News Feed Discussions Inguinal hernia repair without mesh. Desarda?

  • Inguinal hernia repair without mesh. Desarda?

    Posted by caidanfire on August 21, 2016 at 1:12 am

    Hello,
    My husband developed an inguinal hernia (left side). We are trying to locate a surgeon who will do the repair without mesh. We have heard of a technique called Desarda that appears to be well regarded, but can not seem to locate a surgeon in California that performs this technique. We are open to other techniques as well if they do not utilize mesh.

    An additional consideration is insurance type. None of the surgeons in our current plan will perform the surgery without mesh. My husband will be eligible for Medicare in December. He will also be a dual beneficiary with both Medicare and Medi-cal. We have no other insurance options since he has been unable to work for over two years due to the need for a total hip replacement).

    My husband under went a total hip replacement of the right hip (opposite side of current inguinal hernia) in Dec 2015. The surgeon was excellent and did an excellent job using anterior approach. However, my husbands body reacted poorly to the trauma associated with the extensive amount of repair needed and complications set in. He was in pain from the time of discharge that quickly escalated to severe. He was returned through emergency at which time the surgeon was worried about the onset of compartment syndrome and readmitted him to the hospital. To make a long story short – CS was avoided and my husband was eventually released for physical therapy. Physical therapy began in February.

    The hernia happened shortly after physical therapy was commenced, perhaps due to an overly aggressive approach (heavy leg presses for 5 minutes). Physical therapy was stopped by order of the orthopedic surgeon and we have since been trying to locate a surgeon who will do the repair without mesh and takes the insurance we will have in place.

    I related the above history of the hip replacement and subsequent complications so that you can understand one of the reasons my husband does not want a foreign material used in his hernia repair. He experienced EXCRUCIATING pain with the hip replacement that required hospitalization and four different pain meds administered concurrently to handle the pain sufficiently enough in order for him to be able to move the leg.

    He is currently experiencing pain with the hernia and it is still reducible. He takes pain medication for it and a small amount of residual pain from the hip replacement (though that is doing well as the surgeon did an excellent job and could not foresee the complications that occurred after).

    Please let us know if you or any of your colleagues can do the hernia without mesh. As I mentioned, we have heard about an approach called Desarda that is purported to be an excellent technique, but don’t know who uses it. We would also appreciate any information on alternative techniques that are sound and do not use mesh at all.

    Thank you for your time. Kind regards.

    raindrop replied 6 years, 10 months ago 7 Members · 16 Replies
  • 16 Replies
  • raindrop

    Member
    June 3, 2017 at 7:18 am

    All the surgeons recommended on this forum are really far from where I live. Does anyone recommend any surgeons in Illinois who do pure tissue inguinal or femoral repairs? Thank you in advance.

  • drtowfigh

    Moderator
    May 27, 2017 at 4:12 pm

    Dr Burns is very reputable senior general surgeon.

  • WasInTN

    Member
    May 10, 2017 at 5:00 pm
  • Rezzo

    Member
    May 9, 2017 at 10:10 pm

    Has anyone had any experience with Dr. Burns? I recently got in contact with him and I’ve scheduled a consultation to see if he thinks I’m a good candidate for the Desarda repair. I’m 31, 5’9, 180 lbs and this is my first inguinal hernia (right side) so I’m hoping that makes me a good candidate.

  • dhodun

    Member
    April 19, 2017 at 6:28 pm

    caidanfire, do you have any follow up and if repaired how did it go?

  • drtowfigh

    Moderator
    September 13, 2016 at 4:32 am

    Inguinal hernia repair without mesh. Desarda?

    Please make sure you mention HerniaTalk during your consultation.

  • caidanfire

    Member
    September 13, 2016 at 2:21 am

    Inguinal hernia repair without mesh. Desarda?

    Yes. We have been in touch with Dr. Burns in Newport Beach and Dr. Parvez in New Mexico. Both doctors have experience with the Desarda approach and we are in the process of deciding between the two. Both will work with our insurances. Both come highly recommended by others that have had the procedure (google is a great tool for finding others and their experiences). We are leaning towards Dr Burns though because he is of course much closer.

    Thanks for checking. I will try to remember to update this forum with the results. It will be awhile though, since my husbands medicare doesn’t become effective until Dec.

  • Chaunce123

    Member
    September 13, 2016 at 1:24 am

    Inguinal hernia repair without mesh. Desarda?

    caidanfire, did you hear back about the Desarda repair? Any update?

  • Chaunce123

    Member
    August 26, 2016 at 11:53 pm

    Inguinal hernia repair without mesh. Desarda?

    A surgeon with experience in both would be much better at explaining and describing this, but to simplify tremendously based on my own understanding of the two different repairs types:

    Desarda repair – uses a detached piece of the patients own nearby muscle tissue to cover the hernia hole

    Shouldice repair – uses a multi-layer reconstruction of the patients own tissue to stitch the hernia hole closed

    I’m sure that is very over simplified, but it should give you a general idea.

    Please keep us all updated about your decision making, and what surgery type and where you end up going. Follow up is always good, and very helpful to other patients!

  • caidanfire

    Member
    August 26, 2016 at 4:38 am

    Inguinal hernia repair without mesh. Desarda?

    Thank you so much! You are very kind to take it upon yourself to research this for us.

    I have already called Dr. Burns office and they are to return my call tomorrow with concrete information about the insurance.

