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Study comparing Tapp and Shouldice discomfort after 5 yrs
https://link.springer.com/article/10.1007/s10029-007-0214-7
Numbers slightly favored Tapp at 8.5% vs Shouldice at 11.4%.
Involved 867 patients. It’s just an abstract with the paper behind a paywall, so less granularity than one might wish for.
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3 Replies
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Based on my biases…
If you’re a good fit for tissue repair, I would just go with that. It’s not always easy to tell before surgery, though.
Between open mesh and lap mesh, I’m not sure what to say. I’m also biased against lap (for similar reasons to yours), but I realize that this may not be evidence-based.
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I wouldn’t take this study that much to heart. Most of the studies say something like this for one year and trail off quite a bit after that. I’m not even sure what to think of this one, but I wanted to put something up comparing the relative pain of the two. The relative pain is probably the main thing to take away from this.
The conclusion i’m seeing from most of these studies is that, yes, lap has, give or take, maybe 75- 80% the chance of long term pain to open mesh or open tissue, but that difference in the grand scheme is probably not going to convince me to go with Lap.
Maybe the negatives are simply in my head and I need to get past them, but…
1) I don’t like the mesh being that much internal ( possibly sticking to the intestines. Possibly causing some sort of internal stiffness)
2) I don’t think I should do the general anesthesia (I’ve had a heart attack)
3) The mesh is probably a little harder to remove if need be
4) Way too many people here have had trouble with it. Yes, that’s anecdotal, but there is still a strange odds factor that doesn’t make sense. (There might be some sort of nagging discomfort that doesn’t show up on the pain stats.)
5) There might be other reasons why a surgeon might need to go inside at a later date.
6) It’s probably impossible for the mesh not to stick to the cord and the blood vessels on the inside.
7) A chance of causing an incisional herniaAm I looking too much for confirmation of my bias? Maybe, but that’s the way I lean.
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Always depressing to look at these studies, unfortunately. One out of ten with discomfort (even if mostly mild) after 5 years is pretty lousy. Considering the huge number of hernia surgeries, this translates to a heck of a lot of people out there living with long-term chronic discomfort from these surgeries.
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