Did a lot of you ovetthink this?

[Joe]

I had the oppurtunity to speak with Chuck Taylor and he suggests that many of you on the page way overthought this surgery. I think watchful made the point that maybe mesh is used for a reason rather than some consipiracy stuff. I am looking of FB pages and seeing tons of guys going in and getting open mesh —–nearly all are fine. Chuck told me that was his experience as well. EVeryone he talked to and it is now approaching 100 guys said they did no real research-trusted their doctors had mesh placed —after a week of discomfort it was back to normal life. Chuck said he worried about mesh but saw tons of mizxed reviews about tissue repair. Even the success stories the guys complained about ongoing pain. REinhorn in Boston claims .005 percent chronic pain from his open mesh repair. 1.5 inch incision. That seems better than Oceanics case —he was gutted like a fish. Huge scars and weeks after his surgery he is saying talk to me in 6 months. Lots of guys here say well you gotta avoid cutting the cremaster —then you read Baris’s case where it was avoided and he was destroyed. Maybe its a crucial piece of the tissue repair. Now that Lorenz has confirmed that Kang is doing a dubious Marcy repair it seems like his technique is simply not well validated. So I say again –is the simple open mesh technique the best way to go? There is no tension – no deep cutting —no huge and dubious recovery times? I can see how hernia surgery research can ruin your life. Maybe the best advice is what my local doctor told me. Don’t look online — get open mesh and go back to life. Another guy told me to go to Krpata – he does tons of open mesh and will avoid the nerves. So my question again to watchful to oceanic –did you guys overthink this? How real is the risk of open mesh surgery with a surgeon who knows how to avoid the nerves in placing the mesh? My friend had double open mesh a few years apart –he said it was breeze.

[Oceanic]

My scars are no bigger than if you get open mesh, they are not huge, 5 cm each

Gutted like a fish huh? How do you think your surgeon is going to fix you , with a magic wand instead of a scapel?

[Joe]

Oceanic – as i understand it open mesh repair is quite benign. The mesh is placed to support the hernia and the incision is closed. The downside being you have a piece of plastic in you for life. But as Watchful said in one of his posts with shouldice your abdomen has been turned into a sushi roll. On both sides no less. Shouldice appears to be massively invasive and destructive- you went to the best and are saying ask me in year how i am doing??? My local doc is saying a few weeks i will be back to normal with a durable repair. Honestly –can you tell us whether you would do a shouldice again if you could repeat? It doesnt sound like it.

[Joe]

And reinhorn is saying his incision is 1.5 inches –so nearly half of what yours are —he says patients have minor pain and need no pain meds for less than a week. My question has mesh been demonized unfairly?

[Oceanic]

You need to do more research if you think open mesh repair is benign, it’s still major surgery

1.5 inches is 3.8cm, I couldn’t give a damn about the incisons being 1.2 cm longer it has no bearing on the outcome of the surgery how big your incisions are, it’s inconsequential to anything important in this decision and they’ll be faded to nothing in a year

You need to decide for yourself what type repair you want and then just go for it, but you already seem to have all the answers so why bother asking on here?

Also if you believe all the facts surgeons like tell you about none of their patients ever having any problems you’re pretty naive.

• This reply was modified 3 months, 1 week ago by Oceanic.

[Joe]

I am naive but you just dropped nearly 20 k US to be gutted like a fish and writhe in pain that may become chronic thanks to your brilliant research? Look no offense I hope you improve -but I am determined to avoid your fate. There are a million surgeries in the US alone. The vast majority with mesh. Maybe its because it actually works better?

[Oceanic]

Jesus, try and quit it with all the overly dramatic language Joe, ‘gutted like a fish’ (I wasn’t aware you were there to watch my surgery) and writhing in pain which I have never been whatsoever, I flew back from Germany 4 days after having this done remember.

You don’t know my fate any more than I do, I think I’m going to quit this forum for a bit there are far too many drama queens on here.

