GI -the details…

Hernia Discussion Forums Hernia Discussion GI -the details…

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    • #31070
      Chuck
      Participant

      of my case were regular Bard 3d max mesh…he said light were to prone to recurrance…catheter was placed to deflate the bladder…Towfigh says she always does this…but most surgeons with a brain recognize the risks of Cath and just tell the patient to urinate first…mine did not..even though he rushed through bilateral inguinal surgery in 15 minutes…no complications noted in the surgical notes…not sure if this helps you in terms of any removal advice etc…but you do know more than the docs here

    • #31071
      Chuck
      Participant

      Folks i hope my posts have given you some idea about the amount of education you need to get a simple hernia surgery…Mike M has done this and even knew to add an extra day at kangs hospital to address the pinto problem of failed sutures…this is the level of detail you need…you need to understand what they will cut…and where…I thought the shouldice hospital you couldnt go wrong…until i realized you could with trainees…cutting cremaster muscles…jamming in stainless steel…kudos to mike m…to watchful and bryant who are on here hourly scouring the page for tips…Desarda risky…who knew? Yunis put a guy in a bag…who knew…..shouldice has so much chronic pain…who knew…it takes a year of daily particpation on this page to really learn what to do…

    • #31092
      MarkT
      Participant

      The tone you often take is very unfortunate and unhelpful.

      – “Towfigh says she always does this…but most surgeons with a brain recognize…”
      – Shouldice is “jamming in stainless steel…”

      Why do you say things like that? You come off as arrogant, dismissive, and immature as a result.

      I have no idea what your problem is with Dr. Towfigh…but whatever.

      Shouldice has been using stainless steel sutures for many decades, across many tens of thousands of repairs. Instead of ignorantly characterizing that as a negative, maybe find some evidence or simply ask why they (and some others, like Dr. Sbayi) continue to use it?

      Concern over how the cremaster is treated keeps popping up…and yet AFAIK no one has clearly communicated why this ought to be a key concern when deciding between repair options. Again, find out WHY Shouldice (and others) treat the cremaster they way they do instead of ignorantly assuming it to be a negative.

      This “shouldice has so much chronic pain” claim you keep repeating…you cited one study that looked at less than 100 patients who had surgeries performed by non-Shouldice Hospital surgeons…that is not going to be representational of what can be expected from a proper Shouldice repair carried out by experts with that technique.

    • #31097
      William Bryant
      Participant

      Hi Mark, the cremaster is a concern, for me, in that it controls the testicle reflex ie movement up and down. So in some cases your testicle can hang very low and not move up after. One person has said he can’t wear jeans now as his testicle is by his knee.

      Apart from that I’m not sure but for me I generally favour leaving as much as possible as it was.

      I think Shouldice treat the cremaster as they do as a way of helping prevent hernia recurrence.

      What Shouldice offers is expertise. Shouldice Canada. If it was less pot luck which surgeon you got, it would tempt me much more.

      • #31102
        MarkT
        Participant

        My understanding is that it also has to do with visibility, including helping to identify if any other weak areas and hernias are present.

        From Dr. R. Bendavid, who was a Shouldice surgeon, researcher, and co-founding member of both the American and Canadian hernia societies:

        Resection of the Cremaster
        This important step seems to have been entirely forgotten. Few students have seen it performed, and fewer surgeons practice it. This step was clearly described and emphasized by Bassini, repeated by Catterina, and perpetuated by Shouldice. The resection of the cremaster and lateral retraction of the cord bring into view the posterior inguinal wall in a manner that can best be described as a “revelation.” It becomes impossible, then, to overlook a direct or indirect inguinal hernia. The transversus abdominis aponeurosis (i.e., the posterior inguinal wall) is now in full view. Whenever possible, the cremasteric vessels should be doubly ligated separately from the cremasteric muscle”.

        (basicmedicalkey.com/the-shouldice-method-of-inguinal-herniorrhaphy/)

        In any case, discuss it with any surgeons you are considering…ideally, also email or call Shouldice for more info on why they touch it and what risks are associated with doing so. They will flat-out tell you 1 in 1000 for this, 1 in 2000 for that, etc. with regard to their technique. There is no sense assigning it more or less risk than it might have or making it an obstacle to choosing a course of action without knowing more about it.

