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High rates of pain with pure tissue repair?
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I don’t think Mike had major pain issues following his Dr Kang repair. He mentioned in passing some sporadic discomfort maybe at times. He went on to clarify before Dr Kang repair pain was 7 and after 0.0 or near enough I seem to remember.
The ideal would be nothing of course but i also remember a poster saying or asking is anyone’s groin the same after hernia surgery. It may have been your good self Chuck or Watchful.
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Freeman recently had a tissue repair and said he feels fine, I think its still a minority that have chronic pain not the majority of people.
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I am going to follow up with the good doctor kang. Dr kang is a committed Christian – hopefully he can be trusted to give an honest answer.
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Thx watchful. Hoping some kang patients can weigh in. Our friend pinto said he had little pain. Of course his hernia recurred. Kang himself says he sees little chronic pain. Of course Tomas says no pain for desarda. My issue is that I have seen lots of reports of pain with shouldice. From my doctors in DC. From a few studies. From reviews at the shouldice clinic. And from patient reports on Facebook kang says the repair is very invasive that would suggest it’s likley more painful. This is such a nightmare. There really are no good answers. Any input appreciated.
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I don’t think we know the chronic pain rates with Kang. Has he provided them? They may be lower than Shouldice since his procedures are less extensive. On the other hand, if his techniques result in more tension, then there may actually be more pain and discomfort. One of the reasons for the 4-layer Shouldice repair is the reduction of tension.
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Yes, you are correct…I had meant to edit that to say the 2007 British Journal of Surgery study (not 2007 British Study)
The problem goes much deeper than the setting, though that is a big deal on its own. The total # of patients getting a ‘Shouldice repair’ (modified repair, it seems) at that hopsital is about one third of what ONE full-time Shouldice Hospital surgeon would do in a year. To be fair, they are not mere ‘generalists’ doing very few repairs, but they aren’t doing as many as the high-volume specialists either.
IMHO, a bigger problem though is that the results perpetuate in future papers with ZERO context…and then readers come along and fail to evaluate the quality of that ‘evidence’.
It is extremely problematic to say “A recent 10-year follow-up study showed a recurrence rate of 7·7 per cent after primary hernia and 22 per cent after recurrent hernia repair” with no further context…and when digging deeper you find out those percentages are based on an extremely small sample size and (apparently) a modified repair.
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Fair question. These are the options I had:
1) Laparoscopic. As I mentioned before, the best lap mesh surgeon in my area wasn’t sure he could do it in my case. He said there was an 20% chance that he would need to convert to open. I definitely didn’t want something like that to happen. Dr. Towfigh recommended Lichtenstein in my case, although she was willing to do lap mesh. Beyond all that, I was biased against this procedure. I wanted to avoid general anesthesia because my mother suffered delirium and cognitive dysfunction from surgery with general anesthesia. Also, I simply didn’t like the invasiveness of TEP/TAPP and the large amount of mesh.
2) Open. Here I converged on two options. Lichtenstein or Shouldice. There was a third option of posterior mesh, but I didn’t have anyone who could do that – Reinhorn wasn’t taking patients from outside New England.
There were the options of other tissue repairs. I didn’t have a good gut feeling about Tomas, and the Germans recommended Shouldice over Desarda, so I dismissed Desarda. With Kang, I was concerned about recurrence for reasons I described in other threads. My dad had a recurrence from tissue repair, and I believe it was a Marcy-like repair based on what he described. He never had the recurrence repaired, and his hernia is really bad now. It would be a huge mess to fix at this point. Anyway, he has plenty of bigger problems, and surgery is not a good idea at his age.
Between Shouldice and Lichtenstein, I felt that Shouldice would be the better choice. Some studies show pretty similar chronic pain numbers for these, and some show more chronic pain with Lichtenstein. My thinking was why take any chance with mesh complications if I don’t have to, and if Lichtenstein doesn’t really offer an advantage. On the recurrence front, I felt that the Shouldice Hospital numbers are low-enough.
You know the rest of the story. In my particular case, Lichtenstein would have probably been a better choice because of the size of the hernia and my anatomy. My Shouldice surgery ended up being long and difficult, and it led to some chronic pain and discomfort (although not too awful at this point). Of course, I didn’t know all this when making the decision, and I had incorrect information about the size of my hernia because of a grossly inaccurate ultrasound.
With hindsight, I think I regret not going with Lichtenstein. However, if my chronic pain and discomfort resolve mostly over time, and there’s no recurrence, it may turn out that I’ll feel like I made the right choice. I don’t regret not going to Kang. If my hernia was challenging for a Shouldice repair in the hands of one of the top experts, I don’t see how it would have worked with a Kang repair – I don’t see how he would have stitched the huge defect that I had with his Marcy-like repair.
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This reply was modified 11 months, 3 weeks ago by Watchful.
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This reply was modified 11 months, 3 weeks ago by
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Without reading the full paper and seeing how they performed the surgeries, and defined pain, and queried the patients, there’s not much value in the summary. The summary is not clear, and for some odd reason, a different primary author led the effort to rewrite and republish the study results. The link to the 2007 paper contains the full publication, with data.
You can find presentations by experts in each method describing ways to go wrong. Dr. Chen produced a video about the Lichtenstein method and potential problems.
Shocking numbers can be found pretty easily on the internet.
https://www.tandfonline.com/doi/abs/10.1080/00325481.2016.1121090
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No, you have not. You’ve been in echo chambers on social media groups looking at non-respresentative problem cases.
The 27% study is NOT from Shouldice Hospital, the Germans, or anyone else who is an ‘expert’ with that repair, is it? Then that would be non-representative too.
Even if we granted a 27% pain rate, how does 27% = the “nearly everyone” claim from your irresponsible opening post?
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