Dr. Twofigh – Recurrance risk….

[Chuck]

Dr Twofigh….in your interview with Dr Yunis….you say that mesh dramatically reduces recurrance risk vs Tissue repair. Todd Harris states that tissue repairs fail 20 percent of the time. Dr. Voeller implied they just fall apart over time. I made my disastrous decision to pursue lap surgery based on these statements..so it would be nice to know what they were based on. I suspect they were entirely made up. I used to think that the Shouldice Clinic was following up with patients when they stated they had a 1 percent recurrance risk. Now I realize how absurd that notion is. None of these surgeons are following up on anything—and several who went to shouldice confirmed that they were never contacted after surgery…how could these doctors follow up even if they wanted to…with patients coming from all over and moving constantly. The only surgeon with some clarity is Dr Kang…simply because he is close to most of his patients and offers a free repair if his repair fails…So folks are likely coming back to him. Of course we have to rely on him to report the statistics accurately. But he seems to be an honest fellow and one who is curious himself about the success of his surgery. So when GRishkan or Peterson say i have a 1 percent recurrance rate….this is almost certainly a complete fabrication. That said…is there any way to know the recurrance rate for a tissue repair or compare the recurrance rate for a shouldice to a desarda? Everyone reports it as fact that a shouldice repair has the lowest recurrance rate of all the tissue repairs…but what the heck is that based on??? If you are gonna get a sushi roll garnished with guitar string –it would be nice to know it will hold up better than a Desarda or kang repair. Desarda reports a zero recurrance rate for his repairs..how realistic is that. Desarda should have said 1 percent to at least BS some credibility. I would so like to know what i know now when i spoke with peterson and grishkan and tomas…those jokers would have had to account for their statistics…..why i just accepted them as fact i will never know.

[drtowfigh]

All of these questions have been answered and validated with the appropriate references in the literature. That is all we can do. Each individual person’s outcome will be different and may not follow the average seen on a population based study. That is why I follow a tailored recommendation. Otherwise, everyone will have a laparoscopic mesh-based repair.

@chucktaylor, I am just praying for the day my name is spelled correctly.

[Chuck]

Apologies Dr Towfigh….this strikes me of the “learned authorities contend” stuff you will sometimes see in legal briefs….appropriate references in the literature yada yada….folks are making real world decisions based on these statements…so it would be nice to see them well supported. I foolishly trusted doctors. This was my first experience with doctors who were more salesmen then physicians. Dr Carvajal told me he was the busiest hernia surgeon in the country…that my surgery was very easy…and that tissue repairs would never hold and would cause chronic pain. For some reason i just bought what he said…When i talked to peterson and mentioned your concerns about tissue repairs….he said oh i have taken a bunch of mesh out of her patients. You should give him a call and threaten to sue him if he cant back that up…which i suspect he cant. The bottom line is we innocent patients are being destroyed…i had a perfect life…was going to retire…get married and travel the world…I worked for 30 years to save up for it. And one crooked lying doctor stole away my life. He had the audacity to write in the op report that he had thoroughly adivsed me of the risks. In person he said there were “no risks”….pain risk was one in 5000 patients. He told me he was using the best mesh — 3dmax…which i have since learned is pure garbage. NFG always says i cant blame myself. But it was my gulliblity that allowed Dr Carvajal to lie to my face. He ruined my life and i know he deosnt lose a wink of sleep over it. Telling the same nonsense to some other poor sucker today no doubt.

[Chuck]

And talioring repairs is fine….but if you are going to say that mesh dramatically reduces the risk of recurrance….a cite to a study that shows this might be helpful. I don’t know why i didnt ask my doctors for these studies…I stupidly trusted them

[Watchful]

Chuck,

The 1%-2% recurrence at the Shouldice Hospital was based on a real long-term study, and there was independent confirmation based on Ontario insurance data. At the time, I believe studies of this procedure performed at other places, as well as studies of other tissue repair procedures, showed significantly worse recurrence numbers. Of course, their surgeons have changed since then and they haven’t been sticking religiously to the original, so who knows what the numbers would be now. From what I’ve been able to glean, chronic pain is a bigger issue than recurrence over there. Interestingly, that seems to be the case with Kang as well based on the numbers he reported.