Over and out until my next update

[pinto]

@Joe asks a reasonable question and what has ensued here is spirited debate though I don’t agree with what much he says nor some of the tone. But HT’s whole purpose is encapsulated right here —opposing views have faced off. Hopefully if we stay civil, much constructive thought will result. First though to @Joe: You start off by saying,
“I had the oppurtunity to speak with Chuck Taylor and he suggests that many of you on the page way overthought this surgery.” An opportunity with weathervane views—almost daily a different surgeon chosen as his no. 1? And if you quoted him correctly, he can really say people here have overthought their surgeries?? If anyone here does any overthinking it is our friend Chuck.

Second point: Joe be careful where you point to: Oceanic did something not only smart but heroic, as did Watchful though a bit less of a challenge. They went to elite surgeons for a gold-standard approach. OK, they have much discomfort or pain but you sell it short as well as ignoring the scores of sad stories of mesh patients AND mesh’s future prospects of having plastic foreign substance with unforeseen consequences. I am not saying any particular approach is best; I am saying each approach has its pro and con. Sure you can accuse people here overthinking surgery—but they should! Numerous people with life-long troubles from hernia surgery bemoan not having thought carefully enough. So I don’t begrudge you Joe for this thread—it surely is a legitimate and important question. But I think you must also include yourself in the spotlight because your own thinking merits reproach.

[Joe]

Thanks Pinto my point is that everyone here promotes tissue repair as its a much safer option. And I am not sure there is any decent information that it is. It seems to be quite injurious to the tissue. My question is – is mesh truly so dangerous that it must be avoided at all costs. Or are all the mesh problems simply a function of the fact that a massive amount of surgeries are performed with mesh? If there were the same number of tissue repairs would we see lots of problems?? Just on this forum alone we have folks with tissue repairs that were destroyed by Brown -multiple cases —Yunis Multiple cases —shouldice clinic -one case —Koch – one case….and a lot of people don’t know anything about this board. It is kind of the same with recurrances. Kang boasts a low recurrance rate of .05 percent. Yet we find you here on the forum with a recurrance. So my overriding question is what is the relative risk of mesh vs Tissue –maybe there is no way to get a clear anwser. Can I ask you why you didnt pursue the gold standard for tissue repair? ie shouldice. Why did you select Kang? His technique is new—he changes it frequently —and Dr Towfigh believes it is a flawed technique – a Marcy that should only be done in children.

[Watchful]

Joe,

As I mentioned before, in my particular case, Shouldice wasn’t a good fit because of the very large size of the defect, and other aspects of my anatomy. Chances are that things would have turned out better with open mesh, although that’s not a certainly. Maybe Desarda would have been fine as well.

I didn’t have the information about the size before surgery – I had incorrect information from my ultrasound. The lesson from my case isn’t that the Shouldice procedure is bad. Just that the repair choice needs to be tailored. This technique isn’t one-size-fits-all, and it can be difficult on unfavorable cases even in the hands of experts.

Lichtenstein has its issues. It’s not easy to avoid nerve involvement with it, which is the reason some surgeons always resect the ilioinguinal nerve. Some people get symptoms from the hard scarring on the mesh, the adhesion of the spermatic cord, nerves, and other tissue to the mesh. Some people get a bad immune response to the mesh. Most cases turn out just fine, but that’s the case with Shouldice as well. It’s hard to tell how the chronic pain rates compare between the procedures. My impression based on the studies that I’ve seen is that they aren’t all that different, but it’s hard to get solid information in this business.

You’re asking a fair question, though. I can’t really make a strong generic case for choosing Shouldice over Lichtenstein. Now that Kang shared his chronic pain numbers, I wouldn’t be able to make the case for that repair either, particularly since in addition to the significant rates of chronic pain that he reports, it’s too early to draw conclusions about recurrence. Desarda actually seems like the least dirty shirt in the laundry, but quite possibly just because this shirt hasn’t been looked at as carefully.

[Good intentions]

“Overthink” implies either that there is a simple obvious path forward, therefore little thought is required, or that the situation is so complex that trying to understand it is impossible, therefore thinking about it is a waste of time and effort.

I think that the second is closer to the truth. Surgeons around the world are still debating what the best repair method is. The body of literature about hernia repair is full of conflicting data about methods and materials, anyone can find a set of publications that will support any position that they want to promote.

