no mesh surgery with continuous absorbable sutures

[drtowfigh]

The cremaster is cut during a classic Shouldice repair as they feel it improves hernia recurrence outcome. It is unrelated to the pelvic floor.

[kaspa]

After searching through literature I found that they cut cremaster to inspect canal’s floor, which is a frequent seat of second hernias (2/3 of missed hernias).

In Shouldice, “cremasteric tissue is divided leaving the distal end long enough to support the testis, thus avoiding a dependent testis and the proximal stump reasonably short to be incorporated to a newly formed internal ring.”

Source:

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2009.09155.x

[meshless]

Tomas is the read deal.

[Brady]

Is Dr Thomas good surgeon and reputable? Desarda is new and unproven?

[Chaunce1234]

Also a detailed patient report (with photos) for a bilateral Shouldice repair at Shouldice in Canada here:

https://shouldiceherniarepair.wordpress.com/

[Chaunce1234]

Stumbled into a detailed report of another individuals Desarda surgery experience and recovery, available here for those interested in reading it:

https://ihernia.wordpress.com/2015/12/25/i-hernia-3-0/

[Chaunce1234]

quote meshless:

I concur with Good Intentions and Ezzy’s remarks. I had no mesh bilateral inguinal and umbilical repair by Dr. Tomas in Ft. Myers, Florida. I had all three repaired on the same day. It’s been 11 months since my repair. I am happy to answer any questions that lead to my decision, and my experience thus far. I spent about a year researching hernia repair from many types of sources: message boards, NIH articles, other publications, litigation information, Google, etc. I was on a quest to find someone who documented their personal experience with a Desarda repair by Dr. Tomas. I wanted to learn about their experience before, during, and after surgery. Most of what I found lacked documentation for experiences months and years out. The experiences also lacked the details I was looking for about recovery. The best that I found was here: http://thelibrarian.bravesites.com/entries/general/desarda-hernia-surgery. I think it is quite good, compared to what is out there. And it was very hard to find. I decided to document much of my experience, particularly during the 2 weeks immediately after my surgery, about how I felt at every day in the process. But I quickly realized why as time passes by it is harder to learn about someone’s personal experience. For me, there was less to report other than I don’t even think or feel anything regarding my hernias. My two weeks recovery documentation is pretty detailed. If anyone is considering Dr. Tomas or Desarda, I am happy to share.

How are you feeling now? Do you have any lingering pain or complaints after your desarda repair? Was your hernia painful or problematic before the surgery?

Please consider posting your full two week recovery documentation in a separate thread, preferably labeled something obvious like “Dr Tomas Desarda Repair Review – 2 Week Recovery Log” so that others can easily find it if they are looking. It is indeed difficult to find patient testimonials and reports, but they are often helpful, and thus it could be valuable to other potential patients.

Thanks.

[Ezzy]

quote dog:

possibly kind of promotional endorsement
. no even contact info..i want to ask him a few questions….i learned in my life never take anything on face value..Give me the name of that person :}

Well, I can say my recovery experience has been pretty similar to the one reported on the blog, expect for more pain (on my part) the first day or two. I’m almost 6 weeks out and feel great! Trust me, if we was not happy, I would be letting everyone know..

[dog]

possibly kind of promotional endorsement
. no even contact info..i want to ask him a few questions….i learned in my life never take anything on face value..Give me the name of that person :}

[Ezzy]

quote dog:

meshless he web you liked is very suspicious..who is that person..no contacts ..very questionable

Its just a guy blogging about his personal experience recovering from a Desarda repair. What is suspicious about that???

[dog]

meshless he web you liked is very suspicious..who is that person..no contacts ..very questionable

[dog]

We do not use “absorbable” stitches as they have proven to be a very poor method of hernia repair. The majority to which resulting in recurrence of the hernia in the near future post-repair.

Our method does require the severing of the genitofemoral nerve but this does not prevent any muscular actions.

Please let me know if you require further assistance.

Joseph Almonte
Patient Coordinator
Shouldice Hospital

Well…every foreign material in the human body is source of inflammation

Did you do any test before and after for C reactive protein or others to see if stitches can be source of inflammation ?

On other note you divide/Cut the cremaster muscle that can impair work of testicles ..correct ?

Dog

Hello Mr.

I am going to ask that you get in touch with Dr. Robert Bendavid. He leads our research department and will be happy to speak to you. He can be reached at 905-889-1125 ext. 239. If you leave him a message, he will return your call as soon as he is able to do so.