If I remember correctly, your hernia was pretty large, and reached the scrotum. That’s really not the best fit for tissue repair as I learned the hard way. I think you made the right decision, and just got unlucky. At least you were able to address the problem by having the mesh removed. Imagine having bad results from tissue repair, quite possibly with no way to fix the problems, and no way to reverse the surgery.

[Chuck]

I feel for you Watchful…you did crazy due diligence and still got screwed. Almost the exact inverse of my case. My hernia was not huge but it had started descending towards the scrotum. Forcing me to pursue a repair. But I got the hernia in 2016. I stupidly tried to fix it naturally for many months. It was small and indirect. Quick action with one of the best tissue guys probably would have saved my life. I dont know why i delayed in fixing it. As it stands now i am in 24-7 pain and am likely to close the books at some time in the future. I am 61 and had a good life until this disaster. But i always said i would live vibrantly or not at all. So I am not going to soldier on with chronic pain. Nor will i go to some other quack lab coat to try to address the pain with more surgery or nervecutting. While i got the mesh out I might have to have another operation if the hernia comes back…maybe two more…with all the attendant risk and pain. I am not going to go through all that. I consider myself to be careful and smart. But hernia surgery is treacherous and tricky. Bryant aptly called it a minefield. Its sad that i researched it so hard and yet i run into some nunbnut on an almost daily basis who had mesh shoved in open with no issues at all —they never even knew the risks. What I hope Dr Twofigh and other hernia surgeons will understand is that this not just a job…not just a tailoring exercise. Sam Carvajal basically murdered me. Legally murdered me. He was rushing the morning of the surgery and didnt even stop by to say hello and wish me the best. I should have gotten off the table right there and run…I was about to retire get married and enjoy the fruits of a long working career…had saved diligently…invested…worked for 30 plus years. And my life was taken away in a rushed 35 minute surgery so that fat braggart carvajal could keep a golf date. He didnt care at all that he destroyed me. Wouldnt take my calls when i told him i was in killer pain. Imagine that,,,the 1 in 5000 he told me suffered with pain from his surgery. Such a tragedy and there are so many others like me. Mike N—didnt have a hernia but got double meshed and destroyed…. Tim P…small hernia on one side he could have ignored…double meshed…lives in chronic life ending pain…that will probably end when he gets the courage to use his shotgun. David D –double meshed for a small hernia on one side…lies bed ridden at home unable to work. David P. double meshed…mesh removal now on disability at 42. NFG – double meshed…didnt have a hernia at all. suffered for two years before removal..and still suffering….Marc T —triple meshed…no hernia at all. lives with chronic pain and disabikty….and we are told well sometimes surgery doesnt work out. its a tragedy

[Watchful]

Chuck,

I once asked my brother-in-law who is a doctor how come my house gets more diligent care from my plumber than my body gets from most of the doctors that I deal with. His answer was that houses are expensive, while people are cheap. 😉

I don’t know what to do about the excessive load problem with surgeons cramming so many surgeries per surgery day, and rushing things. My dad was complaining about the same thing. He went for a cataract surgery with a top surgeon. Extremely high-volume assembly line operation with the surgeon going from operating room to operating room, doing the main part of the procedure on one patient, and then moving to another who is ready in another room. My dad ended up with some scarring problem in his eye, and an eyelid issue.

I was thinking about the same idea that you were thinking about. When I was considering Dr. Yunis, I was contemplating offering to pay him to clear half his day for me, and not do other surgeries during that half of the day.

I don’t think you screwed up. Watchful waiting is acceptable and actually recommended for asymptomatic or minimally symptomatic hernias like we had. These surgeries are risky even if your hernia is still small. I could have done my hernia surgery decades ago, and suffered from pain and discomfort for those extra decades because of that. With my waiting, at least I was fine all those years when surgery complications would have been much more devastating to the course of my life.

