Had my surgery done finally – Shouldice

[Watchful]

Alan, the pain you mention when standing up for more than a few minutes is very familiar, and also your experience with being the only patient around with this pain.

I also still have that problem, although much improved compared to what it was initially. It’s interesting that Dr. Kang said that your pain is expected. Did he explain what causes it specifically? My surgeon said my pain was unheard of and was thinking about issues with the surgery (like nerve impingement) which seriously freaked me out, and this still worries me.

If I was told this is rare, but known and goes away eventually, I wouldn’t be so worried. I hope it’s just caused by swelling which is pressing on something, and this will go away when the swelling goes away, or maybe caused by some other tissue damage from dissection and stitching that will heal completely with time. These tissue repairs are certainly not as benign as I thought they were, but the alternatives don’t seem to be great either.

[William Bryant]

Can I also ask Alan, if you don’t mind, are you in UK, like myself? How much do you estimate the total cost, if that’s not personal!

[William Bryant]

Thanks Alan. I appreciate the update, I’m sure Watchful will too… Hope it gets better.

[Alan]

Once the local wore off I was in a lot of pain, I’ve never had any surgery before so can’t compare but it was an 8\10 for me the first night (I refused a pain killer injection shortly after thinking I was ok), second day\night there was no pain at all when in bed.

My pain is significantly better now, I’ve been moving about the house fairly easily and can stand upright without pain. I do have pain on the right side when standing for more than a few minutes which I’m hoping will improve – it’s still very swollen down there.

I had two direct and an indirect so Dr Kang said the pain was expected (Apparently direct hernias cause more pain than indirect when repaired).

I was the only patient that seemed to be in pain, everyone else was wondering about hours after surgery (some very elderly gentlemen with low mobility). A few left the same day and a few like me stayed overnight. I needed a wheelchair to get to the reception and crutches to get back to the hotel.

[William Bryant]

Hello again Watchful, I remember reading someone else who said their pain was worse after, initially and for some weeks, I think that was a Desarda repair (less invasive too I think) but all was well eventually so fingers crossed.

Alan, who posts here and went to Dr Kang did say he had pain after for a few days or a week, I’m think that’s what he posted, I think that’s calmed or calming down too. I’m hoping Alan will post again.

Appreciate yours and his, and everyone else’s updates as that’s all we really have to go on.

[Watchful]

Thanks, William. I will indeed give it time before getting more concerned. I think my pain (both initially and what’s lingering) is outside the realm of what is common for this procedure, but I don’t know that it’s so abnormal that I should be very concerned at this point. It’s too bad that the crew over there (doctors, nurses) weren’t more reassuring. I think the big improvement so far is a very good sign, and I hope it will continue, but I live in uncertainty and I’m not back to normal, a situation which may persist for a while. My symptoms right now are still worse than what they were when I had the hernia, so it’s hard to be excited so far.

Yes, I chose my surgeon – this wasn’t a problem actually.

[William Bryant]

Hello Watchful… I can see the reasons now, in your reply to Chuck.

It doesn’t sound like you are many days after surgery yet so give it time. I’ve read quite a few people who have had tissue repair with swelling and pain for months but it all subsides. Hopefully yours will.

Did you choose your surgeon by the way?

[Watchful]

Mark T,

I think there’s a good chance that I will still end up with a problem-free and pain-free repair. I’m optimistic, but not certain. I’ll keep reporting on how it goes. Thanks for your message.

[Watchful]

Thanks, Chuck. I’m optimistic since there has been a significant improvement since the surgery. I just hope it continues improving all the way to complete resolution, and I don’t get stuck with chronic pain. This stuff is really scary.

I had my hernia since birth, and it got worse over the years. The right time to fix it was when I was a baby. It’s a trivial surgery at that point. My parents weren’t thinking rationally about it, and didn’t do it.

