News Feed Discussions Surgeon that will perform a minimally invasive technique without mesh?

  • Surgeon that will perform a minimally invasive technique without mesh?

    Posted by Jeremy B on May 10, 2018 at 9:03 pm

    It seems I would have to fly out to visit German Doctor Ulrike Muschaweck in order to get such a minimalist repair.
    I just want as minimally Invasive as possible, with very little disruption to anatomy.
    No mesh, no redistributing anatomy.

    There is another repair that has had success.
    Fascia transversalis repair
    FTR is based on the plication of fascia using continuous
    sutures and is followed by a second layer of interrupted
    or continuous sutures between inguinal ligament and
    conjoint tendon to distribute the tension.

    MO replied 6 years, 2 months ago 4 Members · 3 Replies
  • 3 Replies
  • MO

    May 13, 2018 at 2:08 pm
  • Good intentions

    May 12, 2018 at 12:45 am

    Here’s a very good video description of the two basic types of inguinal hernia. I’ve noticed that most descriptions of hernia generally stop with showing the abdominal contents just starting to poke through the superficial ring. With the indirect it’s obvious that everything ends up in the scrotum.

    But I haven’t seen a good description of where the direct material ends up. Where does it go after it gets free, which way? After it passes through the external oblique, it must be either under the fat layer or between the skin and the fat layer. Or maybe it’s bluntly dissecting its own pathway directly through the fat layer. In my case, it felt like the material was being pushed medially, toward the center. The initial bulge was peaked and distinct but eventually, as I tried to live with it, it grew to be broad and shapeless. After the hernia repair, when the swelling went down, I could see what looked like the shape of a deflated balloon under my skin. This area would get irritated and swollen with activity, then shrink with rest. Eventually it ended up as a small solid lump under my skin. I would probably make an interesting autopsy case for any students studying hernia repair. Hopefully far in the future, studying the ancient techniques that didn’t work.

  • Chaunce1234

    May 11, 2018 at 11:43 pm

    The “Minimal Repair” by Dr Muschaweck is usually used for inguinal disruption / sports hernia type injuries, I am not sure if applies to a regular inguinal hernia. I believe she performs a Shouldice repair for a typical inguinal hernia.

    There are supposedly two or three surgeons in the USA who perform the same repair as Dr Muschaweck for sports hernia injuries – Dr Boyarsky in NJ and Dr Litwin in MA, here is a brief article from Boyarsky discussing the injury:…thlete-hernia/

    You’d have to reach out to those surgeons and ask them if the same procedure would apply to an inguinal hernia.

    “Fascia transversalis repair” to me sounds like it’s describing half of a Shouldice repair, but I am not a surgeon and don’t know enough about the anatomy to assess that.

    A Shouldice repair from Shouldice has very good results so it likely remains one of the top options for a mesh-free repair if someone is eligible for it and able to travel to Canada.

    Dr Kang on these forums appears to have developed a unique mesh free hernia minimal repair technique with great results as well, but he is based in South Korea so the distance may be impractical for some patients.

    With the indirect hernia, there is also the Marcy repair which is usually performed on kids and youth, but some doctors swear it works fine on adults too if the hernia isn’t too big yet and the patient is not obese. There is also a variation which is laparoscopic and does not use mesh, but you’d have to find a surgeon willing to try it on an adult. Obviously there is some debate here.

    A direct hernia I think requires repairing the actual floor of the inguinal canal, because it has torn through for whatever reason. I don’t know if that is entirely accurate, but I think it’s accurate-ish.

    Desarda repair might qualify as “minimal” to some regard since it’s using your owe muscle as a flap to cover a hernia, whether that makes someone prone to recurrence where the muscle was borrowed from, I don’t know.

    Anyway that’s about it for my knowledge, but do share with us what you find, what you hear, and what you decide on.

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