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Surgeon recommendation in Oregon or Washington that repairs without mesh?
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Peter Billings can do a Bassini repair I believe. But, my recommendation is to go to somebody that specializes in tissue repairs, which means you will have to travel (I live in WA and know of nobody here that does tissue repairs as their primary practice.
Dr. Wright put mesh in me and removed it later. He is a competent surgeon for mesh repairs and told me he could do a McVay repair. But, he also suggested to me that, if I wanted to tissue repair, it might be best to go to Shouldice.
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You might try Dr. Andrew Wright at UW Medicine. Although he is a mesh proponent he also removes mesh so is aware of the issues. If he doesn’t feel confident in his own skills he probably knows somebody that is good.
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Thanks for the replies. I reside in the NW, hence, I was looking for surgeons close to me. However, I am fully aware of the other surgeons you mentioned that are farther East. Dr. Towfigh in California would be the closest travel.
However, going back to your statement regarding “being extremely careful when selecting a surgeon” — are you referring to surgeons that are doing non-mesh ala tissue suture repairs, or are you talking about any surgeon in general? If the former, that makes sense, as tissue repair surgeons (unless they’re trained or specialized like at Shouldice) are more rare. It appears majority of hernias are done with mesh, however, I believe I have a small hernia that may be better suited with tissue repair.
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The closest specialist I am aware of near the Oregon / Washington region would be the owner of these forums – Dr. Towfigh located in Bev Hills, Cali. (310) 358-5020
She has a lot of different options available and is a modern pioneer in the field.
I would be extremely careful when selecting your surgeon. There have been many not so positive stories passed on these forums of local surgeons who are willing to do the repair but are not “experts” with solid track record of positive patient experience.
A few quick searches on here will show you how bad some of the cases can get with the wrong surgeon.
Dr. Towfigh, Dr. Yunis, Dr. Sybai, and Dr. Kang (who I recommend if you are willing to travel overseas) all have positive stories on these forums from former patients.
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https://www.centerforherniarepair.com/?utm_source=GMB_listing&utm_medium=organic&utm_campaign=GMB
There’s Dr Yunis in Florida. I don’t know geography as I’m in UK.
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“Very likely” might not be good enough in your eyes, but in reality that is what we have to work with because we don’t have great data.
Of course there is variation among the Shouldice surgeons…the question is what the *range* of that variation looks like. Since we don’t know, we have to fall back on logical reasoning when thinking about it.
I will point back to what I said earlier…if skill/experience is a primary consideration, then where do you think surgeons are getting better training and more experience with the repair than at Shouldice Hospital? Per the website, all surgeons “regardless of prior experience” are required to assist on 50 repairs before being allowed to perform their own, and then must perform up to 100 more before being allowed to lead a surgical team. Do you think external surgeons are getting the same training and supervision before doing their own Shouldice repairs, never mind performing them with the same regularity?
So while there certainly is variation amongst Shouldice surgeons, that variation is likely to be fairly small after a rather brief period of time…and it is also likely that range still occupies a higher level of the skill/experience spectrum such that even the ‘low performers’ at Shouldice are likely to be comparable (if not better than) the majority of external surgeons who have performed fewer Shouldice repairs and with lower frequency. Of course we can’t KNOW this…but logically speaking, that is a reasonable belief absent evidence to the contrary (evidence we essentially can’t get).
Reviews, blogs, etc. are helpful, but they are neither representational nor verifiable. IMHO, they are mostly useful to identify potential red flags. For example, if you see multiple instances of the same criticism, then you might want to dig a little deeper or ask certain questions. But if you are basing your assessment of a surgeon largely on reviews and blogs, then you are fooling yourself into believing that you have anything close to a clear picture. Further, if you try to compare surgeons on that limited, non-representational, unveriable information, then you *at least* need to adjust the raw number of ‘bad reviews’ to account for differences in how many repairs each surgeon has done, how long they have been practising, etc.
How the cremaster is treated not terribly relevant to the debate on whether it is problematic to not choose your surgeon at Shouldice…it is more relevant when deciding whether to go to Shouldice in the first place.
Observers being allowed is also not relevant to the concern over not choosing a surgeon there…and is even not likely too relevant overall when you consider that hospitals routinely allow residents and other observers (and for much ‘higher stakes’ surgeries than inguinal hernia repairs). If it was such a potential hinderance to surgical teams, it would not be allowed…and Shouldice, as a private hospital that is not affiliated with a university, would presumably have even less obligation/motivation to allow observers if it were a problem. If you want to reach for a possible effect on allowing observers, you could also just as easily frame it as a positive…that a surgeon might be more careful as they want to ‘impress’ or at least not mess up in front of others.
The unknown chronic pain numbers are neither relevant to not choosing your surgeon at Shouldice nor a unique concern to Shouldice…what other surgeons have independently verified, long-term follow-up of their patients to nail down a firm number?
Having said all that, would I rather be able to choose at Shouldice, even absent good data to inform that choice? Sure…even limited, unreliable, non-representatioal information on blogs, forums, reviews, etc. is (hopefully) better than nothing…but my point was merely that not being able to choose at Shouldice is likely not *as big* a deal as it might seem on the surface…because of the training and experience that all surgeons will quickly gain there (compared to the training and volume/frequency of most external surgeons offering the repair).
To the broader question of choosing Shouldice at all, I share some of your concerns and there are things I would like to see changed/improved or be better studied. The multi-day stay is surely not critical for all patients and most other surgeons treat is as day surgery or an overnight stay…more study on the pros/cons of cremaster resection (and perhaps giving patients the option to choose how it is treated)…whether the ‘narrow’ patient profile is too narrow and should be expanded…and some updating of the hospital itself to match more modern facilities. I am also intrigred by Dr. Kang’s tissue repairs, particularly that he treats indirect and direct hernias differently and does not have such a narrow patient profile, and I hope they become better studied.
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It is a worry, but IMHO it should not be as big a worry as it seems on the surface.
Why do we want to choose our surgeon? Because we know that surgeon skill/experience with any repair is an important factor in patient outcomes. How does a surgeon gain a high level of skill/experience? With proper training in the repair and by performing a large number of them with regularity.
Where is there likely to be better training in the Shouldice repair, and where is a surgeon likely to be performing more repairs with higher frequency, than at Shouldice Hospital?
Ask any surgeon you are considering how many Shouldice repairs they have performed to date and how many/how often they perform them today and then compare that to the numbers for even a ‘new’ or part-time Shouldice surgeon. I bet the answers will surprise you.
I don’t mean to imply that there are not excellent options for a Shouldice repair outside the Shouldice Hospital…or that there is not variation in outcomes between Shouldice Hospital surgeons (no doubt some are better than others)…but you are very likely getting a certain ‘high’ standard of skill/experience at Shouldice, regardless of which surgeon you get. That may not eliminate the concern at not choosing your surgeon, but that additional context should reduce it a great deal, IMHO.
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Directly from the patient coordinator at Shouldice. I contacted them. The 2-3 years is for cases requiring general anesthesia. They just rarely do that. “2 per week, but demand for outweighs their resources.” Because I had mesh removal, they said it would probably need to be under GA. They stated specifically that at the moment “wait time for GA surgery is 22 months and the wait time for a consultation appointment is currently 2-3 months.”
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@ajm222 – where are you getting those timelines???
The consulation clinic used to be walk-in, but I see it is appt now (no referral req)…and surgery typically was anywhere from 1 to a few months out. I can imagine the backlog of cases from the pandemic has affected that…but 2-3 months for consult and 2-3 years for surgery…are you sure about that???
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This reply was modified 2 years, 3 months ago by MarkT.
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