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Non-mesh hernia surgeons – any input on Maharaj/Szotek or ???
Posted by retriever on March 2, 2019 at 9:58 pmI’ve been reading here off and on for several months and have learned a TON from this forum – what a great resource! I’m trying to find the right surgeon to do a non-mesh repair on my inguinal hernia (heard way too many bad mesh experiences from friends, and I have more than enough medical issues to deal with already).
From my reading in this forum and others, Dr. Brown in Fremont is very appealing, but also far away (I’m near the northeast corner of Iowa), so I’ve been trying to look at closer possibilities before making a decision.
I’m wondering if anyone has any knowledge of or experience with Dr. Ashwin Maharaj (Ansa Health Care – https://www.ansahealthcare.com/hernia-repair/) – spent time at Shouldice (1300 repairs), now has his own practice in Toronto offering Shouldice repair on an outpatient basis) or Dr. Paul Szotek (Indianapolis Hernia Center – https://www.indianahernia.com/) – his webpage says he does non-mesh repairs (as well as laparoscopic repairs, robotic repairs, etc.). I believe I heard/read that he chooses the best repair based on each patient (like Dr. Brown), but likes to use a partially absorbable mesh if the patient is ok with it but is OK with doing non-mesh repair? No detailed information available on Dr. Szotek’s webpage.
Does anyone have any knowledge or recommendations about either of these surgeons? Or any other surgeons you might suggest or recommend?
Good intentions replied 5 years, 8 months ago 3 Members · 7 Replies -
7 Replies
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quote retriever:I realize that I may unknowingly be surrounded everyday by people who have had successful, pain-free mesh hernia repairs, but I’m not aware of any in my circle of friends/acquaintances. I also realize that those who’s mesh repair is doing fine wouldn’t necessarily have reason to talk much about it (since everything is going well), so I’m probably not as likely to hear about those. But first-hand experiences like those I described above make me want to seek out a good repair without mesh, wherever I need to go to get that. Close to home would be nice, but it’s becoming apparent that may not be realistic so I’m trying to focus on finding the surgeon that’s the best fit for me and my needs – I’m open to any and all suggestions.
Thanks for passing along those stories. I know that when I was having my problems I did not talk about them to friends or family at all. They didn’t know until I found a solution and needed a ride to surgery and a place to convalesce. My friends just knew that I had disappeared from doing the things I used to love to do.
I think that there are probably many more mesh problems out there than are apparent. If your surgeon has no advice and just tries to pass you on to pain relief or urology, why burden friends and family with an unsolvable problem? It’s like having cancer.
Good luck.
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quote retriever:Thanks [USER=”2029″]Good intentions[/USER] – I’ll try to answer your questions in two posts so it doesn’t get too long.
I can tell you what I know about type of hernia. Surgeon I saw said it was inguinal hernia (not femoral – which I already pretty much knew) – said he couldn’t tell by exam if it was direct or indirect, wouldn’t know until he had me opened up, and that it didn’t matter anyway because he fixed them both the same way – mesh. Is that what you are asking?
Current medical state is probably decent overall – late 50’s, male, some ongoing back and foot issues/pain, year-round allergies (used to be severe, have improved somewhat as I’ve aged), and some others I’d rather not mention here. Nothing cardiac or lung-related, no serious chronic disease at this point. But enough to handle on a daily basis that I don’t want to add the potential problems of a mesh hernia repair.
You seem like a good candidate for a non-mesh repair. The tissue around the hernia is probably stronger than the tissue of somebody with other medical conditions. That was the point of my question. Obese smokers with chronic diseases are probably very difficult for hernia repair.
I think that one of the main drivers for developing mesh as a repair material was for the problematic cases, with weak tissue that wouldn’t hold sutures. Once it showed promise it spread to where it is today, viewed as a wonder material that makes a normal person’s fascia stronger than ever before. With no apparent physical side effects. Just mental and emotional effects, like pain and discomfort.
One thing that’s not often talked about but should be is that if you have a failed suture-based repair, pure tissue, mesh can be used almost as easily as if you had used it from the beginning. Laparoscopic placement of mesh behind the abdominal wall. But if you have a failed mesh repair the situation gets much more difficult. I don’t know how surgeons can avoid this reality, if concern for the patient’s welfare is the primary goal.
dog’s story is a good one,with Dr. Brown. Another option for you might Dr. William Meyers in Philadelphia. He also works on athletes so has pretty good feedback about his methods. I’m not sure what repair method he uses.
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quote retriever:I’ve been reading here off and on for several months and have learned a TON from this forum – what a great resource! I’m trying to find the right surgeon to do a non-mesh repair on my inguinal hernia (heard way too many bad mesh experiences from friends, and I have more than enough medical issues to deal with already).
From my reading in this forum and others, Dr. Brown in Fremont is very appealing, but also far away (I’m near the northeast corner of Iowa), so I’ve been trying to look at closer possibilities before making a decision.
I’m wondering if anyone has any knowledge of or experience with Dr. Ashwin Maharaj (Ansa Health Care – https://www.ansahealthcare.com/hernia-repair/) – spent time at Shouldice (1300 repairs), now has his own practice in Toronto offering Shouldice repair on an outpatient basis) or Dr. Paul Szotek (Indianapolis Hernia Center – https://www.indianahernia.com/) – his webpage says he does non-mesh repairs (as well as laparoscopic repairs, robotic repairs, etc.). I believe I heard/read that he chooses the best repair based on each patient (like Dr. Brown), but likes to use a partially absorbable mesh if the patient is ok with it but is OK with doing non-mesh repair? No detailed information available on Dr. Szotek’s webpage.