    Do you know the major differences between the Shouldice and Desarda techniques? I only know that both are tissue repairs. I dont know how each technique is performed, what the pros and cons are for each.

    If you have any information I would appreciate it.

  • Chaunce123

    Member
    August 25, 2016 at 8:22 pm

    Inguinal hernia repair without mesh. Desarda?

    After a little internet research it does look like Dr Bob Burns will perform the Desarda procedure sometimes on request, as Dr Towfigh suggested. Desarda is a new repair type though and I don’t think there is as much research and longterm followup for it, whereas something like the Shouldice repair has a lot of substantial history behind it.

    As for insurance and who takes what plan, your best bet is to call the billing offices of each clinic and ask directly. Typically they know immediately, or they will research and call you back. This list may help, it shows their clinics and contact information:

    Dr Towfigh – http://www.beverlyhillsherniacenter.com/office-address-and-hours.html

    Dr Chen – https://www.uclahealth.org/provider/david-chen-md

    Dr Johnson – http://www.desertsurgeons.com/Surgical-Care-About-Us-Palm-Springs-CA.html

    Dr Burns – https://www.hoag.org/find-a-doctor/b/robert-g-burns-md/

    Dr Philips – http://bio.csmc.edu/view/3815/Edward-H-Phillips.aspx

    Good luck, keep us updated on your case.

  • caidanfire

    Member
    August 23, 2016 at 8:44 pm

    Inguinal hernia repair without mesh. Desarda?

    Thanks!

    Dr Towfiigh do you take the insurance we will have in place? Or do you know if any of the doctors you mentioned do? I will see what I can do to find out about them also.

    Please let me know if you accept dual eligible medicare beneficiaries. We would feel very fortunate to have you perform the surgery if you can.

    And thanks again. You have been very kind and helpful.

  • drtowfigh

    Moderator
    August 23, 2016 at 8:25 pm

    Inguinal hernia repair without mesh. Desarda?

    Desarda technique has been used by Dr. Bob Burns in Newport Beach. I am not sure if he is still practicing.

    The tissue repair is performed by many of us in L.A. area: Myself, Dr. David Chen, Dr. Edward Phillips.

    I also agree that Dr. Johnson in Palm Springs is a good option.

  • caidanfire

    Member
    August 22, 2016 at 2:10 am

    Inguinal hernia repair without mesh. Desarda?

    Dr. Towfigh
    Thank you for your prompt response. We currently have Health-net through Medi-cal but that will become Medicare with Medi-cal in December. We had better insurance 3 years ago, but since the right hip started going bad, he became unable to work and we lost that insurance.

    My husband weighs 189 and is 5′ 11″

    There was a doctor in Lancaster, CA (where we live) who said he would do a tissue repair, but then he stopped accepting our insurance while waiting for the referral to be approved. So there was at least one surgeon who agreed to do it, but is no longer in our network. That leads me to surmise that he is a candidate (possibly?) for tissue repair. I dont know what the criteria is for being a candidate.

    We live about 70 miles north of Los Angeles. Traveling to L.A. is fine as is the surrounding areas. My husband is willing to travel to any part of the state or near states in order to have the best outcome with no chronic pain (as can be the case with mesh). The pain was so very severe with the hip situation (no one could even just TOUCH his leg without terrible pain) that he is now very “gun-shy” of more pain. Initial pain is not a concern, just long term, chronic pain and problems.

    Please let us know if you need any further information or can offer some to us. Thank you

    Chaunce123,
    Thank you also for your response. I have heard that there are about 3-4 who do the Desarda approach, but I dont have confirmation. There is suppose to be one in or near Newport Beach, one in New Mexico, perhaps one in Texas and of course Dr. Tomas in FL. We spoke briefly with Dr. Tomas’ office and were told that he is transitioning to cash only in his practice so he is not an option.

    We are not adamant that the repair is done with Desarda technique, just that a reliable non-mesh all tissue repair is utilized.

    Thank you both for your time. Please let us know if you have any further information or suggestions.

  • Chaunce123

    Member
    August 21, 2016 at 6:39 pm

    Inguinal hernia repair without mesh. Desarda?

    Fellow patient here, not a doctor… so take that for whatever it is…

    The only US doctor I know of who does Desarda repair is Dr Robert Tomas out of Florida.

    In California I know of three doctors who do non mesh repair;

    – Dr. David Johnson in Palm Springs, does Shouldice repair on select patients

    – Dr William Brown in Fremont, not sure what repair type

    – Dr Shirin Towfigh in Los Angeles (from these great forums), who performs non-mesh on select patients

    I am sure there are others out there too, but I am personally not aware of them and haven’t seen them in my own research efforts.

    Keep in mind that non mesh repair is largely patient dependent, meaning it is not always viable for all patients. Things like patient weight and tissue quality matter considerably from what I understand.

    Best of luck, considering keeping the forum updated on your decision making and progress.

  • drtowfigh

    Moderator
    August 21, 2016 at 2:59 pm

    Inguinal hernia repair without mesh. Desarda?

    There are a handful of surgeons who perform non mesh hernia repairs. There are also a couple who perform the Desarda technique.

    I’m not sure if your husband is a candidate for tissue non-mesh repair. That would’ve a discussion to have with your surgeon.

    What insurance plan does he have and where in California do you live?

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