most patients return to full activities and employment within two to three days following the repair.”

Sounds too good to be true, so I’m very interested in input of any kind.

I’m also interested in the practicality and durability of the 2-layer Shouldice vs. the Desarda repair – which (if either) makes more sense from a structural/mechanical/physiological/reliability perspective. I’m not a doctor so I really have no idea which structures of the inguinal area are most likely to provide the strongest, most reliable, most comfortable repair. Does anyone that knows more about this than I do (which is probably everyone reading this post) have any thoughts?

I do have concerns with Dr. Grischkan’s reported lack of interest in dealing with follow-up problems/complications from his surgery – I’ve only seen a small handful of these reports but I find them very concerning. I want a surgeon that will be there for me if I have problems after surgery, not just before.

The reason I’m looking into Grischkan’s repair is that he’s much closer to me than either Tomas or Parvez. However, I don’t want to end up cutting corners to stay closer to home and end up with an inferior repair and/or a surgeon that won’t take care of me if I have problems after surgery. So I guess I’m trying to rule Grischkan and his 2-layer no-mesh Shouldice repair either in or out as a possibility – thus the reason for this much too lengthy post.

I have also found another less-distant surgeon that has offered to do Shouldice or Desarda for me – whichever I want. But as I understand it don’t think she’s done that many of either, so I feel unsure of the quality of the repair I might be receiving. May be fine, or maybe not. Unsure how to proceed there.

I realize that no single method of hernia repair is guaranteed to give perfect results to every patient. Therefore, I’m trying to do what I can to maximize my chances of a good outcome by doing due diligence on surgeons and methodology before surgery. Any thoughts or information anyone may be able to share is appreciated!

hello
fortunately this site offers unrepeatable experiences, and I, when I read stories like yours, I finally recognize myself, because out of here my own relatives consider me a madman, who wants a tailored intervention.
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[DrBrown]

[USER=”2966″]Tino_7[/USER]
I suggest the open non mesh repair with sedation.
Bill Brown MD

[Tino_7]

quote DrBrown:

Each hernia repair needs to be tailored to the patient’s anatomy. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a very good choice, especially if the floor of the inguinal canal is just weak and not fully torn. But there may more tension on the repair than the other techniques. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch to cover the inguinal floor. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. The Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is very strong. But it does rely on an intact inguinal ligament and good tissue in the inguinal floor. Thus, there will be times when the Shouldice may not be possible.

Regards.
Bill Brown MD

Very helpful, Dr. Brown!

I’m meeting with a surgeon who does open and robotic mesh, but was trained in tissue repair as well (Bassini).

I have an indirect inguinal – my second one. My prior was repaired at RUSH University in Chicago (Millikan Modified repair, after Dr. Keith Millikan) two decades ago with mesh + plug. It’s held up well with no issues whatsoever.

I’d prefer an open repair under twilight sedation because of BPH and voiding difficulty. My concern: post op urinary retention and Foley catheter if general anesthesia is used (since I am at risk).

Dr. Grischkan offers a modified, two-layer Shouldice under twilight sedation.

If not for BPH I’d opt for the less invasive laproscopic so I could bounce back faster.

It truly comes to a trade off of potential risks-benefits, doesn’t it?

I’m early 60s, BMI = 25, reasonably good shape but certainly no longer have hard abdominals, thus expecting a longer recovery than my first open repair.

Overwhelmed trying to plan two surgeries close together – praying and asking God for guidance/wisdom.

Thank you.

[DrBrown]

Each hernia repair needs to be tailored to the patient’s anatomy. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a very good choice, especially if the floor of the inguinal canal is just weak and not fully torn. But there may more tension on the repair than the other techniques. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch to cover the inguinal floor. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. The Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is very strong. But it does rely on an intact inguinal ligament and good tissue in the inguinal floor. Thus, there will be times when the Shouldice may not be possible.

Regards.
Bill Brown MD

[Tino_7]

quote joep:

Hi Ddot14, according to HerniaSurge, as per the evidence published so far, Shouldice technique is the best non-mesh repair. They concluded that Desarda repair, at this point, simply do not have required data regarding its outcome, and shied away from recommending it.

https://link.springer.com/article/10.1007/s10029-017-1668-x

I asked Dr Grischkan about the Desarda method and his response was that it has not been around long enough to demonstrate long-term success. He did not appear impressed with it. I do know someone who did great after seeing Dr Tomas in Ft Meyers – he was up and walking that same afternoon with hardly any discomfort.

[dog]

joep We are well aware about it :} How many other thinks { innovative approaches} isn’t recommended by traditional main stream medicine ! My point was dont look for method ..look for doctor who knows them all..and can pick the best for you ! Shouldice can be done with dissolve sutures as well but it is not the point here.

[joserod1223]

Hello!
I recommend Desarda all the way. The shouldice uses steel wire sutures, where as the desarda uses ones that dissolve after 90 days. Plus, I’ve done my research looking into dr. desarda who created the technique, and he endorses the man in Florida who does the desarda repair (the man in florida, dr. tomas is the only one in the USA that desarda personally trained), and he’s been doing it for many MANY years. I’ve read great things about shouldice, but i’ve also read a lot of patients that say they don’t have the same flexibility in the area and that they always feel a tugging because of the wire (which makes me nervous because anyone that’s active will feel that).

Hope this helps!

[joep]

Hi Ddot14, according to HerniaSurge, as per the evidence published so far, Shouldice technique is the best non-mesh repair. They concluded that Desarda repair, at this point, simply do not have required data regarding its outcome, and shied away from recommending it.

https://link.springer.com/article/10.1007/s10029-017-1668-x

[dog]

HiDdot14 It is my humble opinion only … but i would rather focus on doctor and not on the method ..Doctor needs to be not focus on one think…like one tool fits all ..but rather customize his approach after he opens and see what happens…..Dr. Tomas it too much commercialize his business i think ..doesn’t take insurance … Dr Grischkan is great ..but what if 2-layer Shouldice isnt a good option for you ? He doesn’t do Desarda …at list i didn’t hear it. I would recommend to speak over the phone with dr. Brown with https://www.sportshernia.com/no-mesh…repair/repair/ and see if it makes sense for you ! He does DESARDA ROUTINELY ..He also can perform 2 layers Shouldice One more doctor that fits in that category is Jonathan Yunis MD FACS …{Florida} ..I asked him to contact Dr. Desaeds and he did and starting performing his truly simple method.

I believe that they are Both very meticulous, detailed ..I had a great conversation with them! ..They addressed every my concern . They have a great education/experience and have a amazing reviews about their work all over internet .They can perform any methods! ..Just great and caring people !

Jonathan Yunis MD FACS …{Florida}
William Brown MD {California}