Mark T – any thoughts?

[JHawley]

watchfuls assessment of the shouldice repair – is this negated by high volume centers? Who is your go to shouldice surgeon at present? I read good things about Conze Sbayi Yunis

Regarding Shouldice, I think we went over much of this before…

1) It’s not always a very good fit for the person’s anatomy, and it’s impossible to say with certainty in advance if you’re one of the bad fit cases where the surgery will be difficult.

2) A bit too much of a Picasso treatment where your anatomy is changed in an irreversible manner. If it turns out fine, then no problem, but if it leads to discomfort or pain, then your options to remedy the situation are non-existent or very limited.

3) Anecdotally, I get the impression that there’s too much discomfort and pain with this procedure. This is not based on solid studies, so I don’t know for sure. It’s clearly considered a significant issue at the Shouldice Hospital, and the comment from my surgeon that they encounter new chronic pain cases every week was a concern. He wasn’t trying to say it’s common – his point was that it’s rare, but still happens on a regular basis, including debilitating cases (although the vast majority of cases are fine). To me, this seems to defeat the whole purpose of going with tissue repair instead of mesh. Chronic pain and discomfort are supposed to be less likely with tissue repair. If it’s similar or worse, then why do it? Recurrence rates favor mesh. It’s the chronic pain aspect that’s supposed to make you want to go with tissue repair. I’m not at all sure that Shouldice really has this advantage, but who knows. I just find it more questionable now with the information that I accumulated.

4) Like I mentioned in the past, I was surprised that my surgeon didn’t really feel that Shouldice was overall a superior technique. He thought it was a good technique, but mesh-based ones were as good, and he thought the one least likely to lead to chronic pain was laparoscopic mesh (although he said it’s still a problem even with that). Moreover, he said that if I had a recurrence (which is unlikely), lap mesh would probably be the best solution. I didn’t expect to be “holier than the pope” and believe more in Shouldice than a Shouldice Hospital surgeon. It poured cold water on my e

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