Ideally, a person would understand what they expect from a repair, understand the pros and cons of each procedure, and do the calculation that will give them the best odds of success. So, some thought is required, but it needs to be careful and precise. If a person studies a certain repair method and decides that it is best described as being “gutted like a fish”, then they might as well just go to their doctor and take whatever path that doctor sets them on, or get on to Facebook and listen to the guy that knows of ten people who haven’t complained after a certain repair method. Ten out of millions would be the odds calculation there.

I think that a bigger concern for most people is oversimplifying. There is no single repair method that is best for everyone. You do have to put some thought in to the decision-making process.

https://renaissance.stonybrookmedicine.edu/surgery/blog/faqs-about-mesh-in-hernia-repairs#:~:text=Hernias%20are%20a%20common%20health,year%20in%20the%20United%20States.

[Joe]

Good Intentions thanks for your many posts here. I see you have had mesh removal. Can you say in a few words what your strategy would be for another surgery if needed. It seems that few can tailor repairs. Maybe Dr. Towfigh? Or Dr. Towfigh for a consult at least then a repair decision with another doctor? I saw that you favored Kang. Has your opinion changed with the release of Kang’s chronic pain numbers?

[Good intentions]

If I could go back in time, I would have went to Dr. Brown or Shouldice or Dr. Muschaweck in Germany. Knowing what I know now, if I could go back in time I would have stopped playing soccer while the hernia was small and tried watchful waiting. I’ve written about how I think that I created a hernia in healthy fascia by excessive straining, Valsava maneuver type actions to tighten my core, to try and play soccer with a sprained sacroiliac joint. I only had pain after playing a game of soccer. I actually went for a three mile run in the days before the mesh implantation with no pain. The last time I ever really felt normal and healthy. I only chose the TEP repair because of the way it’s made to sound like a permanent long-term solution to the current hernia and any future hernias. I fell for the hype.

Actually, at this point, if I did have a recurrence I might still travel to see Dr. Muschaweck or one of her colleagues trained in her methods. She has kind of fallen off the radar on the site but her career is built on fixing professional athletes. She has almost immediate feedback about her methods since many of her patients are national level soccer players. The various trainers and managers out there just keep sending their players to her. If you consider the financial side, the players as monetary investments, you can see that what she’s doing is probably working. I’m not sure that a Shouldice surgeon would know what to do with the messed up tissue around the orginal hernia. I imagine that they are used to a certain view once they get in there and I still have a piece of mesh and a sizable lump at the old hernia site.

As you can see though, my description is based on what I wanted or will want from a repair, and my own situation. I don’t really care about the scars or any superficial short-term pain, plus I am starting from what is still a very healthy body overall. Other people might have specific health concerns to consider. That’s what I meant about knowing yourself first, then understanding the pros and cons of each repair method.

[Wim]

What do you mean with “open mesh”? Because here too you have several techniques: Lichtenstein, TIPP, TREPP. Actually TIPP and TREPP put the mesh where LAP also put it. TREPP and TIPP can be done with spinal anesthesia. Haven’t found one to do it with local.
“A major advantage over classic surgery is that the inguinal canal is not opened with a TREPP”.
With Kang or Shouldice hospital you can avoid general anesthesia and the
associated risks. TIPP is found in Belgian hospitals and TREPP in Dutch hospitals. Don’t know if als in the UK or USA.

• This reply was modified 3 months, 1 week ago by Wim.

[Watchful]

I never bothered researching open posterior mesh in detail because of the lack of providers offering this, but I always wondered about the differences between Kugel, Nyhus, TIPP, and TREPP. More significantly, I was wondering about why not just go with lap TEP instead. I wasn’t curious-enough to study this topic, though…

[Good intentions]

Here is a new paper about some of those open preperitoneal methods. It illustrates one of those aspects of technology in the medical field. All of these companies have business reasons to promote the methods that use their tools. Some professionals are questioning the assumption that lap is always best.

https://link.springer.com/article/10.1007/s10029-022-02680-0

Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
M. Reinhorn, N. Fullington, D. Agarwal, M. A. Olson, L. Ott, A. Canavan, B. Pate, M. Hubertus, A. Urquiza, B. Poulose & J. Warren
Hernia volume 27, pages 93–104 (2023)

[Joe]

When I first got my hernia I was told oh fix it when you can and my primary gave me the name of a general surgeon. Had lots of friends that had hernias. No one ever said it was the nightmare that everyone on this forum describes. Once you go down this rabbit hole you start to wonder whether there is any technique that won’t leave you in chronic pain. I should have just gone and gotten it done without researching it. Now I am completely stumped. Desarda seems to have gained credibility here. But Dr Twofigh has been trashing if for many years on this forum. And if she doesnt know whats best who does?

