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Hernia size and shouldice
Is there a “description” of hernia sizes – ie., size of chicken egg, walnut, etc.? I’m wondering what mine would be classified as. Is there a size that cannot be operated on without mesh? I have a local surgeon that does the shouldice technique – but I am also concerned about chronic pain after the non-mesh method. He also cuts the genitofemoral nerve and puts it in a muscle to prevent neuroma from forming. I wasn’t aware that cutting that nerve was part of the shouldice technique or if it’s his own change to the procedure. Thanks for any input. I’ve been putting this off (and visiting and posting on this board) for years and the darn thing continues to grow. I am so eternally grateful for having this source of knowledge and everyone’s kind and informative responses. It has been invaluable. BTW – I’m in Houston and the surgeon is Dr. Anthony Echo. He is a plastic surgeon that has specialized in peripheral nerve surgeries. I can’t travel for this surgery due to other health issues and finances.
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2 Replies
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Thanks so much, Good Intentions for your answer. Is there a place I can find the hernia classification by size? I know that over the last several years, mine has gone from “walnut” size to “egg” size. I can still reduce it and it reduces when I lie down. I also noticed that it will move back in completely on it’s own sometimes. It gets sore and the popping in and out bothers me, but I wouldn’t call it really “pain”, more just soreness. It is an inguinal, not femoral according to all the doctors I have seen. (I saw about 6-7 doctors when this thing first worsened. Most of them except Echo did mesh. I’ve had it since 1996, but it wasn’t until 2018 that it worsened). But I don’t know if it’s indirect or direct. Dr. Echo is a “fast” surgeon – he likes to get in and out of the patient’s room. Once you start asking questions, he almost gets into this “passive aggressive” mode – like he doesn’t have time for all the questions. You feel like you are the idiot in the room. I did ask on my first visit if he always cuts the nerve and he said yes as it is the one to most commonly cause pain post surgery (according to him). I have asked his physicians’ assistant about outcomes and she said they don’t measure them – she was rather evasive. I have seen him twice. The first time was back in 2020?, when I met him regarding the hernia. He performed an ultrasound while I was lying down and said it appeared the opening was small. He quickly explained what he did (what I most remember now is the cutting the nerve) and seemed a little more patient at the time. The next time I saw him was 2023? When I made the appointment, they asked if it was for the same reason. This time I was seeing him about my bilateral tarsal tunnel syndrome (he does all types of nerve decompression surgeries). I had to have a phone consult with his PA first before I could schedule. Then when I had the appointment, he came in and was very rushed. I tried to ask him more about my hernia at that visit, as well and at that point, he literally started walking out. I looked at his PA with an expression of WTF??? And she finished up with me. I think it was at that time I asked her about surgery successes and that’s when she said they don’t track them. I went to see him about my foot nerve entrapment because my orthopedic foot doctor (not podiatrist, but surgeon), told me he had worked with “Tony” on decompression of the tarsal tunnel and he thought he was an amazing surgeon and he referred all his cases to him now. I do trust this orthopedic doctor; however, they also could just be buddies. Who knows? Anyway, sorry about the long story, but just wanted to give you an idea of my experience with Dr. Echo. I do know that some surgeons are just that way – that’s why they become surgeons. But it still left me with a bit of a hollow feeling. However, as a last note, I did see a recent review on his website where an athlete (female) had inguinal surgery with him and was bragging about her experience. But I’m an old lady with other pre-existing issues. There is one other surgeon in Houston that may be an option, Dr. Michelle Loor with Baylor, but she’s more into the robotic laproscopic repair with mesh and from what I have read, I don’t think I want that.
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Generally they are classified by size, in centimeters.
Before there was mesh, all hernias were repaired without mesh. There is no certain size beyond which only mesh will suffice. Actually, if you have a laparoscopic procedure mesh is required for all sizes.
Watchful has posted in the past that Dr. Bendavid used to cut nerves when he performed a Shouldice repair. But, like mesh versus pure tissue, each surgeon will have their own opinion and preference. Also, be aware that many surgeons call what they do a Shouldice repair when it is actually a modified method.
Do you know what type of hernia that you have? A direct hernia might do better with a certain procedure than a femoral hernia.
I have seen Dr. Echo’s name before as a hernia repair surgeon. If he is open to answering questions you might ask him how many repairs he has performed and how the results have been. If he gets angry that’s a bad sign. If he doesn’t know, it could mean many things. You might also ask him if he really needs to cut the nerve if you don’t have pain now. Your description sounds like the size change is what bothers you. Why cut the nerve if there’s no pain? It might actually increase the risk of pain.
Sorry that you’re running the gauntlet of hernia repair in today’s world’s. So many choices and so little way to verify what’s best for an individual with specific symptoms. Who knows, maybe “AI” will eventually cut through the chaos.
Good luck.
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