Direct vs Indirect hernia -Best repair option

[MeshorNot]

I think Dr. Harris said my hernia was direct. Again he recommends open mesh. I see that for tissue repairs some say different repairs are appropriate depending on the type of hernia. Dr. Kang has a different repair for each hernia. A marcy for indirect and some say a 2 layer shouldice for direct. As i Understand it, indirect could be fixed by something less invasive like Kang’s marcy or desarda. But a Direct its better to use shouldice? Can someone confirm? Dr. Harris said the beauty of mesh is that it works with all hernias and has the lowest recurrance rate by far. He says it would be the repair he would seek if he needed to fix a hernia. He is a very active guy and he says tissue repairs will not hold up if you are active. Mike says differently that Kang told him no limits. I told Dr. Harris about Mike and Dr Kangs no limits statement and Dr. Harris said Mike would be back on the surgeons table in a few years. I am getting very distressed by this operation as there do not seem to be any good options. Harris gets tons of positive reviews and my GP says he is the best hernia doc in the LA area. If someone could advise on best tissue repair for direct vs indirect I would be grateful

[Good intentions]

Your questions are almost identical to the ones @jhawley and @dconfused77 asked. They got many replies. I would go back and read their various threads.

I would post a link to their account pages but it looks like they have both been removed. DConfused77 admitted that he was actually the old “Chuck”. Maybe JHawley got caught too. He survived for quite a while, there was actually a short overlap with you.

You can put those names in the search box though and the old posts will be found, even though the accounts are gone.

Good luck. Read those old posts, if you haven’t already.

[MarkT]

I get a “Chuck 4.0” (or it is 5 now?) vibe too.

“He is a very active guy and he says tissue repairs will not hold up if you are active.”

Nonsense.

[Watchful]

It’s at least the 6th reincarnation of Chuck. The rumor is that surgeons all over the world are preparing an extra large mesh to implant in him if and when he shows up at their office. It’s called Revenge 3D.

[MeshorNot]

Not following this. I will search for the answers. I am not Chuck nor do I have any clue what you are talking about. Just a guy in laguna with a direct hernia I think. Looking for help. And Dr Harris did say mesh was a better choice for someone who wanted to be active. Not sure what else to say

[Good intentions]

It must be just an odd coincidence then. If you’re not “Chuck” then don’t worry about it.

It’s not clear why you started a new thread though and said and asked the same things you did in your other thread. Also seems unlikely that Dr. Harris would suggest an open mesh procedure when he promotes lap mesh and lap mesh is the recommended procedure, by the “Guidelines”.

Here is some data from his web page. Seems odd that he left out the Pain Domain EuraHS scores. Why? He reports and uses composite scores, and ignores others. Not sure what “Clinical Recurrence” means. I think it means showing symptoms of the original hernia. Probably pain/discomfort.

Choose Your Surgeon Based on Patient Outcome Data

Hernia Surgery

“…
Although basic open surgical hernia repair is still an important option for some patients, every patient should consider being seen by a surgeon who can perform advanced laparoscopic hernia surgery and who uses the newest lightweight mesh. Only a small handful of the hundreds of general surgeons in Orange County, Los Angeles, Riverside and San Diego have the experience to perform hernia surgeries using laparoscopic techniques and use cutting edge lightweight mesh.
…”

[David M]

You guys aren’t giving Chuck enough credit. This is at least his 9th set of clothes. Or 8th reincarnation, as Watchful would aptly say.

I actually have mixed feelings about what Chuck has done. On balance, I agree with everyone else that it shouldn’t be done. It does have negative effects and is pretty repetitious. On the other hand, I think he has tried and to a certain degree succeeded in stimulating thought around Grischkan and Koch with his interviews and Kang and Desarda with his questioning. So, not all bad and I do think he is trying, like we all are, to sort some of this out. I just don’t understand why he has to continually reincarnate himself to do so.

[Mike M]

@Meshornot @chuck

Respectfully, Dr. Harris is wrong if that statement is accurate. As I said in a previous post there have been millions of successful open tissue no mesh repairs that have lasted a lifetime with people that have an active lifestyle. I evaluated many doctors prior to surgery with varying opinions quoting various research studies. Dr. Kang has operated on everyone from Soccer stars to European models to bicyclists who had serious pre-existing medical conditions. All successful.