The hernia was bothering me only occasionally, so I didn’t feel compelled to do the surgery. I did notice that it was growing in recent years, and that should have prompted me to do something about it, but I was too busy with other things, and didn’t feel like doing surgery on something that wasn’t bothering me all that much. It started bothering me much more frequently a bit over a year ago, but I took my time researching what to do because I found out that deciding on how to treat it isn’t so simple.

I’m not sure I would have been able to pull the trigger before it started bothering me more, and before I noticed that intestine was going in there, and that the hernia was reaching into the scrotum. As we all know, the risk of complications from inguinal hernia surgery is far from insignificant, so who wants to take that risk on something that isn’t all that bothersome? The risk of incarceration and strangulation is known to be quite small. It’s a tough dilemma, but, yes, for those who want tissue repair, I think there’s a good argument for fixing it sooner rather than later. I wasn’t aware of any of that at the time. There’s probably not as much urgency with mesh.

• This reply was modified 2 years ago by  Watchful.

[Watchful]

Chuck,

Not sure the Shouldice Hospital would be an option for you since you don’t have a visible or palpable bump. As far as I know, they don’t operate on such cases, or at least they didn’t in the past. Things have been changing there, so who knows – you would need to contact them if you wanted to explore that.

You can ask for a specific surgeon, and they try to accommodate that.

I don’t agree that it’s a “very poor choice”. They actually do very well with it over there. People were mostly doing quite well after the surgery, and I talked to a number of people who had one side done in the past, had perfect results, and came back for the other side. My case has not been so good so far, but it wasn’t typical.

I think there’s a fundamental issue with not tailoring the solution to the patient. At the Shouldice Hospital, there are very rare cases where they use mesh. They do that when your tissues are of very poor quality. Other than that, they just do Shouldice. If you’re overweight, they’ll reject you, but if not, you’re fine for Shouldice.

The problem is that there are cases where performing this procedure is difficult because of the specific anatomy and nature of the hernia. Some surgeons would realize that based on an ultrasound or maybe during surgery, and decide to use mesh in such a case, or maybe some other tissue repair like a Desarda. Based on what I know now about the details of my case, I think I would have ended up with a mesh if I had gone to one of the Germans who do Shouldice as well as mesh. I don’t know if that would have been a better outcome or not, but in some cases mesh can be superior to forcing a Shouldice, Kang, or some other tissue repair.

I described in previous threads my reasons for not choosing Kang. It’s mostly about the lack of data, and concern about potentially higher recurrence rates. Also, my hernia was not run-of-the-mill. It was a large indirect with a scrotal component. I wanted to “play it safe” with an established well-proven procedure with a long history. I’m not sure how well the Kang technique for indirect hernias works with a hernia like I had. It may be fine – I just thought it was too much of an unknown. As it turns out, even repairing it with Shouldice has been difficult.

[William Bryant]

Thanks Watchful… But I can’t see the reasons for your choosing Shouldice below or under. I was hoping to see this..

I have read others saying the pain during recovery was the same as hernia pain prior to surgery.

[MarkT]

Thanks for the detailed posting of your experience, Watchful.

I’ve posted mine many times, but of course they are going back many years and we have wondered what has and has not changed. My main contribution at this point is anecdotal in confirming that both of my repairs were flawless with zero post-op complications or restrictions on activity to date, one side done 30 years ago, the other side almost 20 years ago.

Interesting to note the variation in procedure regarding the cremaster and sutures…that is something we have talked about a lot here, especially the latter.

With the sutures, did they say if they have shifted to exclusively using prolene now? Is it simply the surgeon’s choice? Or something the patient can request? Maybe all new surgeons can/must use prolene, but the older ones still use steel? If it is a complete shift, that would be a *very* new development (certainly within the past 1-2 years, AFAIK).

I also wonder what data or other motivation has informed their decision to deviate from always resecting the cremaster…and how they make that decision for each surgery (indirect vs. direct? other hernia or patient characteristics? surgeon preference? patient request?).

