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Non-mesh repairs for inguinal hernia – best techniques and UK options
Hi everyone,
I’ve recently joined the forum and not had a chance to search through it fully yet and realise already that this topic has come up numerous times, so please feel free to signpost me to suitable posts.
I’m UK based and hoping to find a top surgeon who’s very experienced in performing successful non-mesh repairs for inguinal hernias.
I’m also very keen to know more about the Desarda technique and how effective it is, should any of you be able to shed some light on it for me please? I’ve read a number of studies and meta-studies, mainly from Africa/Asia, which appear to evidence excellent outcomes, though I’ve found some negative posts about it in this forum, which appear to focus on surgeries in the US.
I’ve found details of surgeons in Germany who practice Desarda and/or a Shouldice type repairs – Dr Ralph Lorenz, Dr Ukrike Muschaweck (who’s operated on many top Premier League footballers), Dr Joachim Conze (who I believe took over from Dr Muschaweck at the Hernia Centre, Munich), Dr Andreas Koch and Dr. Martin Wiese (Biohernia). Dr Muschaweck offers her own Muschaweck repair and ran a UK clinic every month before the pandemic, but isn’t at the moment unfortunately. Her costs seem to be around two and a half to three times more than the others and a bit out of my price range really. I know that some of them offer a tailored approach and choose the type of repair during the operation, which I can see the benefits of doing, but I’d like to know for sure that I’d be receiving a tissue based repair, rather than find out afterwards that they’d decided to use mesh.
With the pandemic and associated travel issues, plus concerns about follow up appointments, I’m hoping to find a consultant in the UK, though it seems there aren’t many who offer tissue repairs for people over the age of 30, as I’ve only found four so far, despite fairly extensive research. I’ve found some very high profile consultants who’ve operated on numerous elite athletes across a range of sports, but they seem to use mesh for hernia surgeries.
Of the four I’ve found, from my understanding:
– Simon Bailly apparently practices the Shouldice technique, though I’ve been unable to find out whether he follows the exact same method/a variation, or any information on recurrence rates. I’m going to try and contact him for more information.– Professor Ernest Schilders, apparently offers a laparoscopic tissue repair. I’ve not come across any research on this technique, so haven’t looked into it further.
– The other two consultants offer Desarda repairs, though both have only done about 10 Desarda procedures each (no recurrences that they’re aware of) and tend to do mesh repairs usually. One of them strongly advocated mesh repairs when I contacted him, though the other said he felt that the Desarda repair was a good equivalent to a mesh repair. I felt that he came across well, so I’m hoping to get a referral to meet him, as he only works through the NHS currently, so a faster private/paid for appointment isn’t an option.
I’ve seen some of the posts re Dr Kang’a method, including his own and were he not so far away, I’d have been very interested to have a consultation with him, pandemic allowing. Any plans to open a UK clinic Dr Kang, should you happen to read this?
Does anyone have any experience or knowledge of the consultants I’ve mentioned (including those based in Germany), positive or negative?
I’d be hugely grateful for any further information that any of you are able to share about all this and particularly re excellent UK consultants offering non-mesh repairs. I really don’t want a mesh repair and I’d like to know that the surgeon I choose has an excellent record of successful long-term outcomes.
Many thanks in advance for any information you can provide.
Jack
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4 Replies
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Hi Jake. I did speak to his secretary, who was very nice but didn’t really know anything about his non-mesh hernia repairs, other than he does do them. I haven’t emailed for further details as I’m currently researching the lesser known Moloney Darn technique and am hoping to hear more about it vs Shouldice and Desarda repairs, from the doctors who kindly reply to some of the posts on here. You can read this other post in the list on the forum homepage.
If you do email Simon Bailly, it would be worth asking:
– How many of these Shouldice repairs does he do each year and is it the same repair as per the Shouldice hospital, or a variation of that?
– Would he recommend this repair over a mesh repair?
– What are his recurrence and long term pain rates and over what timescale are these are based on?
– Does he use permanent or absorbable sutures? I vaguely remember someone mentioning he uses absorbable, though I may he confusing him with someone else. Absorbable sutures tend to be linked with higher rates of recurrence in non-mesh repairs apparently.
– Does he cut the genital nerve and cut/reposition the cremaster muscle, as per the original Shouldice technique? This is apparently done to reduce the risk of recurrence, but appears to be contentious in the opinion of some doctors.Please do let me know how you get on.
Many thanks,
Jack.
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@jack2021 I am in a similar position where trying to find someone in the UK who may offer non-mesh repairs. I am leaning towards booking an appointment with Simon Bailey but was curious if you had a chance to go through him yet? Or did you book your appointment with someone else perhaps?
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HI Bust3r,
Apologies for the delayed reply. I drafted a long response the other day, but was timed out when I tried to submit it and haven’t had a chance to try again since.Thanks for your reply, are you in a similar position and looking for a non-mesh repair in the UK?
Re the names you’ve kindly listed:
Emin Carapeti – I ruled out this consultant, rightly or wrongly, due to there being little mention of a specialist interest in hernia repair on the websites he was listed on that I saw. The mention of his having attended the Shouldice hospital didn’t state any training in the technique.
Greg Sadler – oxford hernia clinic – I had’t come across this consultant before and having looked at the website, it appears to advocate mesh repairs.
London Hernia (Largely this is mesh though I think Martin Kurzer may do Desarda or at least a different kind of mesh). – Mr Kurzer kindly exchanged emails with me and has done Desarda repairs, though very few (he was one of the consultants I alluded to in my original post) and he’s an advocate of mesh repairs mainly.
David Nott – I haven’t found much re this consultant, so would need to find more info, though I couldn’t find any details online from an initial search.
Simon Marsh – I’ve not found anything online re this consultant that mentions him doing non-mesh repairs, though that may not be the case.
Aali Sheen – Professor Sheen comes across as a really nice guy and usually offers non-mesh repairs to under 30’s only. He mainly specialises in laparoscopic mesh repairs for older patients.
Simon Bailey – funnily enough I’d found info re Peter Jones before I saw info re Simon Bailey, but I believe Peter retired a while ago now and I was unable to get a response from contact details I found online.The NHS only consultant who can perform the Desarda repair, is called Duncan Light. He kindly exchanged emails with me and came across very well I thought.
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I don’t have first hand experience of the people you’ve mentioned although have seen them when searching. In addition these people/places may do non-mesh or may be people you could look into at least:
Emin Carapeti (shouldice)
Greg Sadler – oxford hernia clinic (basini)
London Hernia (Largely this is mesh though I think Martin Kurzer may do Desarda or at least a different kind of mesh)
David Nott – Does mesh removal so may do a different kind of repair
Simon Marsh
Aali Sheen – Mainly mesh but as he does removal may also be doing different types of repairsI think a lot sway towards mesh and also potentially fall outside Bupa/Axa/etc. In the Bupa finder website you can search peoples names and see what procedures they are doing, which gives you an idea of what kind of surgeries they are doing, how often etc. Although this doesn’t really indicate success rate, technique etc. You may find out more about Simon Bailey by also looking for Peter Jones as I believe Simon was his apprentice.
Interesting that you found people on the NHS that do Desarda repairs, I guess you can’t share names?
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