Dr Towfigh can you explain why you always say

[Chuck]

that lap TEP mesh is the best surgery in most cases. You say this over and over. That Lap is best in terms of recurrance and chronic pain etc. Its in many of your videos. When evaluating the “best” surgery are you including the systemic effects of mesh? I know you believe only certain people are sensitive and you tailor repairs etc…but surely the massive number of mesh complications and the systemic effects of the mesh should be considered when selecting a surgery and as much as i hate to agree with Good Intentions…it seems to make sense for most folks to start with a tissue repair. If you have good studies showing lap repair is better would love to see them

[drtowfigh]

All studies shows superiority of laparoscopic inguinal hernia repair with mesh over open repair with mesh or open repair without mesh in terms of recurrence and chronic pain. That is not refutable.

That doesn’t mean that I believe all patients should have laparoscopic repair with mesh, though some surgeons believe that. I don’t. I tailor the repair options to the needs of each patient.

[JamesDoncaster]

@drtowfigh I cannot claim to have anywhere near the knowledge you have concerning the literature on inguinal hernias. But, it seems a bit outlandish to claim that ALL studies comparing open-mesh, lap-mesh and tissue-based repairs conclude that lap-mesh is best in terms of chronic pain and recurrence. I’m quite certain data out of Shouldice would contradict this.

In any case, I am very glad to know that you do not believe a one-size-fits-all approach is best. Indeed, many factors must play a role in determining what repair is best for a given patient.

One thing I found particularly annoying after having suffered chronic pain from a lap-mesh repair was that my surgeon told me that young, active, lean males that presented with hernia pain (my case) are much more likely to have chronic pain from mesh than older, less-active, heavier males that presented without pain. These data were not given to me prior to my operation and obviously are much more relevant to my particular case than the unconditional data on recurrence and chronic pain that was given to me.

In general, when trying to make predictions about the future, one should ALWAYS use conditional probability distributions (i.e., probability given X, Y, Z, etc.) versus unconditional distributions (i.e., total probability across all populations). it makes no sense to throw away data unless one believes that the data are unreliable or biased. It sounds to me like this is your strategy, Dr. Towfigh. But, unfortunately, others in your field seem to not recognize this.

[drtowfigh]

It is my strategy, @deeoeraclea, but many surgeons would argue that we really don’t have enough solid data to make some of the XYZ claims. We have a lot of research and catching up to do compared to other specialties, such as oncology, where they can quote much stronger risk stratified data.

[Debbie]

Hello there Dr. Towfigh,
In need of a double inguinal hernia repair. I’m reading thin women have more chronic pain. My BMI is 18 what type of procedure would you suggest.

[drtowfigh]

@debbie, depends on the type and size of your hernias and your physical activity level. An open tissue based repair is probably your safest bet, if done by a specialist. Alternatively, a laparoscopic repair with lightweight mesh.

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