My personal 7 day experience after 2-layer Shouldice with absorbable sutures…

[kaspa]

[USER=”2804″]pinto[/USER] , that’s a good question. I think most surgeons add some personal details to any technique. They often (but not always) even call it “modified” something.

Training is sometimes quite deceptive as it can be just just watching, reading descriptions or watching videos. The only real training is doing something under supervision.

A great problem in surgery as already talked here in the forum is that doctors consider each one’s method the best and work back to back instead of exchanging ideas, but I think this won’t improve in the next 500 years…

For [USER=”2329″]Jeremy B[/USER] , I hope everything goes fine and that we have some updates here soon.

[pinto]

First, @Jeremy B and other contributing members: Thanks so much for your input and ditto again to Jeremy B., a great contribution you made. My question: What makes you (to all) think that the surgery was “Shouldice”? Merely by the word of the surgeon? What the surgeon or any practitioner thinks and does can be quite disparate. Indeed the surgeon can add a “curve” to it, making it indistinguishable to the originator himself.

I am reminded of recently found website for a surgeon claiming he performs the X-approach. And his apparent support? He has had conversations with the originator. I kid you not.

By implication, he had never received direct training but apparently by his own observations, perhaps by video demonstrations or written explanations. I dare say that the latter is not proof positive the X-approach is reliably followed and performed. Perhaps Jeremy B’s surgeon is the real McCoy but I think it worthwhile to note that when approaches are critiqued, the possibility exists that the actual approach under our scope is not the real thing.

[patient]

Hi [USER=”2329″]Jeremy B[/USER] hope you are doing well!

Just wanted to know if you could give us an update about your surgery?

Thanks!

[Chaunce1234]

quote Jeremy B:

A ~2 month update on my progress after Shouldice (w/absorbable suture) with Dr. Grischkan in Ohio…

Swelling has reduced to a very minimally raised Inguinal ligament with what feels a pencil girth of scar tissue around the incision site. (The swelling started out nearly hamster size)
Pain is now almost non-existent with intercorse having a slight odd pulling feeling but nothing major at all.
Flexibility is fine; However I have not attempted any yoga or any major stretches yet.
I walk completely normal now and climb stairs with authority. I have snowboarded and x-country skied a few times successfully with only a few moments of very minimal discomfort.
Overall it is a huge relief from what I experienced post-op, and It is definitely better than having to manage a hernia with a truss and walking on eggshells.
I hope my journey can bring some clarity on what one might expect from a primary open shouldice procedure performed by an expert.

Regards,
Jeremy

Thanks for the continued updates on your case and progress. It sounds like you’re doing quite well, back to regular and intensive activities, which is fantastic to hear.

It would be nice if all hernia surgeons in the USA were able and willing to perform the Shouldice repair.

[Chaunce1234]

quote Jeremy B:

A ~2 month update on my progress after Shouldice (w/absorbable suture) with Dr. Grischkan in Ohio…

Swelling has reduced to a very minimally raised Inguinal ligament with what feels a pencil girth of scar tissue around the incision site. (The swelling started out nearly hamster size)
Pain is now almost non-existent with intercorse having a slight odd pulling feeling but nothing major at all.
Flexibility is fine; However I have not attempted any yoga or any major stretches yet.
I walk completely normal now and climb stairs with authority. I have snowboarded and x-country skied a few times successfully with only a few moments of very minimal discomfort.
Overall it is a huge relief from what I experienced post-op, and It is definitely better than having to manage a hernia with a truss and walking on eggshells.
I hope my journey can bring some clarity on what one might expect from a primary open shouldice procedure performed by an expert.

Regards,
Jeremy

Thanks for the continued updates on your case and progress. It sounds like you’re doing quite well, back to regular and intensive activities, which is fantastic to hear.

It would be nice if all hernia surgeons in the USA were able and willing to perform the Shouldice repair.

[Jeremy B]

Thank you DrEarle, I was told that having the absorbable suture might add a 1-2% as far as recurrence rate.
Do you have experience with using absorbable sutures in a hernia repair?