Please let me know if you have any further questions regarding our institution and general queries about becoming a patient at Shouldice Hospital. I will gladly answer any questions to the best of my ability. Thank you once again for writing.

Kind Regards,

Joseph Almonte
Patient Coordinator
Shouldice Hospital

My grandmother was telling me that i am master of asking inconvenient qwesiones ?

[UhOh!]

quote Good intentions:

Here’s an interesting article about the early years of a surgeon’s career. One sentence seems especially relevant. The “standard of care” is the phrase that you’ll see often when looking at why mesh is used. The device makers have managed to make mesh implantation the standard. Which just means that everybody is doing it, whether it’s the best or not. You can’t get in trouble if you’re doing what everyone else is doing.

“Case Selection. Young surgeons need to be constantly reminded to do what is safe, proven, simple, and accepted as the community standard of care. Those heroic procedures done as a resident will get you in trouble more often than not outside a tertiary care center.”

https://jamanetwork.com/journals/jamasurgery/fullarticle/508661

This is absolutely all true, in my opinion. BUT, young surgeons learning and following the “standard of care” (because they don’t have enough experience to know if/when to deviate) does not exempt them from approaching it with skepticism or experienced surgeons from constantly learning. Should a resident approaching their second ever hernia repair attempt a Desarda based on reading about it in a manual (when the attending probably only knows mesh repairs)? Absolutely not. But that same resident should allow their cumulative knowledge and experience begin steering them towards seeking training in a more effective alternative (or developing one) as they continue on in their career.

[Dill]

Yes. Dr Grishckan would not take my insurance. I would have felt comfortable with him from what I’ve read and discussing some things–Dr. Szotek is harder to find out information about and I haven’t approached him yet–am now sending some information to Dr. Yunis in Florida. But the article I posted makes it sound like a lot more surgeons could be doing no mesh without the specific Shouldice of Desarda long-term training. I’m talking to a couple hernia specialists about that.

[Chaunce1234]

quote Ezzy:

I just had one and it hurt really, really bad the first 48 hours. Dr. Tomas does not prescribe any opioid pain killers for pain after surgery anymore (I really could have used them).

That is an annoying and disappointing trend. Some patients do fine without opioids, but others do not.

There is an excellent ongoing series from Fox News on this topic and the patient consequences of the current opioid moral panic. The media/political hysteria about street drug abusers has caused many doctors to be more afraid of losing their license than effectively managing patient pain, which results in leaving legitimate patients – even those fresh out of surgery or dying in hospice – to suffer needlessly regardless of their pain level or condition.

https://www.foxnews.com/health/as-opioids-become-taboo-doctors-taper-down-or-abandon-pain-patients-driving-many-to-suicide

https://www.foxnews.com/health/doctors-abandon-opioid-prescribing-as-state-and-federal-authorities-step-up-enforcement

https://www.foxnews.com/health/undoing-the-harm-of-the-response-to-the-opioid-overdose-epidemic-health-experts-suggest-solutions

https://www.foxnews.com/health/long-arm-of-tough-new-opioid-policies-leave-some-cancer-and-post-surgery-patients-without-painkillers

[Jeremy B]

I just had Surgery with Dr. Grischkan, in Ohio. He will perform the first two layers of shouldice, and PDS absorbable suture upon request.
I am exactly two weeks post op and still have considerable swelling/pain that has not relented. It’s too early for me to tell If the procedure was successful since the swelling is very large.

Regards,
Jeremy

[Chaunce1234]

quote Dill:

First, I’m new to the board–researching everything since I have an inguinal hernia that has suddenly started giving me pain and is getting larger so I have to have surgery. I don’t want mesh; I know that. I’m a good candidate, and shouldice accepted me except it’s out of country and my insurance won’t pay. I’m searching for a place that will accept my insurance and also do no mesh (Ohio won’t). In the meantime I’ve done more research on various sutures–I’m not sure why the steel thread wouldn’t react with some people either–I was very intrigued with this paper I found in one of the threads https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702909/ because it offers something it seems like a lot of hernia specialists could learn how to do and sutures that might not cause reaction. I mean it would be great if more people could get trained be willing to do mesh. Could we talk about this a little bit? Again sorry if I’m repeating some other discussion. Happy for a link if that is the case.

