No mesh tissue repair surgeons in Washington or Oregon?

[DrOrenstein]

No mesh tissue repair surgeons in Washington or Oregon?

When it comes to inguinal hernia repair, tissue-based repairs are certainly becoming a lost art, as Dr. Towfigh already alluded to. Mesh-based tension-free repairs are the norm, at least in the United States. Much of this is due to surgical training in the U.S., with tension-free (Lichtenstein) repairs being taught almost universally, while tissue repairs are rarely taught. While tissue repairs can offer a solid repair, this is best undertaken at a high volume center or with a surgeon with more experience in these types of repairs.

Personally, I do not perform tissue-only repairs in the elective setting. This is due to the fact that I believe that mesh-based repairs are superior in the majority of patients, as well as my limited number of cases in which I perform tissue repairs (namely, only emergent cases where mesh is contraindicated). Additionally, traditional tissue-based repairs are repaired in an open fashion (one bigger incision). Minimally-invasive approaches such as with laparoscopic or robotic-assisted surgery (few small incisions) require mesh placement for reinforcement of the hernia, thus precluding tissue-only repair in the majority of patients.

With regards to the comment that it would be ok to have another repair in 15-20 years, I would argue that doing it right the first time with the most effective repair should be the norm. Re-operative surgery greatly increases risk of subsequent recurrence, chronic pain, and other potential challenges during the re-repair. While no procedure has a 0% recurrence rate, tension-free mesh repairs have been around for many years and have very good long-term outcomes.

Unfortunately, I do not know anyone in the Portland area that routinely performs tissue-based inguinal hernia repairs, but I will keep my ears open and will re-post if I hear something.

[drtowfigh]

No mesh tissue repair surgeons in Washington or Oregon?

hernia repair using tissue only is becoming a most skill. There are benefits and risks as with any repair. In my practice, I recommend tissue repair for inguinal hernias to the very thin, to your non-obese women, and to any who have fibromyalgia, lupus, other inflammatory disorders or sensitivities. It is generally not a good idea to undergo tissue repair in the obese, the elderly, or for recurrent hernias.

In Washington/Oregon try Dr Robert Martindale. I am not sure if he does them but he may. He is at OHSU. Perhaps Dr Orenstein can confirm.

[Beenthere]

No mesh tissue repair surgeons in Washington or Oregon?

I hope we are not looked at on taking over the forum. I can not help on your question but there is a question that I have wanted to ask that ties into this.

From my research in postings on this site and others, it seems that with mesh surgery post long term surgical pain can be 20% or higher with up to 3% disabling, with a very low recurrence rate. Or a pure tissue hernia surgery done by a highly trained hernia expert seems to have almost the complete opposite numbers under 10% pain and maybe a recurrence rate of 20%. As a patient I would go with the second option if I had a choice. I was told by my surgeon no to pure tissue surgery. My guess that he did not have the surgical skills to do a pure tissue surgery. Can the experts shed any intelligent reasons for mesh that outweigh the aspect of incidence of higher pain that might be life long and change your lifestyle? If in 15 or twenty years I need have it redone so be it.