Reversing a modified Bassini SH repair & implications
12/11/2020 at 6:22 pm #28280
Hey everyone, I’ve posted many times here to vent and mostly warn against the surgery that Dr. Brown performed on me.
I’m at a stage where I’m trying to gage the likelihood of getting a surgery where a surgeon would undo the modified bassini repair Dr. Brown carried out on me and restore natural muscle configuration so that I can properly function again. When the muscles are where they are supposed to be, I should be able to rehab and regain function and stability. So I’m opening up this thread to see if anyone has input here.
Before Dr. Brown’s surgery my main issues and pain were in the groin between the pubic joint and the external inguinal ring but at no point did I have a hernia sac or hernia. Now 10 months after his surgery I can’t function or be even slightly comfortable the way I am right now – every single day is hell. I’ve listed it in my other posts but lost proper activation of my entire abdominal wall not only at rest but at flexion – can’t flex properly at all because the tissues won’t move its incredibly tight and uncomfortable. I was told there would be some tightness at the surgery site (groin) that would improve over-time but what It actually is full on mechanical impairment from pubic bone to rib attachments and through all 3 muscle layers and the rectus muscle. Its affecting breathing, back muscles, gait, ejaculative contraction, and obviously my confidence since I cannot properly flex my abdominal muscles at all. Its borderline criminal to do this to an athlete and if I were in a traditional sport rather than being a professional artist I’m almost certain they would never have allowed me to get this surgery or they would be suing right now. Either way – I’m trying to be pro-active and figure out my own way out of this hell before giving up on life altogether.
So I guess there are 2 aspects to this discussion/question.
1. How feasible is it to undo a modified Bassini repair – i.e putting back all the tissues where they originally were without seriously maiming/permanently hurting the patient? Is this even possible after all the overzealous cutting Dr. Brown did when he performed his procedure?? I’ve brought the question up to Dr. Zoland via a call a few weeks back and he said that yes it would be possible to put everything back without seriously hurting the patient. What are the counter-indications here? In terms of inguinal canal integrity, testicular integrity, etc. Would I need a bio-mesh temporarily? Etc.
2. When Dr. Brown performs his surgery, he closes the external oblique opening in two layers – 1 layer being sutured to the transverse muscle and then closes the second half on top of the first half and sutures it to the inguinal ligament.
– So this step alone MAJORLY impairs mechanical function. I am trying to figure out what happens to the tissues when they’re sutured overlapping like this. Do they still maintain individual integrity and shape or do they slowly become one thick tissue/ball of scar. I.E – is it possible to undo where they were sutured, and suture the two halves of the external oblique back together as one tissue instead of an overlapping one and actually regain normal function over-time and with proper rehab??
3. From what I’m understanding – the moment you cut into a tissue that tissue cannot engage at 100% ever again. A muscle has to be able to fully contract and fully relax to be able to properly perform its function in harmony with the rest of the body. But the second someone extensively artificially cuts into the tissue (rather than natural micro-tears from overworking the muscle that heal throughout life) – the muscle loses its ability to do this. We see this in various patients that wake up from surgery and are told that the doctor ”lengthened” their psoas muscle during surgery for example which without fail impairs their psoas for life and create an unbelievable cascade of problems and chronic issues but doctors continue to do this. Dr. Meyers only recently stopped doing this from what I’m reading after realizing it was consistently hurting patients. There are several reports and anecdotal accounts of people having something like this done to them and years of therapy does not help them get proper psoas function ever again.
If this is true and consistent – I cannot wrap my head why doctors wouldn’t approach a ”less is more” approach – even when performing a tissue repair. The idea that someone has a weakness/some tearing in their inguinal floor and that a surgeon decides to extend the defect above and beyond to triple its original size to then ”repair it” by stretching nearby tissues over it is so flawed from a mechanical point of view that I am really struggling to understand why Doctors view this as a viable treatment. I understand that the idea is to ”stabilize” the pelvis or patch a hole but by impairing so much muscle tissue the patient can never actually rehab that stability. He’s now dependent on the sutures holding on while the tissues are perpetually tightened and can never relax. There is no dynamic stability. The patient will inevitably become severely dysfunctional and develop issues way beyond the original issue which we’re already seeing severely in my case.
So now my dilemma is that I’m hoping that someone can go in and put in the muscles back to their original attachments so that I can finally rehab them. But I’m worried that the damage is already done in terms of the connective tissue and nervous input that is impaired because of scar tissue from previous cuts. Cutting into the 2 overlapped halves of external oblique to separate them from their forced attachments to the transverse and inguinal ligament from Dr. Brown’s surgery will obviously cause even more damage to all those tissues – so even if they do undo this overlapping/forced attachments/reconfiguration and suture the muscles back into their original configuration as intended – will those muscles ever regain full function? Or is it already too late. Literature and anecdotal evidence is hard to come by for a clear answer on my end.