[Watchful]

Good find, GI. Should be an interesting read. I’m taking a break from more hernia education, though. I get confused by the contradictory and inconsistent results in hernia research. Also, a bit skeptical of the favorable results in papers for procedures that happen to be practiced by the authors. Chances are that I’ll be able to find a paper by authors practicing a competing procedure which will show the opposite results. 😉 My training is in engineering, so all this is a bit jarring to me, but I guess medicine is a different world.

[Watchful]

Joe – chances are that you’ll be fine with an experienced expert surgeon regardless of the procedure unless there’s something unusual about your hernia. Still, the risk of chronic pain is too high for comfort (even if fairly small), so if you can avoid surgery for now, why not do that? If you see that the hernia is growing, or it starts bothering you more, you can pull the trigger based on your research. You don’t want to wait too long, which is the reason it’s called “watchful” waiting, but you don’t want to take the risks of surgery affecting your life prematurely either.

[William Bryant]

Good Intentions… Just to show all surgeons have their poor results, Dr Muschawek operated twice on English footballer, Glenn Murray ex Crystal Palace striker, both times failed and I successful. Prof Lloyd eventually successfully resolved Glenn Murray’s issues.

I think I’ve mentioned those case before.

[William Bryant]

And unsuccessful that should say.

[Good intentions]

By that logic process, a single bad result being used to define a surgeon, there are no good surgeons on the planet. Good luck with that decision-making process.

[pinto]

Way to go @William Bryant! By offering counterfactuals, you help ensure intelligent reasoning. Without counterfactuals most decision-making would be impaired. Knowing that even the elite docs make mistakes can help avoid blindly accepting medical claims.

[William Bryant]

That’s the problem I’m facing good intentions, there isn’t a single surgeon without a bad result or results.

When you say good luck with the decision making process, that is indeed what people need it seems hence chuck and Watchful saying “pray”.

By the way in actuality, it wasn’t a single bad result for this patient good intentions, she failed Glen Murray twice!

[William Bryant]

Here’s another failed Muschawek procedure quote “Dr Ulrike Muschaweck is the problem here. She is a very careless surgeon.
Her surgery on my hernia in late 2015 left me with sexual dysfunction, incontinence and numbness. Google her with the word “problem” and you will find other cases where her surgery has wreaked havoc on hapless patients.”.

I’d much prefer it if a surgeon had no bad cases, as I’ve said i’m looking for the impossible, but this has always put me off or at least lead me to delay surgery. Hence why I go round in circles.

[Chuck]

Bryant thanks for that find ….yes there are lots of disastrous tissue repairs …even from the best docs. I think most docs are not that careful —its just a job…they dont realize or care that our lives hang in the balance. I tried to get the braggart who destroyed me to pay extra attention by offering more money for a good job….he declined…then destroyed me anyway….I am totally lost on who to see if i need another surgery. Lorenz seems like the nicest guy….Kang is nice…but he cranks out 12 per day….and wonder whether he gets complacent

[pinto]

@Joe: “Just on this forum alone we have folks with tissue repairs that were destroyed by Brown -multiple cases —Yunis Multiple cases —shouldice clinic -one case —Koch – one case….and a lot of people don’t know anything about this board. It is kind of the same with recurrances. Kang boasts a low recurrance rate of .05 percent. Yet we find you here on the forum with a recurrance.”

Joe, you make a common error as many have on this site: exaggerating the failures and minimizing the successes. This site of course attracts people in desperate circumstances while ignored by a vast number of satisfied patients. The failures get magnified here not the successes. The collected wisdom here seems to be that the surgeon is much more important than the method. Make sure the surgeon is a hernia specialist with lots of experience. If your hernia is small and painless go with watchful waiting if it doesn’t curtail your daily living. But I recommend if you want a tissue repair not letting your hernia go beyond medium size. Good luck.

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