It does sound like you had a rather unusual short-term post-op experience. I do recall a fair bit of variation when I was there. The first time, one other guy was also my age (18/19) and he was on a stationary bike the next day, while a couple of other patients (much older) struggled to walk to the dining room and skipped ‘exercises’. The vast majority of us were in between…no issues walking slowly, but not exactly motivated to hop on the bike right away either. One of the older guys had a notably rougher time.

Your experience of the cohort model being problematic during recovery is notable and not something I had previously considered. I experienced it as a reassuring ‘we are all in this together’ type of thing, both before and after surgery…but my short-term recovery also aligned with that of most others, while yours negatively deviated from them. That is something that warrants more study and there should be additional supports in place to not only aid in the recovery itself, but also to address the potential *additional* anxiety from seeing others fare better.

I would like to see the facility upgraded…sounds like not a lot has changed with the ORs and the rest of it looked much the same when I visited around this time last year.

The patient experience is very important, but the end result is ultimately what matters most, so I hope you will continue to post updates throughout your recovery and in the months that follow. Going forward, I hope all goes smoothly and you end up with a problem-free, enduring repair.

[Watchful]

William Bryant,

Thanks for the wishes for continued recovery. The pain isn’t currently debilitating like it was for the first couple of days after surgery, but I still get the same pain after certain activities, just in a milder form. It has been improving over time, but there are some setbacks. For example, last evening after I went for a walk it was worse than during the couple of days before that. Interestingly, it feels a lot like the hernia pain I used to get when the hernia came out, just worse than the hernia pain.

I let the surgeon choose what to do. He didn’t cut the cremaster in my case.

The food was far from the top of my list of things to be concerned about, but it was excellent while I was there.

See below for the reasons for my choice.

[William Bryant]

Good update Watchful. I can empathise with the worry about pain aspect as it would make you very worried. Especially being so well informed.

Did they know you weren’t keen on cremaster cutting? And do you know if they did in your case?

Also did you choose the sutures or do they?

Sorry for all the questions! But one other, what made you choose Shouldice over Dr Kang for example?

Re the cold operating room… I had an operation years ago in UK and said to the people wheeling me in, it’s freezing in here. And they said bugs dont like the cold. Not sure if that’s why but it did strike me how cold it was… And no windows.

Glad you’re over worst, it’s a big blight to get over and I hope you continue to recover well.

Was food as bad as they say?

[Watchful]

GI,

I do want to keep record of my recovery in some form and share it in case it helps others. Not sure how much help it is, though, because this aspect seems to vary a lot from person to person. I need to figure out how best to do this. I’ll post here since I feel loyalty to this forum after interacting with a few members here like yourself over the last year, but there isn’t much activity here for some reason, and it feels like there aren’t many readers. The reason for having so little action on this site is a mystery to me actually.

Yes, they do have the leeway now to modify the procedure, at least in terms of deciding whether to cut the cremaster entirely, and whether to use steel or prolene sutures. Not sure about other aspects of the procedure – I didn’t see any indication that they deviate in additional ways.

[Good intentions]

Congratulations on being able to find enough information to make an informed decision. I’m sorry that your experience was not as smooth as the other patients you encountered. But, on the other hand, you are probably one of the best people to objectively describe the downsides of the Shouldice Hospital experience. From my own experience I suggest that take daily notes, like a diary, over the coming days, if you really want to retain how you felt and what you went through. The brain doesn’t recall stress-filled memories well when the stress is gone.

You said “recently” but can you give a time estimate? Maybe you don’t want to tie yourself to a specific date at the Hospital, which is understandable. But maybe you can fudge it to within a few days.

The comments about the variance from the standard procedure are interesting. Are you saying that individual Shouldice surgeons have leeway to modify the Shouldice procedure within the Shouldice Hospital?

[Alan]

It was $3k (bilateral) for the surgery, flight was £800 and the hotel was about the same (2 weeks).