Everyone seems to forget the history of Mesh and why it exists. Mesh wasn’t invented because no mesh repair had a 100% failure rate and 100% chronic pain rate. It was invented as an alternative to further push recurrences to 0% and reduce chronic pain.

If Dr. Harris made a statement like, “You have a higher *chance* of long term success with this type of mesh and this type of procedure based on current data.” then I would say that is a reasonable statement.

The statement you are suggesting Dr. Harris made would lend me to believe he is no longer open minded to sound alternatives (also with “high rates” of success) and has an extreme bias towards mesh regardless of the patient and circumstances involved. Also perhaps you misunderstood what he stated?

[MeshorNot]

Thx Mike M. But Harris specifically asked me how active I was. I said weights hiking biking tennis. He said mesh is the best choice for an active person. Spinoza came to the same conclusion. Harris believes the risks are way overstated and he sees few bad outcomes. Dr Towfigh also says all the 1 percent recurrance tissue repair promises are inaccurate. Pinto recurred fast. Kristian recurred in 5 years and cites many other tissue recurrances on his forum. There are lots of desarda recurrances. Yunis reports 5 percent recurrance in two years for his shouldice. What about ten years? Keep in mind that many of the studies are short term. Kangs repair has been around for 15 minutes. His statistics mean little. I still think tissue is prob the way to go. But anyone who gets that and goes back to heavy lifting is going back to surgery in my opinion. Kang has the wisdom to develop different repairs for different hernias. You got a two layer shouldice. I am trying to determine the best option for direct vs indirect. Direct seems likley for shouldice. Whereas indirect you have more wiggle room. Everyone here would rather speculate about Chuck than dig in on these important issues.

[Good intentions]

“Everyone here would rather speculate about Chuck than dig in on these important issues.”

Chuck, and DConfused77 and JHawley have already dug deep on your questions. In an almost identical fashion. Have you went back and read their posts? Your comments and stated views and questions are the same as theirs Same questions, same answers, same exaggerations and misstatements. Trying to characterize 1000+ surgery results from a single person’s result is absurd.

Why do you keep reporting what Dr. Harris said (if he actually did)? What are you waiting for? He said what he said you just have to decide whether or not you believe it. If you believe him and trust him then he’s your man. Nobody here can change what he told you. There is more information about him on the internet than any medical professional I’ve seen. His web site is packed with information. He has reviews all over the various review sites and videos on YouTube. What could a comment from this forum change?

[Good intentions]

If you’re considering an open mesh repair, which is apparently what Dr. Harris told you he would do for your hernia, then you might take a trip up to the Lichtenstein Amid Hernia Clinic in Santa Monica. Should be a nice drive, it’s less than 2 hours from you.

If I was getting a Lichtenstein repair that’s where I would try to go, based on Dr. Chen’s various presentations. They seem to address all of the possible problem areas. Probably have the best odds of getting a good result from a Lichtenstein repair at the hernia repair facility dedicated to his work.

https://www.uclahealth.org/locations/lichtenstein-amid-hernia-clinic

Dr, Towfigh lichentstein safety? Todd Harris

[Mike M]

@MeshorNot

Again – there have been countless successful no mesh hernia repairs that have lasted a lifetime in extremely *active* adults and even professional athletes.

That does not mean it is for every one, this does not mean it has a lower recurrence rate than certain mesh procedures, or possibly even chronic pain rate. We can debate that topic. I personally wouldn’t use mesh unless it was the absolute last resort.

However you should not ignore the fact as to how successful no mesh hernia repairs have been over the last 80 years and continue to be with the right doctor and the right procedure even if mesh is the new “gold standard”.

No mesh repairs *work* and they work well.

Better than mesh? Well there are a lot of brilliant minds on both sides of that argument.

Collect the data from all sources and then decide which Doctor you trust more, which procedure you trust more for your situation, and move forward when you are ready.

It sounds like you are all in with mesh and Dr. Harris which is great if that is what you have decided. Let us know the details after the surgery and best of luck!

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