        There are catch phrases floating around like “touching healthy tissue” that are not good substitutes for real knowledge.

    • #31104
      Mike M
      Participant

      @MarkT

      There appears to be some omittance of information regarding the manipulation and surgical modification of the Cremaster muscle in your description. For example: We know by talking to Shouldice doctors that they do at the very least remove up to 50% of “healthy” tissue in order to get a “tight repair” with some removing it completely.

      This is not demonstrated or mentioned in the description you provided but it is done and the doctor will tell you this if asked.

      50% removal of a Skeletal Muscle that maintains a specific function with the male anatomy is kind of a “big deal”, at least to me. As Watchful has mentioned before there are clear cases where this has caused an issue with physical and mental health.

      There are some other doctors like Dr. Yunis and Dr. Kang that use other methods or perhaps different technology that allows them to avoid shaving or removing the Cremaster muscle. I think that is a very important distinction that is not mentioned in your description.

      • This reply was modified 6 months, 2 weeks ago by Mike M.
    • #31107
      Watchful
      Participant

      MarkT… The numbers mentioned by Dr. Netto from the Shouldice Hospital were quite different from 1/1000 or 1/2000. He was estimating 5% for chronic pain (not necessarily debilitating). They are still studying this topic, but he said that they now realize that the number is higher than they expected. He said 1% for chronic debilitating pain.

      • #31114
        MarkT
        Participant

        Hi Watchful – I was speaking more generally when saying “1 in 1000 for this, 1 in 2000 for that” and certainly not implying that chronic pain was so rare. There are many potential complications or negative outcomes associated with surgery, with many of those risks having longer odds, like 1 in 1000/2000/etc.

        I’m aware of Dr. Netto’s comments and glad to see they are looking more closely – better follow-up is clearly needed to get a more accurate picture of patient outcomes. Regardless, he is estimating 5%…even if you double or triple that estimate, it remains far cry from the 36% rate from the one study posted of outcomes from surgeries not performed by Shouldice Hospital surgeons that underlies the irresponsible ‘so much chronic pain with Shouldice’ comments being made in several threads.

      • #31115
        MarkT
        Participant

        Hi Mike – I can’t speak to the specific details and was just quoting something from Dr. Bendavid – and I want to be clear that I’m not meaning to imply that treatment of the cremaster is irrelevant or not a concern at all…I’m asking why it seems to be a barrier and a *key* concern for people looking at Shouldice as an option.

        The reason I ask this is because we have no evidence that the Shouldice treatment of the cremaster is resulting in a very high number of negative outcomes…so when you say “50% removal of a Skeletal Muscle that maintains a specific function with the male anatomy is kind of a “big deal”, at least to me”, my response is to ask how you are evaluating it to be a ‘big deal’ if you don’t know the likelihood of negative outcomes from the way the cremaster is treated? Is it 1 in 100? 1 in 5000? Something in between?

        1 in 100 would indeed be a big deal and that risk level should rightfully cause it to be a *key* consideration…whereas 1 in in 5000 would represent a risk that is well below the likelihood of numerous other potential issues, which would render this less of a ‘big deal’ and relegate it to a relatively minor consideration.

      • #31120
        Mike M
        Participant

        @MarkT – As I stated in the other post I believe this is why I think your input is critical.

        Correct me if I am wrong but recently the Shouldice doctor from CA had some concerns regarding the abnormally high finding of 5% Chronic pain rate emanating from his hospital? Considering that particular hospital “cherry picks” patients it is an interesting note. I suspect that is due to the randomization of which doctor you may or not get at that facility rather than the procedure itself.

        Other doctors performing a modified or similar procedure outside of that clinic have their data closer to 0.5% for the same stat.

      • #31121
        Watchful
        Participant

        MarkT… I don’t know how the body would be able to pull the testicle up if the cremaster muscle and the genital nerve branch are gone. I don’t know if that’s a big deal or not, and I’m not saying that it is a killer issue, but I am curious about how the cremasteric reflex could possibly still work.

    • #31110
      William Bryant
      Participant

      Ah yes, visibility too. I think other hernias can be missed and it also makes access/repair easier…I think!

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