Found a tissue repair surgeon, have many questions!

[Katherine]

Dr. Towfigh – here are the names of the two surgeons I have found in Houston that do non-mesh repair. Do you happen to know either one of them? Both are older and do both mesh and non-mesh repair. Dr. Richard Andrassy is one I saw a few years ago, but at the time my hernia was getting larger, but not symptomatic at all so I decided to just wait. I read some bad reviews about him on the internet, so I decided to look elsewhere this time. However, he did come recommended by some physicians that work with a sports massage therapist that I know. The one I saw last week is Dr. Wade Rosenberg – he is the one I posted about above. He was highly recommended by another physician in the practice who only does mesh repairs. Do you happen to know him? I am at the point where I would like to get it repaired, but just don’t truly know what is the best method for me. I believe I have some form of connective tissue disease, so maybe only a mesh repair would work? Maybe a tissue repair would have to great of a risk of reoccurence?

[drtowfigh]

Please share the name of your Houston surgeon. We have had a lot of people asking for hernia experts in Texas. There aren’t that many.

[Katherine]

I guess I’m so worried about mesh because of the continuing inflammation I’ve had from the reabsorbable mesh in my spinal operation back in 2012. It’s weird because I had a bad feeling right when I was on the pre-op table about the surgery and the surgeon. It’s an extremely risky surgery to begin with. I guess I would describe the doctor I saw (hernia doctor) as just so unpersonable. And it is possible that mesh would be the best option for me – but I did have a successful non-mesh repair in my 30’s that’s still going strong (fingers crossed). I wish I had some way to contact the doctor that did my repair back in the 90’s to find out what procedure he used. The doctor I saw last week is probably about 10 years younger than the doctor that did my left sided repair in 1994, so I would bet their procedures are similar – in fact, he did know my doctor from 1994 and said he didn’t know what he used, but their procedure was most likely similar. I also find it somewhat comforting that the doctor I originally saw gave such glowing recommendations to the older one that I saw – said he trained under him and he was great. Of course, time and age effects collagen tissue an I’m not that healthy 34 year old body builder I was back then. You bring up so many good points that I plan to ask when I see the other doctor next week. I wish I had the energy to do more research, but honestly, I’m totally exhausted with medical research after 10 long years of dealing with my other issue. And I also have bilateral tarsal tunnel syndrome (tibial nerve entrapment at the ankles), which is also a very risky surgery and something else I’m dealing with now. Just feel a bit over whelmed. I’m so happy that you did have a good outcome with your second hernia surgery and mesh removal. There doesn’t seem like there are too many with success with this after having a mesh. One thing the initial doctor the other day pointed out to me (the one that only does mesh), is that there are so many different types of mesh, but most of his patients did have an initial inflammatory reaction to the mesh as a foreign body, but gradually the body accepted it and most of his patients did OK with it. However, he did also say that some people do have long term reactions and there is no way to truly predict that I would be one that would not suffer “mesh” consequences. He was a really good guy, very personable. But, yes, I do need to keep researching, thinking, reading. Once you are cut, that is it. And even though my hernia is getting larger and is mildly symptomatic, a failed surgery which left me in chronic pain would be much worse pain than I am in now. I will read over the link to Dr. Kang’s thoughts – appreciate you finding that and sending it to me!

[Good intentions]

“Chronic pain” is a term that didn’t really exist for hernia repair until mesh was introduced. So I don’t know about its association with any of the pure tissue methods.

It looks like your meeting with the Houston surgeon actually went very well. I don’t see the horrible manner described that you mentioned. And I don’t think that any doctor can guarantee a successful result or no pain. The best that they can do is to improve the odds, based on up-to-date high quality information. That is the main problem with medicine today I think, there are more powerful organizations controlling the information for the purpose of generating revenue or profit. Medicine is being controlled by business entities.

Your connective tissue disorder seems like one of the original reasons that mesh was developed. For extreme and specific instances. But because mesh had other business related benefits it has expanded in to the mess that it is today. It might actually be that mesh would be the best for your condition, if you could find a surgeon who knows how to use it properly. But doctors have to stick to the “standard of care” so that they don’t get sued for “malpractice”, so most surgeons use it in a way that makes the organizations safe and healthy, not the patients. If all practice is bad then malpractice is invisible to a jury. “Everybody does it this way”.

I would just keep searching and reading and thinking. One benefit of finding this Houston surgeon, an opportunity that you didn’t take advantage of, would be to ask him if thinks a pure tissue repair or mesh would be best for you. Also ask him what type of mesh he would use and how he would use it. There are so many different types of mesh and so many different ways to use it that any good attributes of mesh are overshadowed by the bad. It is chaos that is protecting the companies that profit from mesh.

Anyway, here is Dr. Kang explaining his views on the original Bassini procedure, and what he calls the corrupt Bassini procedure, linked below. I wish I had better answers. I can say that when I had mesh implanted I didn’t really feel comfortable with the surgeon that did it, he didn’t really seem confident in what he was proposing. I don’t think that he believed in the material or the procedure but it was “how it’s done”. Standard of care for hernia repair. But I trusted a surgeon friend who vouched for him and went ahead with it. On the other hand, when I had the mesh removed three years later, I trusted Dr. Billing just through talking to him over the phone. He was confident and understood the problem and felt that he could help, and he did. So, your own personal feelings come in to play I think, if you feel that you’re a good judge of character and ability. I should have trusted myself when I had doubts about the surgeon who was doing the mesh repair.

