Hernia in NYC/Manhattan

[Watchful]

Some Lichtenstein surgeons routinely cut the ilioinguinal nerve, or some branch of it – not sure what exactly. I don’t know about Dr. Jacob.

Note that even surgeons who don’t cut routinely will cut sometimes if they feel it’s needed. This happens in tissue repairs as well if there’s some nerve that gets in the way. The nerve anatomy in that area varies quite a lot from person to person.

[David M]

Yes, I believe he routinely cuts them, or something. As you say, though, some feeling is lost in certain areas, but the implication was that this is less important than preventing the pain from nerves traumatized by the operation results.

Been a long time since I saw the video, but I believe he asked the audience how many did this. There was a significant percentage, so it’s an important question to ask.

[David M]

I could be wrong, but I think Brian Jacob was the one who said in one of those hernia surgeons meetings on youtube that he routinely took the nerves.

[MarkT]

Your hernia is small, you’re relatively young, and you’re active/fit. It seems likely you would be a good candidate for a tissue repair and I would thus consider a Shouldice repair with Dr. Sbayi (who was trained in the repair at Shouldice Hospital).

I don’t see the value in assuming even the relatively small unique risks associated with mesh, unless there is good reason to do so. I also see little benefit in waiting too long to get it fixed, given that your hernia is symptomatic and you lead an active lifestyle. I certainly agree that it is important to learn more and not rush into a decision…but getting too bogged down into the drama on this forum will likely only raise your anxiety level. There is a lot of ‘muck’ to sort through here, unfortunately.

I had two repairs at Shouldice hospital (one side just over 30 years ago, the other about 20), with zero post-op complications or restrictions on activity since, but that is just my experience. It is a strong, proven tissue repair with many decades of history behind it…but also a comparatively complex/nuanced one that you want done by a skilled, experienced, high-volume expert in THAT repair (and that advice really still applies for any type repair).

I would recommended at least consulting with Dr. Sbayi as you contemplate your options.

[Chris]

Sorry to add:

Is there any general preference between Dana Podolsky (actually a she) and Yuri Novitsky at Columbia?

I think the forums generally refer to Novitsky?

[Chris]

Thanks!

Sorry – I meant that I think that I’m locked in within the organization. Meaning if I see Dr. A at Mount Sinai it is unlikely I can see someone else at Mount Sinai. But I plan to see a few of the hospitals/practizes and see what people are saying to get a hollistic picture about different views.

[Good intentions]

If you just want to get the surgery method of the day by the most capable surgeon in that technique, then Jacob, Dalkin, or Novitsky are good candidates. Sbayi has expertise in the Shouldice method. Podolsky publishes about robotics so he might be doing a TAPP mesh repair. Actually Jacob, Novitsky and Dalkin might be also.

You said that once you choose you’ll be locked in. So, you kind of have to decide what matters most to you, the repair method itself or the surgeon’s knowledge of a certain type of repair method.

At your age you certainly have a lot of life ahead of you. Whatever you choose, the results will be with you for the rest of it. Doctors can think about the 85 patients that they helped (as far as they know) and ignore the 15 that they hurt (those are mesh repair numbers). It’s just the reality of their lives. Try not to be one of the 15.

You’re doing the right thing by researching options first. Things just aren’t very clear at this time. Even the “International Guidelines” of hernia repair are being revised, and they seem to be having difficulty deciding what should be in the updated document.

There really is a lot on the forum. Not much has changed in the last 15 years, except for the advent of robotic surgery. It’s the latest new thing. The materials and methods are all about the same. So the odds are too.

[Chris]

Thank you a lot for the prompt response.

Right now I honestly don’t know much besides that it has been diagnosed by a radiologist. It had been hurting for 1-2 days prior to my diagnosis and definitely since then (not much though). Feels a bit unstable on the right side. I have not talked to any surgeon yet. I’m pretty active (I think the deadlifts did it) and in my 30ies so it definitely would impact my life if I would not fix it. That being said I’m aware that there’s risks – hence the research regarding the doctors :).

I will read the forums in more detail but the main reason I posted was to find an initial surgeon in NYC that can tell me what’s going on and who can walk me through options. For the ultimate surgery I will obv. do more research – I’m happy to travel if it makes sense.

[Good intentions]

To be clear, in my post above I was combining recurrence and pain, as “problems”. Both are bad, and even the experts aren’t sure how to avoid either. The factors involved in controlling the problems are still unclear.

[Good intentions]

Spend some time reading posts on the forum. This is not a typical “what’s best?” forum. Is your hernia direct or indirect? The description sounds indirect. Why do you want surgery? Is there pain, or does it hinder your activities? Hernia surgery is very risky, both in the probability of problems (10 – 20% chance [guesstimate] of recurrence or some sort of pain) and the difficulty of fixing those problems if they occur. Surgery involves permanent changes.

Spend some time educating yourself. Don’t be in a hurry to get “fixed”.

A typical surgeon will tell you that the “vast majority” of patients don’t have problems. That doesn’t tell you the whole story. There are many references to professional publications on the site. Read a few and learn the real numbers. Good luck.

[Chris]

Additionally if someone has ideas as to who is good at Mount Sinai / Lenox Hill / NYU Langone it would be helpful. I kind of think that once I see someone at a place I’m locked down within that specific organization and will have a hard time changing doctors.

As of now the names I have are:
Brian Jacob as private practice (mentioned often in these forums)
Flavio Malcher at NYU Langone
Samer Sbayi at Northwell
Patrick Dolan at Mount Sinai

Already mentioned:
Gregory Dakin at Weill Cornell
Yuri Novitsky or Podolsky at Columbia

Chris

[Chris]

Thanks!

Have you seen a standard list of questions that people can take to the surgeon?

I’ve been putting it together based on the comments / my own research, but have not seen anything on this website or anywhere else.

[Chris]

Okay thanks.

I’m would def. consider flying to Canada for a repair if it makes sense. I will see what Dr. Sbayi says. It might make sense to screen it through him and then go to Canada for the actual surgery.

Is Muschawek in Germany an alternative people have used here? Both seem to be tissue-only and Muschawek seems to be focused on people doing sports?

[Chris]

Thanks! With ‘taking out nerves’ you mean that he has no other option than to cut through them and the patient loses feeling in certain spots? Just want to make sure I got the vocabulary right.

• This reply was modified 10 months, 1 week ago by  Chris.