No-mesh inguinal hernia repair near Minnesota/Midwest?

[Ddot14]

I’m trying to find an experienced no-mesh hernia surgeon to repair my 4-week-old inguinal hernia. Of the 4 people I know who’ve had similar hernias repaired with mesh, 3 are now living with chronic pain and discomfort – no recurrence of hernia but apparently mesh-related issues. I’ve tried to read both sides of the mesh issue, and have decided to try to avoid mesh and its potential complications at this point in my life – I have enough issues already and don’t care to add that one if it can possibly be avoided.

I’m located in Minnesota and would obviously love to find a surgeon in-state, but am willing to travel if necessary to see an experienced, talented, and supportive surgeon. I would like to find someone in the Midwest someplace (Minnesota, Wisconsin, North or South Dakota, Iowa, Illinois, Indiana, etc) if possible, but will consider traveling farther if I need to. I’m aware of Dr. Kevin Petersen in Las Vegas and Dr Robert Tomas in Florida, but I’m unable to fly and the long drive with a hernia isn’t very appealing if I can find closer options. But I’ll do it if I need to!

I’m scheduled for a consult in a couple of weeks with a “Top Doctor” general surgeon here who does many hernias. I’ve tried to get information from his nurse and others at the clinic but nobody seems able or willing to tell me much about his experience or areas of expertise. The best I can get is that it’s possible he might possibly consider a no-mesh repair if conditions are ideal, but it sounds like he normally uses mesh. I’d like a surgeon who prefers to do tissue-only repairs as a general rule, rather than as a lesser- or rarely-used option. How do I determine if this surgeon would be a good choice?

Any thoughts or opinions? Recommendations on qualified surgeons I might look into in my area or out? Advice on how to try to find local/regional surgeons experienced with no-mesh repair?

If there’s a better place/forum for me to ask this question please let me know. I’m just trying to do my due diligence, and this kind of info seems very tough to track down online.

Thanks for any help you can give me – this forum is a wealth of knowledge and information!

[Good intentions]

The Shouldice hospital is close – https://www.shouldice.com/

Be careful with a doctor who says that they’ll do it if conditions are “ideal”. That just leaves the door wide open for waking up with mesh.

Can you give more detail on your friends who had mesh, then chronic pain? It’s going to take numbers and examples to break down the resistance to accepting that any mesh, anywhere, one-size-fits-all, is guaranteed to give good results. And that chronic pain is more than just minor discomfort. The mantra is so strong that many doctors don’t even see the original concerns about mesh, tacks. See the other recent thread.

The widespread rejection of the thought that a mesh implantation can cause problems is pretty incredible. Highly educated people who just refuse to see it. It makes you wonder what they’re being taught in medical school and residency. Reject, reject, ignore seems very common.

No offense to the doctors here who are listening and thinking. It’s the others that seem brain-washed. Or, even worse, know, but are accepting the failure rate, for the “greater good”. It really impacts a person’s faith in the medical system.

[Momof4]

Good Intentions, I agree with your statement that “the widespread rejection of the thought that a mesh implantation can cause problems is pretty incredible”. I’ve recently wondered that if the doctor admits that mesh is causing problems, is it then harder to justify the continued use of mesh in future patients!! I know everyone reacts differently and there are many factors to be considered in choosing the best hernia repair for each individual, but there certainly are patients who should not have mesh implants. Dr. Towfigh has identified certain subsets of patients (those with autoimmune, allergies to polypropelene, very thin, etc.) who will not do well with the standard mesh repair, if there even is such as thing!! Thank you to the doctors on this forum that are considering individual factors and tailoring their hernia repairs for each patient. I speak from experience because I had an allergic reaction to polypropelene, which had been implanted for hernia repair and, ultimately, Abdominal wall reconstruction, and was removed after causing two years of suffering with pain and systemic reactions. I am not sure that I will ever fully recover from all of the damage caused by the mesh and multiple surgeries, but I am doing everything I can to try and make that happen. So, when a doctor doesn’t acknowledge or believe that mesh causes problems, I feel like that is a slap in the face to those who have suffered so much! Certainly makes one lose faith in the medical system.

[Ddot14]

Good intentions – thanks so much for your comments.

I have indeed considered Shouldice, but they appear to be cost-prohibitive. A bit too pricey for us to handle at this point in time. Still trying to find someone in the Midwest someplace that does quality non-mesh hernia repair. Not looking too promising at this point though, unless someone here has names or ideas where to look.