Final part – I’m suspecting that the major part of the dysfunction of the entire abdominal wall and the rectus is because the transverse fascia along with the transverse and internal oblique are forcibly pulled across – joining the conjoint tendon to the inguinal ligament to ”repair” the inguinal floor. This outwards pull on tissues is why my rectus is so affected. This is further evidenced by my previous surgery on my right side where the surgeons had only cut into my external oblique and which not give me any rectus or abdominal dysfunction whatsoever – only minimal weakness in the area of the scar.
– Is this step even possible? What would happen here in terms of my inguinal canal? The major component of this ”repair” is this pull of the transverse fascia from the conjoint tendon to the inguinal ligament. So what are the implications here if we were to reverse this??
I’m trying to study this in and out so that if I do end up finding a surgeon I feel genuinely loves his job and wants to help potentially save my career – I cover all my bases and I can go in with a plan in mind.
If you guys know of a surgeon that is great also please go ahead and recommend.
Thank you in advance and sorry for the wall of text and technicality of the questions. Just trying to save my career and my life.
12/19/2020 at 10:35 pm #28329
I hope you’re getting more answers from Drs. Zoland and Meyers.
I think your questions about the closing of the External Oblique Aponeurosis get into complexity of the anatomy of the inguinal canal. My understanding is that the modern Shouldice or Bassini uses the external oblique aponeurosis just anterior to the inguinal ligament, but still on the inferior wall, as part of the reconstruction of the posterior wall of the canal after the cutting of the tranversalis fascia. This is not part of the closing of the E.O.A., which forms the anterior wall, and is typically done with an absorbable suture (mine was Vicryl).
However, the Desarada procedure uses a flap of that E.O.A. from the anterior wall to reinforce the repair on the posterior wall. In order to do this, the flap of muscle must be freed, i.e. they cut into the muscle medial to the canal to create the flap that is then pulled posteriorly into the canal. My understanding is that Brown does this or something similar to reinforce his repair.
Again I hope you are getting the help and advice you need from the surgeons you’re talking to. But my informed guess is that the Bassini repair on the posterior wall should not be reversed, instead it’s the Desarda or Halsted reinforcement that involves cutting into muscle and relocating it to a different area of the anatomy. For the male anatomy there is the additional complication of muscle that should be anterior to the spermatic cord now being relocated posterior to the cord. There are people on this forum who have gone through Desarda reversals with some improvement.
I have 4 lines of Prolene reconstructing my posterior wall by connecting the superior wall (transverse abdominus, transversalis arch, internal oblique) to the inferior wall (inguinal ligament, external oblique aponeurosis). Today I’m 2 days short of 2 months out from surgery and in the past week I’ve cross-country skied, downhill skied, and jogged, all without pain. With the complexity of your repair I wonder if the reversal will ultimately be the Desarda/Halsted “reinforcement” and whatever else he did to address the sports hernia, and not the posterior wall reconstruction of the inguinal canal.
12/20/2020 at 8:58 am #28330
One caveat is if you think you’re reacting to the suture material on the posterior wall (in this case silk which is much more inflammatory than Prolene). If that’s the case then you probably do want that removed, and most likely they’d need to place a mesh. In your shoes I’d want a Nyhus repair with polypropylene mesh. But given my experience and the preferential use of “tension” tissue repairs for low BMI dancers I’d doubt that the tension itself is the problem.
- This reply was modified 1 year, 9 months ago by Thunder Rose. Reason: spelling error
12/20/2020 at 5:08 pm #28332
Hey thanks for even replying. First of all – I am just now finding out that he used silk suture when THE ENTIRE POINT of me going to him was because he said he only use absorbable material and doesn’t think the body should have foreign objects in them. I still don’t think the sutures is the problem but its just another thing that’s really shade from him.
We literally discussed this before his surgery and I asked – is there going to be something left in me or is it absorbable and he said no everything will eventually dissolve but from the OP report it is silk sutures and from the internet silk sutures don’t dissolve.
So great – one more lie from him. I genuinely do not understand how this man sleeps at night. He absolutely butchered me for nothing. I did not gain a single benefit from his surgery and he destroyed my groin for no reason.
