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Mesh-Free Tissue Tissue Repair Techniques
Hi guys. Does anyone have knowledge of how the tissue repair approach of Dr. Towfigh or Dr. Kevin Petersen compares and contrasts with Shouldice for an ilingual hernia repair? Are they two-layer repairs? Four-layer? Is the cremaster resected? Shouldice may not be an option for me so am looking around. I live in the SF Bay Area but am very open to travel to get the best. Opinions welcome. I’m checking out a Dr. Jeff Gutman locally as well.
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3 Replies
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Mesh-Free Tissue Tissue Repair Techniques
dropbear, this is from a fellow patient and I am not a doctor: Shouldice in Toronto is a good option if you can travel to Canada and afford the associated out of pocket costs. They have fairly strict requirements, do require a multiple-day hospital stay, encourage patients to immediately move around, and don’t generally do full anesthesia, all of that is part of their routine protocol. Cost estimates from I have heard without insurance are around $7000 USD total. Some things to keep in mind about Shouldice and a Shouldice repair: you must not be overweight, and you must have a reasonably obvious palpable hernia. If you are overweight they will prescribe weight loss and will not do surgery until you meet a normal BMI requirement, and if your hernia is not found on exam they will not do surgery.
A Shouldice option in the USA is Dr David Johnson in Palm Springs CA, he worked at Shouldice for several years and still performs the same Shouldice repair by request, as well as the other standard mesh repairs. Dr Towfigh also performs a Shouldice repair as mentioned here. I believe Dr Yunis in Sarasota Florida also performs a Shouldice repair too, surely there are others out there as well but it’s generally harder to find in the USA.
I believe Dr Petersen uses a modified Bassini or McVay repair, but that is based upon web research and not a direct conversation.
A non-mesh option in the bay area is Dr William Brown, he focuses on sports hernias but also will do a regular inguinal hernia as well. Dr Gutman in Los Gatos is highly experienced but I believe is primarily Laparoscopic, I’m not sure if non mesh is an option there.
Your best bet is to inquire directly with the surgeons or surgery centers you are interested in and ask questions. Good luck and keep us posted on your decisions and progress.
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Mesh-Free Tissue Tissue Repair Techniques
The Shouldice technique is tried and true. Many of us use it as our go-to repair technique for non-mesh open inguinal hernia repairs. The Shouldice Clinic in Toronto has the most experience in it and has published the best outcomes.
The Bassini is another technique. It is basically half of a Shouldice (2 layers instead of 4 layers). I resort to this if the Shouldice seems too tight for the patient.
There are 100s of other techniques that have been validated over the past century or so. Nowadays, most surgeons do not have enough experience and volume with open non-mesh repair, and few are trained in it during their residency. I predict it will make a comeback when we see more mesh-related complications.
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Mesh-Free Tissue Tissue Repair Techniques
Please ignore. Shouldice it is.
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