Regards,
Jeremy

[DrEarle]

Jeremy B – Thanks for the posts and update. Glad you are feeling better. Your concern about a recurrence once the sutures absorb is reasonable, but there’s nothing to do about it. Absorbable sutures do not equal certain recurrence however. It’s usually best to continue on with your life, and worry about it only if a problem arises. Best – DE

[dog]

Thank you for update! I can only imagine how worry you were. So glad it is over!!!

[Jeremy B]

A ~2 month update on my progress after Shouldice (w/absorbable suture) with Dr. Grischkan in Ohio…

Swelling has reduced to a very minimally raised Inguinal ligament with what feels a pencil girth of scar tissue around the incision site. (The swelling started out nearly hamster size)
Pain is now almost non-existent with intercorse having a slight odd pulling feeling but nothing major at all.
Flexibility is fine; However I have not attempted any yoga or any major stretches yet.
I walk completely normal now and climb stairs with authority. I have snowboarded and x-country skied a few times successfully with only a few moments of very minimal discomfort.
Overall it is a huge relief from what I experienced post-op, and It is definitely better than having to manage a hernia with a truss and walking on eggshells.
I hope my journey can bring some clarity on what one might expect from a primary open shouldice procedure performed by an expert.

Regards,
Jeremy

[Jeremy B]

Thank you for sharing paco. Who performed your surgery? And have they used absorbable before during shouldice?
I’m a little worried If my repair will hold once the sutures are absorbed.

[Jeremy B]

Thanks for sharing paco. Who performed your surgery? Have they done Shouldice before with Absorbable?
I’m a little worried now about recurrence once the sutures are absorbed.

Regards,
Jeremy

[paco]

Glad to hear you are better.

Attached photo of my incision site.

I take this opportunity to update my state after my mesh removal, neurectomy and Shouldice repair with absorbable sutures.

Well, 1 month and 15 days exactly after my surgery.

There is a huge difference between mesh vs non mesh. During mesh dressing… no walk, no sex, extreme pain, no no…
Now… walk, run, activities, etc.

Pain, marginal. Only slight discomfort sometimes.

The only problem not related with the current surgery is that my systemic inmune disease and damage caused by the mesh is still present, but slightly and slow improvement however. My IgE levels are going down slowly.

If I could turn back time…

[dog]

quote jeremy b:

hello all, below is my progress ~1 month post-surgery:
The swelling has decreased to about half.
There is still a very hard lump around the incision site, deeper than skin level.
Numbness still remains from the incision to the base of my package.
Walking and general movement has become less painful, i even went snowboarding with no issues.
I hope the healing continues and can get to a point where i’m glad to have had it done.

Dog, in response to your message; dr. Grischkan only performs shouldice.
I researched all methods and watched loads of surgeries to come to my conclusion on choosing this method and surgeon. Was it a good choice? Time will tell; i’m about a month in and the negative issues vs positive is about the same as if i still had the hernia, just different. The major positive thing is not having to worry if my hernia is out or not and constantly checking myself down there (what a nightmare for years). The negative issues are a hard lump, numbness, minor pain which will all hopefully diminish with time.

Why i chose shouldice and not desarda.
Desarda method seems to alter the anatomy more than shouldice; it incorporates a strip of external oblique and moves it down to the deepest fascia layer. Shouldice seems to repair the issue directly by suturing the facia back together. My thinking is that your anatomy is closer to how it was before the hernia existed once tissues have remodeled. With desarda you’re always going to have a piece of external oblique sewn down into a deeper layer rendering your anatomy vastly different from original. Shouldice also has an extensive track record regarding recurrence and chronic pain. I couldn’t find enough information on desarda other than dr. Desarda himself promoting this method. I guess what is important is that the repair will hold and not feel strange or painful long term.

Regards,
jeremy

sooo glad you are better!!!!!

[Chaunce1234]

quote Jeremy B:

Hello all, below is my progress ~1 month post-surgery:
The swelling has decreased to about half.
There is still a very hard lump around the incision site, deeper than skin level.
Numbness still remains from the Incision to the base of my package.
Walking and general movement has become less painful, I even went snowboarding with no issues.
I hope the healing continues and can get to a point where I’m glad to have had it done.

I’m glad to hear you’re able to return to activities like snowboarding. Thanks for the continued updates on your progress.