Does anyone have any knowledge or recommendations about either of these surgeons? Or any other surgeons you might suggest or recommend?
Dr Paul Szotek in Indiana occasionally interacts with this forum, so you might be able to ask a question to him directly here [USER=”1197″]pszotek[/USER], or by sending an email on his own website.
Dr David Grischkan in Ohio is also in your general neck of the woods and has significant experience with non-mesh hernia repairs.
Shouldice hospital is located in Toronto CA and is basically the world expert on Shouldice repairs, if Dr Maharaj in Toronto was also trained there he is likely very skilled in that repair method.
There are certainly other options scattered around the USA too.
You’ll likely have to travel outside of Iowa, as non-mesh inguinal hernia repair practice is unfortunately becoming an increasingly rare skill. You might try calling around and asking older local surgeons if they are familiar with the non-mesh procedure and have confidence in performing it as well, but getting specific procedure questions passed front desk staff can be challenging or impossible sometimes.
Good luck and keep us updated on your case and decision making.
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I’m happy to share about friends experiences, at least as much as I know. All had inguinal hernia – don’t know if direct or indirect.
1) Age 45 or so at the time – had non-mesh repair probably at least 10 years ago – hernia incarcerated and was handled on an emergency basis. Spent a week recovering in ICU but has had no problems since.
2) Close relative had a total of 3 inguinal hernias over a period of years, all repaired without mesh (one was a small recurrence of a much larger hernia repaired years earlier). Aside from the small recurrence, he never had any issues or chronic pain with any of the repairs. Repairs were all done before mesh became popular in the hernia world.
Three others I know all had mesh repairs:
1) One had mesh repair at least ten years ago (around age 60?), tries to stay physically active (no sports) but has pain/discomfort at hernia site every day. Has had since it was first repaired – went back to the surgeon more than once, tried other doctors to try to get rid of the pain to no avail, finally resigned himself to living with it the rest of his life.
2) Second had severe pain immediately after mesh repair – lasted several weeks if I remember right. Pain finally subsided, felt pretty “normal” for several years I believe, then pain returned with a vengeance. Doctor said no recurrence at the time – I’ve lost touch with him so don’t know current status.
3) Third has pain that borders on disabling. I don’t know when repair was done, when pain started, or what steps he has taken to try to get relief (not something he likes to talk much about).
4) Also learned, while discussing my hernia with yet another friend, about her brother who had mesh repair and has had two recurrences since initial repair, both repaired again with mesh. Don’t know timeline on those as I don’t know him, but seems like the initial hernia was within the past 8-10 years.
I realize that I may unknowingly be surrounded everyday by people who have had successful, pain-free mesh hernia repairs, but I’m not aware of any in my circle of friends/acquaintances. I also realize that those who’s mesh repair is doing fine wouldn’t necessarily have reason to talk much about it (since everything is going well), so I’m probably not as likely to hear about those. But first-hand experiences like those I described above make me want to seek out a good repair without mesh, wherever I need to go to get that. Close to home would be nice, but it’s becoming apparent that may not be realistic so I’m trying to focus on finding the surgeon that’s the best fit for me and my needs – I’m open to any and all suggestions.
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Thanks [USER=”2029″]Good intentions[/USER] – I’ll try to answer your questions in two posts so it doesn’t get too long.
I can tell you what I know about type of hernia. Surgeon I saw said it was inguinal hernia (not femoral – which I already pretty much knew) – said he couldn’t tell by exam if it was direct or indirect, wouldn’t know until he had me opened up, and that it didn’t matter anyway because he fixed them both the same way – mesh. Is that what you are asking?
So far as activity after repair, I can safely say no high-level sports or heavy weight lifting or workouts. Would like to get back to daily walking (1 hour/day, not a runner), basic exercise, and low-level sports with my kids/grandkids. Most of my work is handyman-type work – you name it, I pretty much do it – so would need to have strength and good flexibility to get on the floor, on roofs, reach on ladders, move and work on large appliances, crawl under cars and in tight places, and be able to do at least moderate lifting and carpentry/mechanical work. If you need more specifics just ask.
Current medical state is probably decent overall – late 50’s, male, some ongoing back and foot issues/pain, year-round allergies (used to be severe, have improved somewhat as I’ve aged), and some others I’d rather not mention here. Nothing cardiac or lung-related, no serious chronic disease at this point. But enough to handle on a daily basis that I don’t want to add the potential problems of a mesh hernia repair.
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[USER=”2806″]retriever[/USER] Forgot a notification…
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There are several recent posts about Szotek on the site. The search box on the upper right works pretty well. You’ve probably read them already.
Can you give more detail on your hernia? “Inguinal” covers many different types. Also, the type of activity you plan to do after repair will help focus any advice. And some description of your current medical state.
Could you talk about what your friends have told you? Some of us are trying to collect stories, both good and bad, so that we can distinguish the good repair methods from the bad ones. Unfortunately, at this time, stories on the internet is the “state of the art” for hernia repair research.
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