Open Tissue Repair – Cooper’s (McVay)

[sensei_305]

Has anyone here had a tissue repair done that has not been Desarda or Shouldice? I am scheduled to have bilateral tissue repair done via open incision Thanksgiving week this Year after my scar tissue failing to hold up post mesh removal. Surgeon will take a look at the current state of my anatomy with a scope before proceeding with the open incision repair.I have read posts here from others who have gone back to the gym and playing sports post tissue repairs. I am ok with accepting that those days are gone. I just want to feel healthy and have a normal happy life.

[Anonymous]

What type of repair is your surgeon planning to do? I was advised that since its virgin tissue (lap mesh removal should not affect it), the repair should hold up as well as if a tissue repair had been done initially. So with that in mind, maybe its best to select a shouldice from the shouldice clinic with its 1 percent recurrance rate? Who is doing your repair? It might be time to sharpen your pencil sensei we cant afford another mistake?

[G]

sensei_305 I had a pure tissue (no Shouldice, no Desarda) repair done by Dr. William Brown (now retired) about three years ago. No pain, great result. Dr. Brown was a very accomplished surgeon and seemed to care about his patients. He was very sought after and was a proponent of no mesh surgery when very few were. He was at the forefront of mesh removal surgery when others were telling the patient it was all in their mind. I’m about 70 years old now and work full time plus frequent overtime. I also workout at the gym and run for hours on end. Dr. Brown and his wonderful staff gave me my life back. Two pure tissue no mesh surgeons that are still working come to mind. Dr. Kim in Korea and Dr. Peterson in Las Vegas NV. One final note, do your own research and do not put your trust in the echo chamber on this or any forum. Many so called expert patients on this forum came up with poor results after producing walls of text and debating for years. It’s ultimately your call sensei_305. Good luck.

[Jenifer]

Hi I was wondering if you got permanent sutures in your tissue repair or all dissolvable sutures? I’m scheduled to have my femoral hernia repaired in October by pure tissue and asked the surgeon if I can get dissolvable sutures and he said yes he has some that will dissolve in a year and he said that will give enough time to bond all together.

[drtowfigh]

Recurrences are higher with absorbable sutures. It is not how they were originally described. You cannot expect the same outcome by changing the sutures.

[Jenifer]

Hi I have been worried about recurrence with dissolving sutures but my surgeon thinks I should be ok since I’m slim…I think this article is interesting to… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702909/

[ajm222]

My surgeon used absorbable sutures, and he has a great reputation. H thought for my indirect inguinal hernia it would be effective given my health and age, providing sufficient scar tissue was created. I do think he also was concerned though because he removed my old mesh and probably worried there was a small chance I could have issues with the permanent sutures.

I also know that Dr. Kang used to primarily use absorbable sutures with great success. He did apparently recently switch to non-absorbable sutures because he did have some cases of recurrence, and started to believe that very few patients had issues with the non-absorbable sutures, so on balance I guess decided to make the change. But the difference in recurrence rates was small – something like 1.5% vs. 3.5% (just a guess, can’t remember, but roughly close). And the recurrences were probably mostly folks with unique situations involving age, weight, hernia type, etc.

I don’t personally know how absorbable sutures would be able to hold a repair together, but frankly I don’t even know how non-absorbable sutures would be able to hold a repair together. Or even mesh. None of the techniques seem to make a lot of sense to me.

[Jenifer]

Thanks for sharing! That’s good to know your Dr used absorbable sutures. Dr kang % results before his switch was still really good…I’ve been reading about absorbable vs non absorbable and they say that after awhile the non Absorbing sutures start to loose there strength as the scar tissue forms and encloses around and over the suture so it’s the scar tissue that takes over and creates strength. The body does the same thing with the absorbable but the absorbable eventually leave and the scar tissue is there holding everything together. But in some cases people may need the non absorbable to give 2 layer strength if scar tissue is likely to tear (people that do a lot of heavy lifting, weight etc.) …So they can both work very well in the right situations from what I’m reading.

[ajm222]

My only concern is whether or not the regular short-term absorbable sutures hold strongly enough to provide adequate time for the repair to get strong. I probably should ask which specifically were used in my case but I think it was the ones that immediately start dissolving and lose much of their strength after 4-6 weeks and are mostly gone in 6 months.

