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Shouldice or Mesh ?
I’m male, 41 and have had a small left inguinal hernia since November 2023. I have low grade discomfort, mostly when standing for very long periods of time. I’ve stopped some weight lifting exercises (i.e. lower body), and playing singles tennis but otherwise I can do most activities without limitations ( I wear a truss when weightlifting and have adapted exercises to reduce intraabdominal pressure)
option: 1. I live in Canada and can have surgery at the Shouldice hospital soon (without ever meeting the surgeon, they simply required a written note from my physician that I have a palpable and reducible hernia). It is however a 5 hour drive from my city and I read that the recovery is much longer; in addition it appears more invasive and that impairment of certain anatomy (i.e. cremaster muscle) is possible. The scar from the Shouldice procedure is certainly larger as well.
option: 2. I also met with a local general surgeon who uses mesh (ProGrip) and remarked that it was a simple day procedure and that he has even repaired some recurrences from Shouldice patients (i.e. I’m sure the opposite may be true as well).
option #3 – I could also continue waiting without surgery.
Any advice?
Also – Can one procedure (i.e. tension repair) increase the incidence of developing a hernia on the other side?
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8 Replies
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i had lap/robotic for rt inguinal hernia with mesh behind abdominal wall . Phasix mesh. supposed to dissolve in a year or so. there are many types of mesh out there. get a few opinions from hernia
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Should I be worried my surgeon prefers General Anesthesia instead of localize for non mesh? I noticed many surgeons prefer and do Localize.
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Thank you for posting. I have had repairs with pain as a complication. Could you share a little bit more about how to avoid increasing abdominal pressure while weight lifting? I am interested if I can apply it to myself. Thank you?
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You’ve learned quite a bit in just four to five months. Congratulations. What type of truss are you using while weight-lifting? Does it help? What type of hernia?
You didn’t say what type of procedure would be used for the mesh implantation. Progrip is used for many hernia repair procedures, from Lichtenstein to laparoscopic.
What made you narrow your options down to just mesh or Shouldice? And how did you end up on Herniatalk? Just curious.
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Thank you for your replies.
Yes I may wait a bit longer and postpone my surgery (Shouldice) – there is the small risk of incarceration/strangulation (1-3%)? which is usually not an issue if one is in an urban area and has access to an ER but I do sometimes travel and hike in remote areas.
I am using this truss (https://comfort-truss.com/) during activities; I do find that it helps; the trick is to apply it when the hernia is reduced (i.e. when on your back) and to find a suitable tension. Making sure I don’t use any valsava breathing when lifting is also important.
I am actually not 100% sure of the progrip hernia repair – i believe it is lichtenstein but can double check.
I’ve narrowed it down to these 2 options because locally I only have access to mesh repair, and I would not bother to travel to another city unless it was for tissue repair.
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This reply was modified 1 month, 2 weeks ago by Derek.
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The type of surgery for the mesh implantation is very important. Lichtenstein is an open surgery. The piece of mesh is smaller but it is in front of the abdominal wall, rather than behind like in a laparoscopic implantation.
The situation you describe is very typical. Each surgeon learns a specific method and that is what they do for the rest of their career, in most cases. They are insulated from the long-term results of their work by the bureaucracy and lack of interest or even avoidance by the corporations they work for. Get second, third and fourth opinions, with details of their procedure and the material used, and you will probably get second, third and fourth variations for the same hernia. The only consistency is the chance of chronic pain and problems.
The scientific publications that describe efforts to quantify the mesh chronic pain problem consistently come up with about a one in six chance of chronic pain or discomfort of some kind after a mesh implantation. Some researchers find much higher numbers, others find lower. But the 15% number just keeps coming up. It’s kind of shocking how common it is and how it is just accepted as “normal”. One of the major lawsuits today is based on the “failure to inform” the patient, by the corporations or individual surgeons, of the much higher possibility of problems than the typical pre-surgery pamphlet shows.
https://my.clevelandclinic.org/health/procedures/17967-hernia-repair-surgery
“What are the risks or complications?
As with all surgeries, hernia surgery has some risks. Some you’re more likely to experience shortly after surgery. Others typically show up in the long term.
…
(Last words, way down at the bottom. No quantifying, no description. Vague words. And this is from one of the preeminent hernia repair clinics in the States. They even have a separate pain clinic to address problems after the fact. But no clear warning before.)
Some people experience long-term pain after surgery. Pain that lasts longer than three months is called post-herniorrhaphy neuralgia. If you’re diagnosed with this condition, you may need medications or surgery.”
my.clevelandclinic.org
If your hernia is causing unpleasant symptoms like pain or pressure, it may be time for surgery to fix it. Here’s what to expect.
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This reply was modified 1 month, 2 weeks ago by
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Hello Derek,
I’m in similar situation to you and I’ve been waiting 2 years plus. Since both surgeries can cause unwanted effects I’m not rushing to surgery.
I do favour tissue repair.
If you’re on Facebook try and find hernia mesh hurts too forum.
Hello Watchful, glad you’re posting again. Bit scared to ask this, and you may think it impertinent, but hows your recovery going?
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My advice – continue waiting. I don’t see why you would take the risks of surgery when your hernia symptoms are mild.
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