Need Help With Female Inguinal Hernia/want no mesh/keep searching for surgeonsI

[Dill]

Thank you. I would be very comfortable with Dr. Brown but I can not afford the travel, stay and out of pocket. I need to try and find closer and someplace my insurance will approve. I can’t believe how difficult this is in the midwest.

[retriever]

[USER=”2758″]Dill[/USER] – I empathize with you 100%. You and I are in very similar situations, just opposite sexes. I can’t answer many of your questions, but will offer what I can. I’m also located in the Midwest, and share your frustration with the apparent lack of no-mesh hernia surgeons in this part of the country. I continue to look but without success thus far. Some of the names you mentioned: Dr. Yunis – agree that making contact with/getting a response from him/his office is difficult if not impossible. Indianapolis Hernia Center offers no-mesh option but seems to prefer lap surgery (and likes OviTex – did my own research and decided against OviTex even before reading Good intentions’ excellent write-up on it). I researched and talked with the Ohio Hernia Center – same concerns as you with follow-up, as well as other concerns. I also considered Shouldice, but not sure the hospital setting, procedural rigidity, and potential follow-up issues are a good fit for me.

If you do ever get to the point of seriously considering the 95% absorbable mesh (you mentioned that in another post) please, if you haven’t already, read Good intentions’ post: https://www.herniatalk.com/10510-new-material-ovitex

FWIW, below are surgeons I’ve considered so far who do no-mesh repairs exclusively, or almost exclusively:

At this point Dr. Brown is a very appealing option – have not contacted him yet but you can learn a lot about him and his hernia repair experience/philosophy from his excellent website. I also understand that Dr. Brown is very responsive to questions via email or phone. Only drawback is that he’s far away, which introduces the complexities and stresses of air travel, hotel, car rental, etc.

If you are considering a Shouldice repair, Dr. Ashwin Maharaj is probably closest to you, but is out of country (Canada) so your insurance may balk. He spent time at Shouldice (~1300 repairs worth) and is now in private practice in Vaughan, Ontario (northern suburb of Toronto) – his stated objective is to bring the Shouldice repair to the outpatient setting. An additional unstated objective appears to be to change things in the traditional Shouldice experience that may be a bit outdated or off-putting. His website is fairly informative. Dr. Maharaj is happy to talk on the phone or via Skype to answer any questions you may have (both he and his office have offered this via email). They are also quite responsive to email. As of a couple of months ago total cost for unilateral no-mesh Shouldice repair was $4250 U.S. – not sure how that may compare to your insurance out of pocket cost (not that that should be the deciding factor but I know it enters one’s mind).

Dr. Zafar Parvez in Artesia, New Mexico is an attractive option if you’re interested in a Desarda repair (does Bassini repair if for some reason you aren’t a good candidate for Desarda). I’ve talked with him on the phone, very helpful, love his approach to performing the surgery, but the hospital he is now working at can be extremely difficult to communicate/work with, especially if he isn’t covered by your insurance. I was never able to finalize costs with them, but not for lack of trying on my end.

Dr. Tomas in Florida is another Desarda option – have also talked with his office. I understand he’s an excellent surgeon and gets good results, but some of the things I was told when talking with his office raised red (or at least yellow) flags so I tempered my enthusiasm a bit and kept looking. But the hand-holding through the process from his office seems first rate.

Dr. Petersen in Las Vegas was mentioned as a possibility, but he uses general anesthesia and takes no insurance – last I heard cost for inguinal hernia repair (unilateral) was about $5000. He has lots of info on his website and the FAQs are very interesting to read through. But I have some reservations so have not pursued talking with him at this point.

Not sure if any of this is useful to you or not – just trying to help out a fellow weary traveler…

[UhOh!]

quote DrBrown:

Dear UhOh!
If the hernia can be identified on physical examination, then there is no need for an imaging test.
Ultrasound results depend on the expertise of the technician.
Best wishes
Bill Brown MD

Thank you. I should add that the reason I requested the test was to help me decide how immediately to pursue treatment. The thing I cared most about was sac content, and mine was shown to contain only fatty tissue, hence not rushing for surgery.

A friend in radiology cautioned me about operator dependance for US and therefore I wanted it for my own knowledge, not for a treating physician to rely on.

[DrBrown]

Dear UhOh!
If the hernia can be identified on physical examination, then there is no need for an imaging test.
Ultrasound results depend on the expertise of the technician.
Best wishes
Bill Brown MD

[UhOh!]

For what it’s worth, I went for a consult last fall with Dr. Wilson Hartz at Northwestern Surgical Associates* and he said he could do it, did it for many years, would do it if requested, but probably hasn’t done one in about three years. However he said that he prefers mesh and tends to use it because it’s the standard of care and offers more consistent results (i.e. issues of tissue quality).

Personally, I don’t think it’s right to push a surgeon to use a procedure other than that they consider best, because it’s not really setting either of us up for success, but perhaps worth a consult? Only other info I have is that he told me he uses a Bassini repair for indirect, and a McVay for direct. Not sure his preferred anesthesia regimen; we didn’t discuss.

I seem to recall Dr. Towfigh mentioning a surgeon in WI, at MCW, I believe, who does non-mesh repairs.

Most surgeons don’t seem to bother with US imaging if they can confirm a hernia on physical exam (I still asked another doc for imaging order and had it done).

*Sees patients/does surgery at Northwestern Memorial, but different group for insurance/billing purposes.

[Good intentions]

Dill, I don’t know your financial situation but you might find that you’ll spend almost as much out-of-pocket trying to use your insurance as you would if you just traveled to your preferred choice. Also, consider the length of time that you want this to last, trouble-free. It’s probably worth spending more than you would on a new car, maybe even a house.

I tried to stay within my insurance program too and it was a big mistake. My choices were limited and I ended up just going with the “system”. Even just the hernia repair cost more than projected, then the problems afterward were multiples of that initial cost, in many different ways. Plan for the rest of your life and make the investment now. And, all scars fade.

I just posted this in another topic but Dr. Petersen of No Insurance Surgery in Las Vegas seems to fit what you’re looking for. Search those names and his site will come up.

Of course, Dr. Brown seems a better choice. He just posted approximate costs for a hernia repair at his place in another topic. A couple of thousand dollars under a typical deductible. And it includes all extraneous costs, like anesthesia, which can add up to quite a bit.

https://www.herniatalk.com/10684-request-to-surgeons-offer-no-insurance-payment-options-for-hernia-surgeries

Also, have you consulted with Dr. Towfigh? I think that she offers mesh-free repair but I’m not sure where you would fit in to her decision-making process. It’s the first tweet on her Twitter account.

https://twitter.com/Herniadoc

Tweets by Herniadoc