[Jenifer]

The body starts to make scar tissue right away which is good but regardless my surgeon suggested the long term absorbable sutures they dissolve in about a year.

[drtowfigh]

Unfortunately this paper is an open access article in a non surgical journal.

I’m not saying absorbable suture fails in everyone. It’s just common knowledge that the results are inferior to those with non-absorbable sutures. And scar tissue alone is inadequate to prevent hernia recurrence.

As long as you and your surgeon have an understanding of what risks and benefits you are choosing, and are informed, that’s what matters.

[ajm222]

Thanks, Dr. Towfigh. That makes sense. It would certainly be disappointing to think my trusted surgeon used inferior materials for my repair and that it was likely destined to fail. But I suppose there are often professional disagreements in terms of the best materials and methods. And each individual case is unique.

It looks like that article was written by the famed Dr. Desarda himself. I wonder why he didn’t publish it in a surgical journal.

• This reply was modified 1 month, 3 weeks ago by ajm222.

[Jenifer]

Hi what would you say the best non absorbable suture is that may have the least foreign body reaction?

[Watchful]

Based on the research I did a while back…

Stainless steel causes the least amount of reaction (unless you’re allergic to its elements such as nickel). Hardly anyone uses it in hernia surgery, though, because it’s a pain to handle.

I believe polypropylene is the most commonly used suture material in hernia, and it causes little reaction typically. I read that polybutester and nylon cause even less tissue reaction. Note that tissue reaction isn’t the only important property of suture material, and I guess polypropylene has the best combination of properties since it’s the one most widely used.

[Jenifer]

Hi I came across this article from Dignity health about sutures. I’m wondering now if late absorbable and non absorbable mean the same thing? It states the non absorbable dissolve about 300 days and that’s how I understood the late term absorbable to do. https://www.dignityhealth.org/conditions-and-treatments/emergency/stitches

[G]

sensei_305 I mistakenly typed Dr. Kim rather than Dr. Kang as the pure tissue surgeon in Korea.

[Larry]

This is My account first-day. I’m glad I found your forum. I’m sorry if I’m off topic so just let me know where to go. My surgeon’s office said there’s nowhere to go:
How do I find a Shouldice or Desarda surgeon? My local surgeon’s office says everyone in New York State uses mesh. I found one name in Stony Brook but I’m in upstate New York. I have what is considered a small hernia that recurred 64 years after the first repair. Thank you for your consideration.

[ajm222]

Hey Larry – the shouldice surgeon (Samer Sbayi) would probably be worth visiting despite the distance. He has a great reputation. There are likely some older surgeons in your area that have done tissue repairs if you don’t want mesh. You may need to just call around. But ideally you’ll want to go to the most reputable tissue repair surgeon you can find even if it involves some travel. If nothing else, Dr. Sbayi’s office may be able to give you some names. And Dr. Towfigh sometimes chimes in with recommendations. You may also be able to use the search tool in this forum to look for surgeons in upstate NY that will do tissue repairs. Any idea what type of repair was done specifically during your first go ’round? How was the recovery? Seems it was extremely successful. Not uncommon for those older repairs. Still not 100% sure why they have mostly gone away and switched to mesh. Seems unnecessary when all things are considered.

[Jenifer]

I would just call around in your area, that’s what I did and found a general surgeon with 30 years experience has good reviews and can do tissue repair..

[Good intentions]

64 years ago? 1959? You must have been very young. Do you remember the details?

Your surgeon said “there’s nowhere to go”? Do you mean to find a Shouldice or Desarda surgeon? How did you learn about Shouldice and Desarda? That’s a bit deep in to the hernia repair methods, for a person new to the field.

Good luck.

[ajm222]

sock puppet alert? 😉

[Watchful]

The good old Chuckster is baaaack 🙂

[G]

“You cab fool all the people some of the time, and some of the people all of the time, but you cannot fool all the people all the time.” Abraham Lincoln. I wondered when someone would catch on. This thread appears to be swarming with sock puppets

[G]

“Talk to the hand” Martin Lawrence 1992.

[Author]

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