Just diagnosed with an inguinal hernia

[dave11]

Watchful, the Prolene 0 is nonabsorbable, but Yunis explained that the sutures do not do the primary holding at my 6 month post hernia surgery. He went on to say the adhered tissues form healthy scar tissue barriers that do the primary support. I was a little confused because I thought the stitch work was the main barrier. However, once again I was pleased that my body was able to form the barriers. I really do wonder what happens to the Prolene 0 long term being subjected to various body internal conditions. The Internet shed no light. You really are “watching” Watchful. “Dissolves” was wrong word. I do get the feeling if I live long enough my body will diminish the Prolene 0 also. I have had no inflammation from the Prolene, and in a way, the more support it gives the better for me.

[dave11]

One more thing regarding the 4 layer Shouldice is that those 2 extra layers are mostly placed to reduce tension and do not necessarily contribute to a lesser recurrence rate. As for my 2 layer, I have absolutely NO TENSION now and I am glad I avoided all that extra Prolene 0 suture work. I always remember Dr. Kang saying the 4 layer is “unnecessarily invasive.”

[dave11]

Watchful. I have tried quite successfully in my life to keep any material sold at a hardware store out of my body. I would NEVER put wire sutures in my body. In fact, after having to get a plate and screws put in my wrist after wrist surgery, I had them removed after the radius bone healed with superior wrist function . Our bodies can be wonderful healing solutions if we nurture them. The sutures used during my Shouldice have dissolved per Yunis leaving healthy scar tissue as barriers to future hernias. The Desarda technique has a lesser reputation than Shouldice and is more destructive to body tissues. This might be a factor if recurrence surgery is needed. At least for me, the Shouldice experience has been great!

[Watchful]

Thanks, dave11. If the amount of prolene suture material is the concern, it’s possible to use steel, but then your options are even more limited in terms of places to get it done. Were you considering going to the Shouldice Hospital? Also, were you considering the Desarda procedure? I know Yunis offers that.

[dave11]

Sheldon and Watchful, by the way, my hernia was NOT small when I actually got the surgery. My point is body tissue progressively weakens with aging, and getting a hernia fixed earlier can prevent further worsening. My smaller indirect inguinal hernia had turned into more moderately sized BOTH indirect and direct 4 months before the surgery. After waiting 8 years, I can’t preach getting preemptive surgery, but there is a proper time to avoid a much larger hernia situation. When it comes to bodily decline, advancing age always eventually wins.

[dave11]

Hi Watchful, a lot of decision had to do with my age and toning down heavy activity. Also, Dr. Kang recommends two layer because four layer has too much suturing. The Dr. Jones’ two layer video seems to confirm it has plenty of suturing of its own. Dr. Grischkan’s extreme number of successful two layer (vice four layer) Shouldice surgeries was important input too. If I were a lot younger and very active lifting, I would consider getting a four layer for the little extra long term protection. Right now, my two layer is quite solid and the surgical area has healed extremely well. I hope this helps.

[Watchful]

Hi dave11,

Why 2-layer and not 4-layer? Doesn’t 2-layer have more tension and higher recurrence than 4-layer? I’m guessing it was because your hernia was small.

[dave11]

Hi Sheldon, I waited over 8 years to get a somewhat small right side inguinal hernia repaired because occasionally through exercise and heat therapy it would reduce to very small. Problem with anyone over age 50 is that our abdominal tissue is not restoring as well as when we were 20. In fact, our body loses 1% of collagen production each year from age 20 on. For me, at age 75 now, that is a 55% reduction, which really affects the quality of skin and internal body tissues. So, I decided it was only going to get worse even on my well conditioned body, and it did. Thus, I did enormous research on no mesh surgery and surgeons worldwide. Drs. Grischkan, Brown, Kang, and Yunis stood out because I prefer not to place mesh in my body. Please read new website page sportshernia.com/why-not-mesh for the most clear reasons for getting a no mesh hernia repair. My favorite initially was Kang, but his South Korea location was a big problem during pandemic. On further investigation, Dr. Yunis was chosen, especially with the very competent help of his admin assistant Melanie. She answered all questions and arranged consult one day and surgery the next quite smoothly. In early August 2021, I flew to Sarasota from Pensacola to have two layer Shouldice surgery performed, and the results have been outstanding (see my other posts for details). At 6 plus months post surgery, my lower abdominal area has returned to its previous very good form before I even acquired the hernia. Dr. Yunis runs a class operation at a very fair price, which my insurance paid, and provides exceptional skill in performing diverse surgeries. I hope this helps you a little in deciding. By the way, I can be quite critical of poor medical care, but the secret for healthy life is to avoid such doctors. Thanks for Hernia Talk!