Also, I think you picked the right procedure. There are horror stories with open mesh, lap/robotic mesh, and tissue repair. Look at the numbers posted by Kang for chronic pain. I think the statistics were actually very much in your favor with the procedure you picked, but you got unlucky. I don’t know about your surgeon. Maybe that’s where you skimped a bit on the research because you focused so much on the procedure, and not enough on the surgeon.

I consulted with about a dozen surgeons, and 8 of them were tissue repair surgeons, all considered among the top tissue repair surgeons in the world. Not even a single one of them told me that Shouldice is a difficult surgery with a large hernia, and maybe it’s better to go with mesh in that case. Some examined me in person, and in other cases it was a video call, so maybe one of the remote ones would have said something after examining in person, or doing an ultrasound, but I’m still shocked that nothing was mentioned about this. They mentioned the importance of the quality of the tissues, but that was about it. With my surgeon, it was “large hernia – no problem – Shouldice is a top choice for your case” on exam before the surgery, and then “difficult surgery because of the large hernia” when I talked to him after the surgery. I don’t know how to reconcile what happened on the exam day with what happened on the surgery day.

I’m still frustrated by this journey, but I have to let all that go. I’m focusing on healing, and if there is no significant improvement, I will at least try to have it diagnosed with imaging. Fortunately, I’m not in pain and discomfort much of the day. I do get it every day for some parts of the day, but most of the time I’m ok if I do the right things in terms of activity. It sounds like your situation is actually worse since you mentioned 24/7. Really sorry to hear that. I would definitely make some efforts to have it diagnosed if I was in that situation.

[Chuck]

Thanks watchful. But I think you are wrong. Hernias should be fixed assp while small. I get the risk of pain but your odds are much better if it’s small. I can’t fathom why I delayed. I didn’t focus enough on the surgeon. But my doctor had over 30 years of practice. He was advertised as the top SILS surgeon in the world. There were videos about him. L He was a super confident braggart. In retrospect that should have put me off. But he really sold SILS surgery as state of the art. He claimed 5000 lap surgeries. I am part of a group of the busiest hernia surgeons in the country he said. This is easy for me. Research said a lap surgeon should have 250
Surgeries minimum. So I thought I was good. I asked other surgeons about 3dmax mesh they said it was good. It’s garbage per dr B. I think yunis uses it. I thought this was routine out patient surgery. Big mistake. I didn’t realize it might be my cause of death. Had I done do I might have searched for the best lap surgeon. To me it seemed like pulling a tooth. Very wrong assumption. My mistake was not understanding the urgency of getting it done. I also was terrified of chronic pain. And open surgery intuitively seemed like a greater risk for that. I got suckered by the minimally invasive lie. I had a bunch of friends with open mesh and no pain so not sure why I thought that. I really think that if I hit it early and used open mesh my odds would have been very good. I read all the mesh horror stories. But doctors told me to ignore them. A million suregeries a year something bad will happen with some and those will go to the net to bitch. The fb chat rooms were only 3000 strong and vast majority were women complaining about other meshes. In the end the obvious eluded me. Plastic does not belong in the body. Fix it soon with the best tissue guy in the world. And pray. Now my useful life is over. I tried to fix the issues with removal. It didn’t work. More surgery won’t fix anything. I know that now. And if the hernias recur what then. More surgery. More pain. Life with chronic pain is not life. I just have a great family and the best gf in the world. So it makes it sad to go. But it is what it is. I will wait a full year from removal before I consider my exit strategy. But I have no life now except pain depression and deep regret for not seeing this risk more clearly. Maybe my story can help another. Or maybe it will jolt doctors like Dr towfigh into trying to be more honest with their statistics and pronouncements. Only one doctor. A Japanese guy said. Yes. There are serious risks with mesh. I will try my best to avoid them. Tag at actually put me off. I thought this guy is not confident. Dumb.

[Author]

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