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Minimalist repairs vs. mesh
Many patients consider the Kang repair and the desarda repair to be minimally invasive. Less pain quicker recover. But neither repair has around very long so recurrance rates are hard to assess – though desarda has been around longer -I see lots of failures on the forums . Kang says he can do another tissue repair in the event of failure most doctors would insist on mesh. And the desarda failures i am seeing are being repaird by lap mesh. So we have to weigh a minimalist repair against a mesh repair done by someone highly qualified -Chen – or British Hernia Centre – These are probably much more likely to last and there is a solid recurrance record for these repairs. So its fine to say kang repair is the less invasive approach – but if you are looking at multiple surgeries instead of one and done maybe its not? I wish there was more clarity.
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6 Replies
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Watchful thanks so I trust that the Germans are a better option because there is no way you can tell whether your tissue are weak or you have poor anatomy until they open you up? Did the germans ever tell you what they thought the difference in recurrance rates was? Yunis told me the difference was very slight in favor of mesh. Its troubling that the all of the surgeons who may be able to tailor repairs in this fashion are close to 60 or older. I still think most of these doctors are just guessing and have very little data. Has your opinion of the Kang repair changed at all? We keep getting report after report of seemless surgery with little pain and no recurrance at least short term. Kang continues to maintain that mesh is never necessary even for hernias the size of a babies head. Thanks for your opinions on these matters. Its like having a doctor on the forum. I would venture to guess you know more than many doctors about the options we have.
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Grischkan and Petersen are exceptions if that’s what they said. If you ask surgeons who do both, such as the Germans, Towfigh, Yunis, you’ll hear the opposite about recurrence (higher rates with tissue repair).
Chronic pain is a harder question. Not much clarity on that.
As I said many times before, if I had to do if all over again, I would do Lichtenstein in my particular case. I think that in some simple/easy cases tissue repair is a better choice since the risks of mesh are avoided while still providing a good repair. With a large hernia, weak tissues, bad anatomy, just go with mesh.
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Watchful – GRishkan specifically told me that his shouldice had a much lower recurrance rate than mesh. Peterson said his recurrance rate was lower than mesh. Who knows what the german surgeons would say. But its not true that doctors will concede tissue repairs have a higher failure rate. Though a friend who went to a surgeon who does both mesh and tissue said he always recommends mesh for a lasting repair. He told my friend that even the shouldice repair done at the shouldice clinic would likely fail quicker than an open mesh repair. There is this idea floating around – from Kody Oceanic and even yourself that tissue repairs have a lower risk of chronic pain. But I cant find any studies that support this. And almost everyone I speak to with a tissue repair says they continue to feel it to some degree. Many with open mesh – spinotza and company say they feel nothing. There are no answers at all. British hernia centre and Todd HArris say they never see chronic pain. Harris doesnt even warn patients. I spoke with Harris’s top nurse and she said she hasnt seen anyone coming back complaining with pain in the 5 years she has worked for Harris. I questioned her quite closely and she appeared honest. In the end I cant help but wonder if the open mesh repair isnt the best overall. There is no way to know and of course if you get it and it goes bad your life ends.
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@markk
Yes, recurrence rates are believed/known to be higher for tissue repair of inguinal hernia. I don’t think doctors are hiding this (quite the contrary) – they will tell you exactly that if you ask. Tissue repair of inguinal hernias has largely disappeared from modern medicine for good reasons. The results weren’t particularly good back in the days when it was widely practiced. That doesn’t mean that mesh doesn’t have its own issues, of course.
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There is a lot of data on the recurrance rate for lichenstein repairs and the repair has a long history. Kangs repair – the latest version is 4 years old. So the longterm data for Open mesh repairs is a lot more robust. Without good data how can you say the likelihood of recurrance is very low across all repairs. Though the doctors wont tell you this, Tissue repairs have a significantly higher recurrance rate than mesh repairs. All these 1 percent recurrance figures are nonsense. More likely the lifetime risk for a tissue repair failure any type is above 15 percent.
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“I see lots of failures on the forums” is not evidence…that is just you talking.
“These are probably much more likely to last…” is not based on any good evidence…you are basing that on an illogical opinion. You can’t first note that there is no long-term data for Kang, then claim that something else is probably more likely to last than Kang. If there is no data, there is no data…you can’t make a probability claim without any data.
For most patients with unremarkable inguinal hernias, the likelihood of recurrence is VERY low across repair types that are done by a hernia speicalist…so basing your choice of which primary repair to get by which may easier to fix in the very unlikely event that it fails, seems rather misguided.
Get a repair that is appropriate for your particular situation, and get it done by someone who is an experienced expert with that repair. That’s the best you can do.
There is no ‘clarity’ that is going to point to one repair or surgeon above all others, so you may as well stop searching for it.
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