Here is that link to Dr. Kang’s thoughts – https://herniatalk.com/forums/topic/kang-repair-question/

Kang Repair question

[Katherine]

I have thought about that – maybe scheduling another appointment. After he told me he could do a pure tissue repair, I asked him if I could ask him some questions and he was receptive. Unfortunately, I had questions that were more related to the shouldice repair, not the Bassini. These are the questions I asked and what I remember as the answers.
1. What type of tissue repair do you do? Bassini.
2. Do you cut any of the nerves during surgery? No, I try not to. He sorta “chuckled” at this answer – like cutting nerves was not something he does. I did go to a surgeon last year that routinely cuts the genitofemoral nerve — so I automatically eliminated him from my list.
3. I asked him what type of sutures he uses. I think he said prolene.
4. What type of anesthesia do you use? General.
5. Do you routinely ligate and resect the hernia sac? I believe he said yes, although he got a little more technical that I understood.
6. Do you routinely transect the round ligament? I think he said yes. At this point, he said “you have done your research” and I explained about my failed spinal surgery and why I have so many questions.
7. What type of complications have you had with surgery? He paused, then looked at my questionably. And I said – like chronic pain. I didn’t like his answer here as he kinda looked to the side and said none, really.
8. With my connective tissue disorder, will it make surgery more difficult? He said possibly, but that is probably why you have a hernia to begin with.

So I think I asked some reasonable questions, unfortunately, I didn’t ask specific questions to the Bassini because I just wasn’t prepared. I suppose I could reach out to him and ask either through the patient portal, writing him a letter, or another appointment.

I have an appointment with another doctor next week who supposedly does pure tissue repair. I think I’m a little more prepared this time. I need to do some more research on the Bassini repair in the event he does this repair.

Looking over the forum, it seems the Bassini repair is associated more with chronic pain? Is this true? You seem to be one of the most knowledgeable people on this forum (although there are many – I’m truly impressed with this forum and so blessed I found it). And the doctors that participate are top notch (unfortunately none are in Houston).

Any other sage wisdom by you or any one else would be most appreciated! Also would really like to hear comments by our participating doctors if they wish to enlighten me further.

[Good intentions]

You could just try to push through his bad manners and contact him again. You might end up surprised. At least ask him if he knows the difference between the modified Bassini and the original Bassini. You could also pose the question to his staff and ask if they can relay a reply back to you. I always tell people to write their questions down before their visit so that they don’t get the stage fright that you got and leave without answers. You could even write him a letter so that he can respond in his own time. Doctors have to limit the time of their visits because they have a day’s worth of appointments to get through.

He’ll either get angry, maybe defensive, and cut your questions short, or he’ll realize that he’s talking to somebody that has done their home work and change his tone. I am sure that most doctors get simple nonsensical questions on a regular basis. It must be tedious.

Good luck. You don’t have anything to lose, really. He’s not going to refuse to operate because you ask too many questions, I’d guess.

[Katherine]

Thanks Good intentions for your thoughtful comment. Yes, from looking over previous posts that is what I understand about the Bassini. So I guess it all depends on which method the physician uses. From the reviews I’ve read online about him, everyone says he has a bad bedside manner! And this is not just hernia surgeries as he does other general surgeries. However, in the majority of the reviews, most of the people say that he did an excellent job on their repairs (whether hernia or other). There were only a few negative reviews on his surgical skills and those were not hernia repairs. I’m not sure how many tissue repairs he currently performs – I would guess that since he is in a large hospital practice where most of the doctors do mesh, he probably does, too. But at least he has a number of years experience doing it the old fashioned way. I did find some reviews where some people did have hernia surgery by him (don’t know if it was mesh or non-mesh) and they were pleased with the results. Of course, I also don’t know how much you can trust these reviews posted on the internet. He didn’t act like he didn’t want to do mesh – or have empathy for me for not wanting it. He just examined me and then said, we can certainly do a tissue repair on you. I guess he felt that way by the examination. I would hope that he wouldn’t do the repair poorly subconsciously – but you never know. Bottom line – I didn’t like his demeanor and don’t have enough info about his particular Bassini repair, but I’m in a real predicament. I already have a chronic pain issue from a previous failed spinal surgery which makes it extremely hard to travel (I can’t sit without really bad pain so there goes any airplane or car travel for any long periods of time). And I am on a very limited income as I am on disability, so I don’t have the discretionary income to be able to easily fly somewhere and stay for a week. So two strikes against me and thus the desire to find someone locally. Plus, I’m just a little scared of getting a hernia surgery right now with COVID going on. I’m not really scared about the COVID, but I am worried that if I do get it and end up with the severe coughing right after surgery, that would not be a good thing at all.

[Good intentions]

Dr. Kang has written about the Bassini and the “modified” Bassini procedures. His impression was, if I recall correctly, that the modification actually made the results worse and that’s part of what gave pure tissue repairs a bad reputation. It was, apparently, a simplified version, not taking the extra care needed to get a good result. Remember, hernia repair is a high volume procedure. The simpler the better. Get ’em in, get ’em out.

Does the surgeon still prefer the Bassini method or does he only do it if asked? His manner might have been brusque because he doesn’t really want to use that method. He might already be a mesh convert and would rather do a mesh implantation.

If you post his name there might be info out on the web. Of course, if he found out he might not be happy.

Really though, the fact that you think his manner was horrible is enough isn’t it? I would just move on and find someone you can trust. If he doesn’t have empathy for your concerns about mesh then he probably does not believe that there are problems with mesh. Subconsciously he’ll even have a reason for you to have a poor result. Because he believes in mesh for hernia repair.

• This reply was modified 3 years, 3 months ago by  Good intentions.