Question for Dr. Towfigh

[Chuck]

Dr —-you do a variety of tissue repairs it seems…very few doctors can do more than one type…and of course they all tell us theirs is the best….i know the approach has to be tailored….but in your experience what is the best overall tissue repair in terms of durability and chronic pain….you say shouldice is too tight….desarda is not well supported….what tissue repair is the best for small indirect hernia

[drtowfigh]

All tissue repairs are tighter than mesh repairs.

Shouldice is the best repair option from a recurrence standpoint. But it’s not necessarily the best for small inguinal hernias in women (I prefer March for those) and it’s not for femoral hernias (McVay is more appropriate). Bassini is another options especially in revisional repairs where tissue planes are hard to assess.

We usually add a fascial release if the standard tissue repair is too tight.

[Chuck]

Thanks doctor….do these repairs stay tight? I have heard some guys complaining that the shouldice is still tight a year later? is there any hope for a good repair where pain becomes unnoticeable?

[drtowfigh]

It all depends on the patient, type and size of hernia, surgical technique, etc.

Tissue repairs can loosen up over time.

[Author]

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