This comment you made:

“Be careful with a doctor who says that they’ll do it if conditions are “ideal”. That just leaves the door wide open for waking up with mesh.”

is exactly what I’m concerned about. The most well-intentioned promises up front aren’t likely to prevent a mesh-leaning surgeon from resorting to a mesh repair if he/she sees something at all suggestive of possible recurrence once they get me opened up. Makes me very skeptical about seeing any surgeon other than one that is quite open and up-front about avoiding mesh repairs, understands the reasons to avoid them, and can demonstrate consistently positive outcomes.

The problem becomes finding such surgeons. To this point I’ve had zero success calling surgeons’ offices and asking questions about preferred repair types, if they offer non-mesh repair, how many hernia repairs they do/have done, outcomes, complications, etc. Staff (including nurses) either truly don’t know what the surgeon does (seems strange not to be able to give prospective patients information that would help “sell their product”), or they don’t want to/are not allowed to give that information out. It makes it very frustrating and very difficult to find surgeons that are experienced and comfortable with non-mesh hernia repair.

So, we’re left posting on forums like this, desperately hoping to get recommendations of non-mesh surgeons others have identified or stumbled onto. Something is wrong with the system – sad.

My appointment with a local hernia surgeon is coming up in a couple of days. I don’t have high expectations but am trying to assemble enough good questions to help me find a good fit. It’s hard to know how much to believe even when asking questions directly to the surgeon. Not that they’re intentionally trying to mislead or deceive, but rather that they likely often have non-existent or incomplete follow-up information on patient satisfaction, complications, or repairs gone bad, and/or they repeat the “mesh as the gold standard” mantra they’ve heard from every direction since med school. In the end hernia repair is really about choice and quality of life for the patient, not about theoretically shaving a percentage point or two off the recurrence rate.

I don’t mean to sound harsh – that’s not my intention. But this issue just shouldn’t be that difficult. Hernia patients need and deserve treatment choices, and realistically speaking we don’t have them in this country anymore. I feel for you surgeons out there who are trying to walk this tightrope and provide what is best for your patients, and I certainly wish more of you would take up the challenge of becoming proficient in and offering your patients non-mesh hernia repair as a viable and readily available option to mesh repair.

[Good intentions]

I’ve read of a few places that use the Shouldice method in the United States so I searched “shouldice hernia repair united states” on Google. Here’s one interesting place in Ohio. No idea about them other than they’re on the internet.

https://herniasurgeries.com/modified.htm

Have you tried sending a message to Dr. Towfigh? She is active in the area of no-mesh hernia repair, as you probably know, and probably knows of others. Click on her screen name and you should see how to send a message.

http://www.beverlyhillsherniacenter.com/hernia-surgery/hernia-repair-techniques/#1472573567285-ed4d539b-3184

[Good intentions]

quote Ddot14:

I’m located in Minnesota and would obviously love to find a surgeon in-state, but am willing to travel if necessary to see an experienced, talented, and supportive surgeon. I would like to find someone in the Midwest someplace (Minnesota, Wisconsin, North or South Dakota, Iowa, Illinois, Indiana, etc) if possible, but will consider traveling farther if I need to. I’m aware of Dr. Kevin Petersen in Las Vegas and Dr Robert Tomas in Florida, but I’m unable to fly and the long drive with a hernia isn’t very appealing if I can find closer options. But I’ll do it if I need to!

Just had another thought also. Don’t be too economical or “practical” when making your decision. The effects of a poor decision will last for the rest of your life.

I think that one of the problems with today’s hernia repair with mesh method is that it is so easy to do the repair quickly, with no short-term complications. It’s a battle of short-term results versus long term results. We all tend to think in the short-term, and even long-term to most of us is months or a year or two. Both patients and doctors tend to lean toward the mesh repair, I think, because it gives immediate relief and seems so simple. Just get that mesh to cover the defect with a lot of extra just-in-case material, then get out. The patient only has to plan for a few hours away from home. It all seems so simple. The protruding abdominal contents are placed back where they should be, the mesh covers the hole, and the access holes are sewn up. One to two weeks later the patient is functional. But the relief is not full or complete. The patient ends up at some lower level of the person they expected to be, with no apparent solutions.

So, even though you’re avoiding mesh, to avoid long-term problems, you’re still planning in a short-term, convenient, way. I did the same thing when I had mesh implantation. I was close to traveling to the Shouldice Hospital but then a different easier path appeared, with confident people telling me it was safe and effective.

Just an observation and maybe a push for you to go a little farther to get what you want.

Don’t overlook also though, that there are many stories of successful open repairs with mesh. But open repair has more short-term risks, like bleeding and infection. It leaves a bigger scar and there might be a bump. Healing is slower. But the long-term results might be better.