[Alephy]

The way I see it, there are lots of variables at play e.g. the skills of the surgeon, materials, patient’s anatomy etc etc….there is one thing though that people seem to agree on: if the mesh needs to be taken out, it is really a difficult procedure and requires a true specialist! Also the recovery from this procedure may take a long time too (to see improvements that is). Personally this is the reason why a mesh that would disappear after a certain time seems (to me laymen) a better compromise, so as to reduce the odds of a potential major problem with the mesh…of course I would still argue that people eligible for that should also be offered a pure tissue repair, but this may not be viable to all…

[Good intentions]

A thought that occurs to me now and then is that a mesh repair is like an “all-in” bet in gambling. The overall odds might be in your favor but if you lose you lose a lot. A pure tissue repair is like a small bet, that, if you lose, you can still continue to seek a win.

That seems to be the disconnect a person finds when they are talking to surgeons. The surgeon sees the wins of many patients, and the losers just cease to exist, in their minds. Oh well, too bad, but look at all of these winners.

So, long-term, the results of chronic pain from mesh need to be compared to the results of chronic pain from a pure tissue repair. What are the odds of having chronic pain, what are the odds of successfully removing the chronic pain if it occurs? Chronic pain has to be considered in depth for hernia repair. If it isn’t then the patient is just making an uninformed gamble.

[Good intentions]

Where did the thoughts originate? Where is the supporting information?

The AHSQC seems to be collecting some useful information. Apparently it is only good for a 30 day evaluation though, at this time. It says that open, lap, robotic, and Shouldice all have about the same rate of problems, for 30 days. I have not seen any studies that show that Shouldice causes more chronic pain than any mesh repair.

Finally, the major and main question of how a mesh problem is addressed compared to how a pure tissue problem is addressed is not covered. Mesh problems are much more difficult to solve than pure tissue problems.

The AHSQC is a new effort to understand the problem and, at this time, the best that they can do is to say the situation is undefined in the long-term.

https://link.springer.com/article/10.1007/s10029-019-01968-y

“Results
4613 patients met inclusion criteria. 1925 were repaired using an open technique (42%), 1841 were repaired using a laparoscopic technique (40%), and 847 were repaired using a robotic technique (18%). The Shouldice technique remains the most common tissue-based repair performed in the AHSQC. The Lichtenstein repair is the most common open mesh-based repair. Minimally invasive approaches to unilateral inguinal hernia repairs remained very common in our series. The robotic approach accounted for nearly one-third of the minimally invasive inguinal hernia repairs.

Conclusion
In general, all of the repair techniques reported similar and low rates of 30-day complications. The AHSQC continues on-going efforts to improve long-term follow-up and looks forward to addressing long-term outcomes such as recurrence and chronic pain with increasing data acquisition.”

[drtowfigh]

Here are my thoughts:
– I do prefer watchful waiting if your inguinal hernia is not affecting your daily activities
– If you are fit and healthy, the laparoscopic with mesh is the best overall repair, if performed by a specialist: short recovery, low recurrence rate, lowest chronic pain risk. Otherwise, an open repair is best.
– If you have a direct inguinal hernia, the tissue repair is not your friend. It may be too tight and cause more chronic pain than any other repair option.
– The open preperitoneal mesh repair is worst of both worlds. I would only recommend that technique if you have a recurrence from an open anterior repair AND you cannot get anesthesia. It is not considered the best option for primary inguinal hernias.

[William Bryant]

Hello Sheldon, theres quite a number on here, myself included, who are waiting rather than surgery.

When I first found out I had a hernia, I wanted it ‘fixed’ asap, however I soon started reading about the problems mesh can cause, sometimes same with tissue repair. Ive put off surgery through mainly being afraid and also not wanting to be in a worse situation than I am by having it.

Before I had a hernia, I assumed it was minor, easily fixed and low risk. I was wrong.

Personally, I am discounting mesh, and considering shouldice, Desarda or Dr Kang.

It’s difficult deciding! Easier waiting!!!

[Watchful]

That’s my understanding too regarding your own tissue growing and paticipating in holding the load. This is not specific to Prolene stitches, though – the same happens with steel, and also with a mesh.

[Watchful]

Thanks, dave11. Didn’t Dr. Yunis use Prolene in your procedure? I believe those are non-absorbable. Steel is also non-absorbable, of course. The advantage of steel from what I read is that it generates less inflammatory reaction in the body, although I don’t know how significant or meaningful this is.

[sheldon]

thanks

[Wim]

What about the open “transrectusschede-preperitoneale procedure” TREPP?

[sheldon]

Why do you think the “The open preperitoneal mesh repair” is a bad choice?

[sheldon]

thanks – nice to know I’m not alone