Two surgeons in the midwest who perform non-mesh hernia surgery:

– Dr Paul Szotek in Indiana

– Dr Grischkan in Ohio

Shouldice in Toronto is a valid consideration. Insurance might not cover it, but depending on what your deductibles and co-insurance is, it might be cheaper to go to Canada anyway given the comically expensive mess that is US health insurance and medical billing.

If you’re interested in traveling elsewhere in the USA there are a handful of other non-mesh hernia surgeons too, but finding a non-mesh hernia repair is surprisingly difficult given the high demand and patient interest.

Keep us updated on your case and decision making.

[Ezzy]

quote meshless:

I concur with Good Intentions and Ezzy’s remarks. I had no mesh bilateral inguinal and umbilical repair by Dr. Tomas in Ft. Myers, Florida. I had all three repaired on the same day. It’s been 11 months since my repair. I am happy to answer any questions that lead to my decision, and my experience thus far. I spent about a year researching hernia repair from many types of sources: message boards, NIH articles, other publications, litigation information, Google, etc. I was on a quest to find someone who documented their personal experience with a Desarda repair by Dr. Tomas. I wanted to learn about their experience before, during, and after surgery. Most of what I found lacked documentation for experiences months and years out. The experiences also lacked the details I was looking for about recovery. The best that I found was here: http://thelibrarian.bravesites.com/e…hernia-surgery. I think it is quite good, compared to what is out there. And it was very hard to find. I decided to document much of my experience, particularly during the 2 weeks immediately after my surgery, about how I felt at every day in the process. But I quickly realized why as time passes by it is harder to learn about someone’s personal experience. For me, there was less to report other than I don’t even think or feel anything regarding my hernias. My two weeks recovery documentation is pretty detailed. If anyone is considering Dr. Tomas or Desarda, I am happy to share.

There has been a good discussion going on over at https://forum.bodybuilding.com/showt…353003&page=47 about Desarda and other hernia repair experiences. Just be warned, there is one poster (drgephys – who is not a medical doctor) who has a lot of strong opinions about tissue-based repair, but really has no clue what he is talking about.

[meshless]

I concur with Good Intentions and Ezzy’s remarks. I had no mesh bilateral inguinal and umbilical repair by Dr. Tomas in Ft. Myers, Florida. I had all three repaired on the same day. It’s been 11 months since my repair. I am happy to answer any questions that lead to my decision, and my experience thus far. I spent about a year researching hernia repair from many types of sources: message boards, NIH articles, other publications, litigation information, Google, etc. I was on a quest to find someone who documented their personal experience with a Desarda repair by Dr. Tomas. I wanted to learn about their experience before, during, and after surgery. Most of what I found lacked documentation for experiences months and years out. The experiences also lacked the details I was looking for about recovery. The best that I found was here: http://thelibrarian.bravesites.com/entries/general/desarda-hernia-surgery. I think it is quite good, compared to what is out there. And it was very hard to find. I decided to document much of my experience, particularly during the 2 weeks immediately after my surgery, about how I felt at every day in the process. But I quickly realized why as time passes by it is harder to learn about someone’s personal experience. For me, there was less to report other than I don’t even think or feel anything regarding my hernias. My two weeks recovery documentation is pretty detailed. If anyone is considering Dr. Tomas or Desarda, I am happy to share.

[Ezzy]

quote Dill:

First, I’m new to the board–researching everything since I have an inguinal hernia that has suddenly started giving me pain and is getting larger so I have to have surgery. I don’t want mesh; I know that. I’m a good candidate, and shouldice accepted me except it’s out of country and my insurance won’t pay. I’m searching for a place that will accept my insurance and also do no mesh (Ohio won’t). In the meantime I’ve done more research on various sutures–I’m not sure why the steel thread wouldn’t react with some people either–I was very intrigued with this paper I found in one of the threads https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702909/ because it offers something it seems like a lot of hernia specialists could learn how to do and sutures that might not cause reaction. I mean it would be great if more people could get trained be willing to do mesh. Could we talk about this a little bit? Again sorry if I’m repeating some other discussion. Happy for a link if that is the case.

I recently had the Desarda repair done with Dr. Tomas in Ft. Myers Florida. Only 5 weeks out, but so-far-so good. I was in the same situation as you – wanted no-mesh, but could not find a surgeon using my insurance. Dr. Tomas is a cash-only doctor, but surgery prices are listed on his web-site and truly all-inclusive (except for travel). I have a fairly high deductible, so it was not much more just to pay out of pocket. Overall, I had a very good experience (other than the pain for the first week).