If somebody on the inside collected information they might find that there are specific bad materials and/or bad methods. Everybody would benefit if the bad actors could be rooted out. It might be though that the biggest device makers are the bad ones, and they control the field. Until somebody identifies who the bad ones are though many people will assume that all mesh is very risky and avoid it like you are.

Good luck.

[Red Oak]

Ddot14, can you update us on whether you found a surgeon, and how the procedure went? I am a thin female with an IH, also looking for a non-mesh repair in the midwest, preferentially in the Chicago area. Family responsibilities make traveling extremely difficult.

[Chaunce1234]

[USER=”2335″]Ddot14[/USER] and [USER=”2678″]Red Oak[/USER]

The following may be helpful leads for both of you seeking a non-mesh hernia repair in the midwestern USA, not quite in either of your states but somewhat close:

– Dr David Grischkan in Cleveland, Ohio

– Dr Paul Szotek in Indianapolis, Indiana

Good luck and keep us updated.

[Jeremy B]

I am in the same boat; live in Minnesota, even checked with Mayo clinic, all mesh. I think Grischkan in OH is probably the closest non mesh hernia specialist. I wish someone here could speak to Grischkans results.

[Chaunce1234]

quote Jeremy B:

I am in the same boat; live in Minnesota, even checked with Mayo clinic, all mesh. I think Grischkan in OH is probably the closest non mesh hernia specialist. I wish someone here could speak to Grischkans results.

I can’t speak from specific experience but you can find a lot of reviews and thoughts of Dr Grischkan around the web. Beyond that, his website says he has repaired something like 20,000 hernias, which is a huge number, I’m not sure if there are many other surgeons with that volume of experience fixing only hernias.

There’s also the Shouldice clinic in Toronto Canada, which is fairly close to the midwestern states as well. Most USA-based insurance probably won’t cover Shouldice, but then again the all-in cost of Shouldice is still often less than deductibles and co-insurance with many insurance plans.

[dog]

quote Chaunce1234:

I can’t speak from specific experience but you can find a lot of reviews and thoughts of Dr Grischkan around the web. Beyond that, his website says he has repaired something like 20,000 hernias, which is a huge number, I’m not sure if there are many other surgeons with that volume of experience fixing only hernias.

There’s also the Shouldice clinic in Toronto Canada, which is fairly close to the midwestern states as well. Most USA-based insurance probably won’t cover Shouldice, but then again the all-in cost of Shouldice is still often less than deductibles and co-insurance with many insurance plans.

Chaunce1234 You are SOOO correct about deductibles !!!! Boy i still like more [h=1]DESARDA technique…. If i would go for Shouldice ..My choice would be this doctor https://www.centerforherniarepair.com/meet-dr-jonathan-yunis/[/h]

[drtowfigh]

University of Minnesota has a hernia center under Dr Archana Ramaswamy. Try that.

Not aure if they offer tissue repair.

[Red Oak]

Chaunce1234, thank you for those recommendations! I have been in “watchful waiting” for about 6 years, and am just now starting to get discomfort at the end of the day that makes it uncomfortable to take long walks or exercise. Earlier in the day, no problem. I would like to find someone who does non-mesh and has extensive experience operating on women (Momof4, your situation is exactly my concern), since I have allergies and sensitivities that would make it more likely for me to have issues with mesh repair. I have looked at Dr. Szotek’s website, as he is closest to the Chicago suburbs. I plan on contacting his office. Is there somewhere on this forum where I can find patient reviews of specific doctors or surgery centers? Thank you!

[Momof4]

Did you try the center in Minnesota that Dr. Towfigh recommended? I would trust her recommendations. When you say that you have allergies and sensitivities, that should be a red flag when considering implanting a synthetic material in you. Be advised that most permanent sutures are polypropelene as well. I had some skin patch allergy testing done with mesh and suture samples. Dr. Towfigh referred me for that. The tests certainly aren’t perfect, Dr. Towfigh admits too, and one of the allergists that I saw didn’t feel like skin patches are a good way to test for implant reaction. One thing he did say though was if I did react on the skin he certainly wouldn’t recommend implanting that material. He also said that a negative skin reaction doesn’t mean you won’t react to same material when implanted. It’s complicated and I’m not sure there is a good way to know how someone will react to an implant. People with pre existing allergies should be very careful!!

