Impossible decision

[Harry]

Guys new to the page and faced with what seems to be an impossible decision. Had mesh removed and now facing a recurrance. Lap Mesh was taken out robotically by yunis. Now small direct recurrance on the left. Possible direct recurrance on the right.

Options if i dont want mesh appear to be

Dr. Kang – who does a minimal repair with a low recurrance rate. He says he does recurrances after mesh removal.

Shouldice clinic – not sure if the repair hernias after mesh removal but I don’t like that you cant select your physician. Its hard to even find who works there and what their background is.

Desarda – tomas says he wont do a desarda on removal tissue. But maybe Dr. Desarda himself will.?

The German surgeouns –looks like Dr Conze is a favorite here —does anyone know if he can fix a recurrant hernia from mesh removal?
If so does he just do shoulice repair. Wiese lorenze and Koch other options?

Yunis – but he is mostly a mesh guy–some experience with shouldice and desarda but not much—nice guy but has hurt some folks too. Chuck Taylor indicates that shouldice is very invasive and has a high prob of chronic pain? Watchful describes his pain from shouldice.

William Bryant and Mike M talk about Bassini–but cant find anyone who does them. Dr Towfigh says she does a bassini –and thoughts appreciated. Bottom line is that i dont like any of these options and its why i selected lap the first time which turned out to be a disasster. Any help appreciated

[Harry]

I dont want to put mesh back in but some say lichtenstein done by a very experienced surgeon may be the safest option

[Harry]

Good Intentions I have been reading your posts with interest. I see that you had lap removal both sides? Guessing you have not had a recurrance. Who do you plan to see if you get a recurrant hernia? Appreciate all your learned posts.

[Good intentions]

I have not had a recurrence. Dr. Billing did leave a small piece of mesh in the area of the original hernia though. He said it was too tangled up with critical structures to attempt its removal.

If I did have a recurrence or a new hernia I would seriously consider Dr. Kang. But I would probably also contact Dr. Billing again, because he is, to me, obviously very thorough and rigorous in choosing the best surgery for his patients. I am fairly certain that he has converted to open surgery from lap in the past, at times, and knows the anatomy well. It would be interesting to know if knows the difference between the original Bassini and the modified Bassini, and which he would choose. He started as a lap TAPP mesh surgeon but apparently has a robotics system now.

I would also spend some time researching smaller names in the hernia repair field. We are all so used to the internet now we tend to overlook people that are out there but not active or talked about on the internet. I just moved to a new place and had to find a new dentist. I was surprised at the variation in ideas about care among the few dentists I talked to. I also realized that my previous dentist had been very good.

There are good skilled surgeons out there who are just not well-known.

[Good intentions]

Here is an older Topic from someone who was talking to a surgeon who used the Bassini method. She did not find out if it was the modified or original method though and has not been back. His name is in the last post, Dr. Wade Rosenberg, of Texas.

Found a tissue repair surgeon, have many questions!

This is probably him –

https://www.houstonmethodist.org/doctor/wade-rosenberg/

[Harry]

Good Intentions thanks so much. Kang does seem to be the safest bet. The thread you posted seemed to suggest that Bassini was associated with chronic pain. In another post Chuck taylor advises that he spoke with a forum authority who recommended Bassini as least invasive. But it seems Kang knows the whole waterfront of repairs and has developed a minimally invasive repair that is not associated with chronic pain. I feel like a real dope for agreeing to laproscopic sugery. It was presented as the safest option for recurrance and chronic pain. But it appears it is the exact opposite. Fortunately all the mesh is out for me -but i am still dealing with pain. This whole area is such a minefield – I wonder if anyone gets a good result.

[Good intentions]

A thought that I just had – any surgeon out there that uses the Bassini method will probably be considered an eccentric. Mesh has grown in to the repair field at a steady rate through the training programs at places like the Mayo Clinic. Many or most surgeons in practice today never learned how to do a pure tissue repair method.

So, when you’re talking to various medical professionals, like nurses, doctors or surgeons, ask about the oddballs that don’t use mesh or those that know the “old arts”. Many of them have probably converted to mesh or laparoscopic but there are probably resisters out there. It is dangerous to leave the herd though. They will not be “state of the art”.

Can you share some details on your mesh ordeal? The type of hernia you started with all the way to mesh removal, if you can stand reliving it. Every story is helpful in showing people what is happening out there. How even the smartest people get fooled (including the surgeons).

[Harry]

Looked at the issue hard. Had one hernia indirect on left. Surgeon found another hernia on the other side. Ultrasound confirmed it though no bulge. The studies appeared to say lap posed least risk of chronic pain. No surgical pain quick return to work. Most of the “studies” didnt say want the doctors told me. Thought it made sense to knock out two hernias in one surgery. Dumb. But there are no good answers here. Seems like lots of pain with the gold standard Shouldice. Desarda seems to be hit or miss and recurrances. Desarda skewing his studies. I never expected so much dishonesty about a medical procedure. Lap seemed to be what most docs recommended. Hope you survived your removal with litte damage

[drtowfigh]

Just to clarify. I offer Marcy, Shouldice, Bassini, McVay, and r-IPT (robotic Nyhus-Condon) repairs.

It all depends on the needs of the patient.

[William Bryant]

Are there any reasons for each method?

What would be the decision process between Shouldice, Bassini or Marcy for example.

That would be really helpful to those who are facing just such a choice – and who have not had benefit of medical training or experience.

[Author]

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