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Is Lichtenstein the best overall repair?
Folks…every time I talk to someone i tell them i had a hernia mesh disaster….without fail the person says oh i had a hernia…they put mesh in open…i had a few days of mild pain and then NOTHING. I have heard this 62 times now. Some getting meshed on each side and NOTHING. Our friend and hernia expert JF thinks flat mesh placed in open fashion is a safe repair…and my experience though informal seems to bear this out…maybe its because of the lack of tension. You will hear Dr Yunis say open is the highest risk for complications…but remember he is a LAP surgeon…and Lap surgeons are notorious for cherry picking studies…if i ever come across a lichtentein patient that complains i will post here…but so far zero out of 62 people. Tissue repairs are dicey…even the successful repairs…the folks dont say NOTHING when asked if they feel anything…they say i feel something…not enough to mention…Mike M…or Thunderose…some periodic burning at the surgery site….or our freind Watchful with his shouldice issues…I ran into numerous shoudice patients who felt the repair years later…when lifting weights…or babies or when dogs pulled etc….so i ask again…is lichtenstien really the safest way to go???
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8 Replies
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Speaking of an open lichtenstein, would Dr. David Chen be the BEST surgeon to have one done? It seems he has really perfected and tailored the technique.
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Yes, right now you don’t have surgical damage on the anterior side, only posterior. If you now get open tissue repair and then a recurrence, you’ll be messed up both anterior and posterior. I wouldn’t take a chance with anything that isn’t known as solid in terms of recurrence, which means either Shouldice or open mesh.
The major downside with the Shouldice Hospital is that they don’t tailor the repair. You will get Shouldice regardless of whether that’s a good fit for your case or not. They apply Shouldice by hook or by crook even in cases where it’s difficult and Lichtenstein is not. You don’t want a difficult surgery for many reasons, including the higher likelihood of chronic pain. Even in the rare cases where the tissues are falling apart, they will still do what they can with Shouldice, and reinforce with posterior mesh.
All this is not a problem for most patients because Shouldice is a reasonable fit in most cases. However, if you are one of the unlucky ones with a hernia and anatomy which make Shouldice difficult, you are in a bad situation there.
With Conze, you don’t face this problem. He is very proficient with both open mesh and Shouldice, he is not biased, he does a thorough exam and imaging, and he actually does some thinking and planning based on that before surgery.
If you are certain that your case is a good fit for Shouldice, then the Shouldice Hospital is a reasonable choice, but remember that they will not approve you without a significant hernia that’s evident in a physical exam.
If you decide on Lichtenstein, then Chen is an option, but he is extremely busy there at UCLA. A year ago, the wait time for a consultation was 4 months. Care after surgery can be a problem. I mentioned before the guy on the bodybuilding forum who had Lichtenstein surgery with him, and then had pain and discomfort for months. He said he couldn’t get follow-up help. I would feel more comfortable with Conze, but the fact that he’s in Germany makes things a bit complex. Towfigh is another option. I’m sure there are other highly capable open mesh surgeons in the US. I didn’t really research that much because I wasn’t going in that direction.
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Jordan also concurs with your Conze recommendation because Conze can use a flat mesh if needed….Jordan also says flat mesh open is very low risk in his view…he rarely sees problems….he even says flat mesh might be less risk for chronic pain than shouldice…if i went the flat mesh route….then would you suggest chen over conze?
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Watchful…at some point i am gonna have to pay pal you….your advice has been spot on….your only competition in this space is from Jordan Fitzsimmons…he has reseasrched this just like you, His opinion is that my previous mesh placement is not an issue because it was on the back side….so the tissue if the hernia recurs will be virgin tissue and any repair should hold as if it was the first repair performed….that said he said he would not risk a kang repair….he advises Shouldice. I assume you would concur? I trust that the surgeon you saw at shouldice must have been the worlds best shouldice doc…you have been reluctant to name him…but is that who you would recommend for an uncomplicated shouldice repair? or is conze your man still….
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Watchful thanks….it seems as if your advice would be not to risk a kang repair with a recurrance because it might not hold up as well as a shouldice from conze? When i asked Dr. belyansky about this he said –the tissue repair would be done on virgin tissue….so it would be as if it was a first time hernia rather than a recurrance….any thoughts about this?
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Chuck,
In terms of tissue repairs, Conze does mostly Shouldice. He can do Desarda as well, but that’s not his preference typically. If you want Desarda, then Lorenz would be a better choice. Conze didn’t mention any other tissue repairs when I talked to him.
Recurrence shouldn’t be taken lightly. You pretty quickly run out of good options to fix it. You already had lap mesh, robotic removal, and now you think you have a recurrence. Say you fix it with Kang and it recurs down the road, what will you do? You really need this to be your last fix.
My advice would be the same as before. First, if all you have is some minor pain and no bulge, just wait, and don’t do anything. If it’s more serious than that, get properly diagnosed to see if you really have a recurrence. I’m guessing Dr. Towfigh could help you with that. You can decide on the procedure and surgeon later.
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Watcfhul thanks…and as always thanks for all your DD. Honestly you know more than the surgeons. I dont want to risk mesh again. I actually met a guy last night with double mesh —titanium tacks –and god awful lap surgery and he has been fine. It makes no sense at all given what I know now about that garbage surgery. So I think I have narrowed my decision to Kang, Weise and Conze…leaning Conze based on your recommendation. I did like that Dr. Towfigh seems to be able to perform multiple tissue repairs…and I think there is some merit in her contention that a woman might perform a daintier surgery. But then she is not a pure tissue surgeon and spend a lot of time implanting mesh. I like the Conze isnt doing 12 surgeries a day…and that he gives a detailed consult. Does he have a wide array of tissue options? of is it just shouldice and desarda? It seems like shoudice really presents a high risk for chronic pain. Maybe worth the risk of recurrrance with a lighter Kang style repair.
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Chuck,
None of these is really safe (all are a crapshoot), and it’s impossible to say what’s safest because for one patient one particular type of repair may be safer, and for another patient another type of repair may be better.
As I mentioned before, I have encountered people who had trouble from a Lichtenstein repair. One friend had it done 20 years ago, and still has occasional (albeit rare) pain. One of the surgeons I met needed a neurectomy due to chronic pain after this procedure, and he now always cuts the ilioinguinal nerve when performing this procedure. There was a guy on the bodybuilding forum who did a lot of research, and then went to Dr. Chen (considered one of the best) who performed a Lichtenstein on him. You can read his posts after his surgery. He had some pain and discomfort for months. He did get better eventually if I remember correctly.
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