Honestly everything you just wrote makes sense…I’m just completely speechless that someone would do this to me, while meeting my parents who flew out to meet him in person beforehand and knowing that I was at the peak of my career. He assured me that I was a perfect candidate and that I would be back within 3 months. I’m 10 months in and I can’t tolerate more than a 30 minutes walk and I’m uncomfortable the entire time.
He literally ruined my life and I genuinely don’t know thats its possible to have a normal life after what he did to me. I went from pain but able to do things to MORE pain and completely dysfunctional.
I think I’m ready to give up to be honest. Zoland says he could undo the surgery without any issues but I don’t see how. You know the craziest thing is I know for a fact Dr. Brown reads my posts on here and doesn’t in the slightest feel anything in regard to how he destroyed me and hes doing it to other patients, I’m in contact with a bunch of patients that were his after me and he’s still doing these repairs and not a single one of them recovers they all feel like crap. And Dr. Towfigh still endorses him like this is okay. In what universe is this normal? I cannot find a single athlete who has recovered from Dr. Brown’s Sports Hernia surgery.
I genuinely feel like I’m in a horror movie.
Thanks for the reply you’re awesome for even replying. I haven’t talked to Meyers yet because Covid is out of control and I don’t feel comfortable flying to meet him right now but I will eventually.
I’m glad you’re doing well. Wish you all the best.
12/20/2020 at 5:29 pm #28333
Please don’t give up. I think you’ve read about the SH patient — the wife on the runner’s blog — who went to Meyers after Brown and had a lot of improvement. Grischkan does Desarda reversals so that’s another potential option. I went to Yunis and he did amazing work with me — he’s also a vascular surgeon and I believe his work is world class but he works with insurance and for me at least was fairly affordable. He does revisions and Nyhus repairs but I’m not sure what he does for SH.
I’ve been reading Atul Gawande’s books about surgery and medicine — the early ones (Complications and Better) — and he talks about how slow the system is to recognize bad doctors, or doctors who were once good but become bad due to psychiatric problems or alcoholism or drug abuse or illness or whatever. It really really sucks. I think you are doing a great service by telling your story.
12/20/2020 at 5:44 pm #28334
I’ve been reading about Dr. Yunis and he seems amazing and I genuinely regret not hearing about him before. Granted at no point did I have an actual hernia so his name didn’t come up because I wasn’t looking for hernia surgeons at the time.
See the one thing this forum and Dr. Brown did right – and my acupuncturist in L.A warned me about this – is they managed to be the first results that come up when you start researching a little online. Their marketing investment is great.
Dr. Brown bought out and is exploiting the domain sportshernia.com portraying himself as someone who has been getting athletes back on the field for 30 years. Yet I cannot for the life of me find a single athlete let alone a professional athlete that got his surgery and went back and recovered.
I have read the post from the wife on the runner’s blog and I had genuinely hoped that she was not an athlete and that her complications were from just not being as conditioned from the get go and what not. And now I find myself in her shoes.
And I don’t know how to cope. Any job I’ve ever held in my life I’ve held with such integrity and accountability. I don’t understand how these doctors are just allowed to continue doing what they do after destroying a life.
I’m going to be honest, I don’t know if I have it in me to keep going. The weekend before Dr. Brown’s surgery I was supposed to perform at the Grammys and I turned it down to get what was supposed and easy and clear surgery so that I can actually get back to 100%. I really was reaching the peak of my career, signed to the biggest agency in LA that sponsored my U.S Work Visa and what not. And It took Dr. Brown 1.5 hours to absolutely shred me. It’s too much to handle to be honest.
It’s 100% my fault. Reading through his procedure now – not a single step makes sense. The reconfiguration that he calls ”reinforcement”. All the unnecessary extra cutting. None of it makes sense to anyone who studies the body and the muscles. I was at a point where I told myself I needed to just trust that he knows what he’s doing and that he would only do the strict minimum – that he wouldn’t do anything to hurt me. And that he wouldn’t look in the eyes of both my parents and lie to them.
Boy was I wrong…..
Anyways I appreciate you. Best of luck with everything.
02/16/2021 at 3:37 pm #28606chaunce12345Participant
PeterC, how are you doing now? I am sorry to hear you are still in pain, I hope you are seeing improvements.
Out of curiosity, have you tried anything to relax the muscles? I know Dr Towfigh as mentioned using Botox before for that purpose. Does anything help with the pain, or make it particularly worse?
What was your original diagnosis, and how was it diagnosed? Was there an event that led to the beginning of the pain? How long did you have pain before your surgery?
There are people on this forum who have had positive experiences with Dr Brown for hernia repairs, but it sounds like you did not have a hernia.
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