[Ddot14]

Interesting and helpful discussion – I really appreciate everyone’s help and Input! I apologize for taking so long to reply. Been busy with family medical issues 🙁

No, I haven’t yet found a surgeon to perform a no-mesh repair on my inguinal hernia, but the urgency is ramping up as my hernia is becoming more symptomatic and increasing somewhat in size. The surgeon decision is made more difficult because I am unable to fly, so will have to drive to wherever the surgeon is located – thus the reason for trying to find a no-mesh hernia specialist as close to Minnesota as possible (which I now realize isn’t likely to happen). Like Red Oak, family responsibilities make it challenging to travel, but it’s important to get to a great surgeon rather than end up with a sub-par repair so I’ll need to make it work somehow.

Thank you [USER=”935″]drtowfigh[/USER] for checking with your contacts at the University of Minnesota hernia center and confirming that they know of no local tissue repair surgeons. If you can’t track down anyone in Minnesota, there probably aren’t any, which confirms what others of us have been finding. It seems that there are multiple good options on the west coast, maybe a few in the southwest, and some in the northeastern U.S., but most other areas seems more or less devoid of no-mesh hernia specialists. Do you know of any qualified surgeons in this “black hole” area?

[USER=”2678″]Red Oak[/USER], how are you getting along? Have you had a chance to talk with Dr. Paul Szotek in Indianapolis? He is close to you and his website says he does no-mesh hernia repairs. It doesn’t say what repair methods (Shouldice, Bassini, Desarda, etc) he uses or how long he’s been doing them. Not sure if he also does mesh repairs so be sure he knows you are wanting no-mesh repair. I think he accepts insurance but also offers a fixed price hernia repair and it appears that he may offer a lifetime guarantee if the repair fails? Interesting. I haven’t been able to find much information about him online, but was wondering if you have learned anything that helped you make a decision either way. There doesn’t seem to be a lot of detail or specifics on his website, but the list of hernia work he apparently does, including recurrent hernias and mesh removal, is pretty lengthy. I’d be interested to find more input on Dr. Szotek and read some of his no-mesh Inguinal hernia repair patients’ experiences and impressions to see if he might be a possibility for me.

Just some thoughts and a bit of an update about my lack of progress so far. I’m still in the thick of things though, so any additional thoughts, suggestions, or other info are appreciated!

[Ddot14]

I too would like to hear more detail about Dr. Grischkan’s results. I had looked at him a while back but was concerned that his website is somewhat contradictory about whether or not he uses mesh (gore-tex?) in repairs, and when I called his office the person on the phone also seemed somewhat non-committal about mesh. As I understand it, the mesh patch would be very small if used at all. I don’t know enough about the technicalities of hernia repair to understand if his modified Shouldice repair is good, bad, or unknown so far as recurrence and chronic pain rates. He claims good results for recurrence, but I’ve not seen his method compared to any other repair type, so don’t know what to make of that. He’s done a ton of hernia repairs using his method, so it seems like there should be more information available someplace. I think I remember reading that he was also very expensive for those without insurance he accepts.

[kcm]

I considered surgery with Dr. Grischkan. If you fill out his online form he will call you personally.

[dog]

Dr. Grischkan.Is a great choice !

[drtowfigh]

[USER=”2335″]Ddot14[/USER] unfortunately there is a black hole. You are right.

You’d have to travel. Closest would be Ohio, Michigan, Indiana.

[Ddot14]

Thanks for your response, [USER=”935″]drtowfigh[/USER] – I so appreciate that you take the time to respond to this forum on a regular basis!

I’m assuming you are referring above to Paul Szotek in Indiana and David Grischkan in Ohio? Please correct me if I’m wrong on either of those!

I don’t believe I know about any tissue repair hernia specialists in Michigan. Can you tell me who you have in mind?

It looks as though it may also be time to look at enlarging my search area, so any particularly strong recommendations/ experiences anyone may have for highly qualified, experienced inguinal hernia tissue repair surgeons are welcome, regardless of location. Seems like nothing’s ever easy… 🙂

[drtowfigh]

Toronto, for the Shouldice Clinic is another alternative near you.

That said, if you’re going to travel by plane, not sure it matters the distance. We have a lot of names listed here for tissue repair, including my own. Use the Search option on this site.

[Ddot14]

Thanks [USER=”935″]drtowfigh[/USER] – I forgot to mention that I’ll likely have to drive wherever I end up going, as the person available to go with me can’t fly due to medical issues. So closer is better (probably can only travel about 450 miles per day), but if I can’t find a match anywhere “close”, I need to plan for a longer drive (ick) or find someone else who can travel with me (unlikely).