[Jeremy B]

Hello all, below is my progress ~1 month post-surgery:
The swelling has decreased to about half.
There is still a very hard lump around the incision site, deeper than skin level.
Numbness still remains from the Incision to the base of my package.
Walking and general movement has become less painful, I even went snowboarding with no issues.
I hope the healing continues and can get to a point where I’m glad to have had it done.

Dog, in response to your message; Dr. Grischkan only performs Shouldice.
I researched all methods and watched loads of surgeries to come to my conclusion on choosing this method and surgeon. Was It a good choice? Time will tell; I’m about a month in and the negative issues vs positive is about the same as If I still had the hernia, just different. The major positive thing is not having to worry if my hernia is out or not and constantly checking myself down there (what a nightmare for years). The negative issues are a hard lump, numbness, minor pain which will all hopefully diminish with time.

Why I chose Shouldice and not Desarda.
Desarda method seems to alter the anatomy more than Shouldice; It incorporates a strip of external oblique and moves it down to the deepest fascia layer. Shouldice seems to repair the issue directly by suturing the facia back together. My thinking is that your anatomy is closer to how it was before the hernia existed once tissues have remodeled. With Desarda you’re always going to have a piece of external oblique sewn down into a deeper layer rendering your anatomy vastly different from original. Shouldice also has an extensive track record regarding recurrence and chronic pain. I couldn’t find enough information on Desarda other than Dr. Desarda himself promoting this method. I guess what is important is that the repair will hold and not feel strange or painful long term.

Regards,
Jeremy

[dog]

Dear Jeremy B ..Yep i hear you . How are you ?

Did you discuss with Dr. Grischkan { excellent doctor} dr.Desarda method as on option ? …to me {i am not the doctor} perform invasive Shouldice repair….on already inflamed tissues passably wouldn’t be a good call…but it is in my humble opinion only…

Here is what Prof Desarda saying about Shouldice repair..below http://www.desarda.com/why-not-shouldice-surgery You can imagine the degree of throttling and necrosis of the muscle or ligament of 1-2 mm width when they are stitched again and again in 4 layers with synthetic threads or fine stainless steel wire. (See through following sketches)

[Jeremy B]

GI, I did get the Operative Report; I made Dr. Grischkan very aware I would not accept any mesh and reminded him the day of surgery.
One thing that was odd about the report is that it states that:
“Shouldice repair was fashioned with 2-0 PDS in the usual manner with four runs.”
Maybe I got the standard sholdice?, I guess it doesn’t really matter at this point.

another thing that concerns me from the report is a statement: “There was excessive inflammation and friability of the tissues.”
Does this indicate an underlying Issue?
Is Friability secondary to Inflammation?

Regards,
Jeremy

[Good intentions]

I don’ t know if this will make you feel better or worse, but my surgery site from mesh removal is still changing, a full year later. There have been long periods of time where it seemed like improvement had stopped, but then more change and improvement happened. The body just keeps adapting, trying to get back to the original design. Sometimes it seems like it’s on its own schedule, independent of activity. I’m finally to the point where I live a normal life, and don’t hold back to save the site of the former mesh from pain.

Here is the link to Dr. Grishkan’s practice. He says that he does use a “special” mesh for certain cases. Have you seen your surgery notes? I’m not trying to add something scary, just curious about the details. Looks like he’s popular with the body building crowd so you’d imagine that the lump will reduce, but they do seem to recover faster, by the stories.

Good luck.

http://www.herniasurgeries.com/

[Jeremy B]

Hello all, It has been three weeks since I had a Shouldice operation with absorbable sutures performed by Dr. Grischkan.

Recap: 37yo 170lb 6′ 2″ athletic male; barely noticeable hernia for a couple of years that was painless.
During the last year I managed it with a truss.

Update:
The area is still very swollen, Id say unchanged;
Pain is slightly more tolerable and comes and goes in waves.
I am a bit more mobile and am forcing myself to walk at a normal pace.
The incision has wept a little bit the last two mornings after showering.

This is very frustrating, however; I am getting slightly used to the suck of it all.
I hope you all have a good holiday, I’ll post more in the coming days.

Cheers,
Jeremy

[Chaunce1234]

Sorry to hear the swelling is still prominent. How are you feeling otherwise? I imagine it’s frustrating to wait for a seroma to slowly go away, are you able to massage it as Dr Towfigh suggested?