I’d love to have a tissue repair consult with you or some of the other doctors listed on this site (would be so nice to start at the top!), but for the reasons above am first trying to stay as close to home as reasonably possible. I realize that may not end up being realistic for multiple reasons. Insurance is also a challenge so finances also figure in depending on doctor, etc.

I have indeed seen and noted names of tissue repair doctors on this site, and they’re very helpful. But I hadn’t seen anyone in Michigan as you mentioned, at least not that I recall. Is Shouldice in Toronto who you meant when you mentioned Michigan, or was there a specific doctor or clinic actually in Michigan you were thinking of?

[Red Oak]

Ddot14, I have not yet had surgery and did not call Dr. Szotek. I can’t find any information about him other than his own website. I’d like information that is unbiased.

Health issues of one of my children have put my own issues on hold. In the past year, my symptoms have not worsened and so I am still “watchful waiting”. Most days, I feel no discomfort, even after a long walk. Some days, the bulge is bigger at the end of the day; other days, not so much. It is completely reducible. I am now 7 years into watchful waiting and hoping that I can continue on this way for a while. What is the longest anyone has heard of staying with watchful waiting? Can I just continue to live with it as-is?

[scaredtodeath]

I think for a very long time possibly

[Tino_7]

quote Ddot14:

I too would like to hear more detail about Dr. Grischkan’s results. I had looked at him a while back but was concerned that his website is somewhat contradictory about whether or not he uses mesh (gore-tex?) in repairs, and when I called his office the person on the phone also seemed somewhat non-committal about mesh. As I understand it, the mesh patch would be very small if used at all. I don’t know enough about the technicalities of hernia repair to understand if his modified Shouldice repair is good, bad, or unknown so far as recurrence and chronic pain rates. He claims good results for recurrence, but I’ve not seen his method compared to any other repair type, so don’t know what to make of that. He’s done a ton of hernia repairs using his method, so it seems like there should be more information available someplace. I think I remember reading that he was also very expensive for those without insurance he accepts.

Dr. Grischkan will attempt a tissue repair first, but if it is too large for that, he will use a Gore-Tex mesh. I consulted with him and he said my hernia (Grade 2) can be a tissue repair, but cautioned me that if it grew too much he’d have to use mesh. He did say the quality of his mesh was above that used in all other mesh repairs at hospitals.

[UhOh!]

quote Tino_7:

Dr. Grischkan will attempt a tissue repair first, but if it is too large for that, he will use a Gore-Tex mesh. I consulted with him and he said my hernia (Grade 2) can be a tissue repair, but cautioned me that if it grew too much he’d have to use mesh. He did say the quality of his mesh was above that used in all other mesh repairs at hospitals.

Perhaps you can comment, based on your interaction, but reading Grischkan’s website, it sounds as though he’s using mesh for a fundamentally different purpose than the majority of surgeons.

From what I understand, it’s usually used as a “patch” which, when combined with tissue ingrowth, serves the function of a bandage or splint. It sounds, from what I’ve read, that Dr. Grischkan is trying to get the Gore-Tex (which I thought was a bit stretchy) to mimic the form and function of the damaged fascia itself. It would be reasonable to expect different results, no?

[Tino_7]

quote UhOh!:

Perhaps you can comment, based on your interaction, but reading Grischkan’s website, it sounds as though he’s using mesh for a fundamentally different purpose than the majority of surgeons.

From what I understand, it’s usually used as a “patch” which, when combined with tissue ingrowth, serves the function of a bandage or splint. It sounds, from what I’ve read, that Dr. Grischkan is trying to get the Gore-Tex (which I thought was a bit stretchy) to mimic the form and function of the damaged fascia itself. It would be reasonable to expect different results, no?

I could be mistaken, but my response to Ddot14 was based on my recollection of a very brief conversation with Dr. Grischkan – too brief to elaborate further. I hope I haven’t introduced any confusion to this topic. You certainly appear to know far more than do I, as I couldn’t even draw the conclusion you did.

[UhOh!]

quote Tino_7:

I could be mistaken, but my response to Ddot14 was based on my recollection of a very brief conversation with Dr. Grischkan – too brief to elaborate further. I hope I haven’t introduced any confusion to this topic. You certainly appear to know far more than do I, as I couldn’t even draw the conclusion you did.

My conclusion (still as much a question as anything) was based more on what I saw on his website than anything discussed here.

[Tino_7]

quote UhOh!:

My conclusion (still as much a question as anything) was based more on what I saw on his website than anything discussed here.

Lol, I was impressed enough by your ability to draw that conclusion/formulate that kind of question. Shows quite a bit of knowledge, I think.

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