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Hernia Repair Research
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I would like to summarize my research on hernia repair procedures and the surgeons who can perform them.
I have a small (neck = 1cm) direct inguinal hernia. I had it for a few months. It is reducible, asymptomatic and contains fat.
First off, I want to say that for researching options to repair it, this site’s archive has been an invaluable resource. As are Dr. Towfigh youtube Q&As and interviews videos. So, a grateful thanks for all key contributors on this forum and for our host.
So, here are my research results and analysis:
There are 2 classes of options: mesh or no-mesh. For mesh, you have open, laparoscopic and robotic. For no mesh, the only option I considered is Shouldice, which has over 70 years of practice and is well studied.
In 1990, about 94% of hernia repairs where Shouldice. Today this number is less than 1%, as mesh repair totally dominates the field. What this means is that very few surgeons in US do Shouldice today (see below). Why this is so, I have some ideas but I do not want to go into it now.
What I did next was a risk/benefit analysis of mesh implantation vs Shouldice.
There are 2 main risks:
1. Risk of recurrence. Here the stats I saw are the same, at under 2% or so, with the caveat that Shouldice patients should qualify for the procedure, while Mesh is done to everybody. The Shouldice qualification, for low recurrence, means a BMI less than 25 and being generally healthy.
2. Risk of complications. This is the biggest risk with Mesh. On a large study I seen from 2021, at 5 years 4-6 % of patients reported severe or disabling symptoms: chronic pain, mesh migration entangling nerves/spermatic cord, mesh “eating” into organs, inflammation (as mesh is a foreign body for the immune system), etc. Other studies show more alarming rates, between 15%- 30% overall severe complication rate. The Shouldice repair, when performed at specialized centers, offers extremely low complications rate, under 1%.
So, the result of my risk/benefit analysis is very clear: I should do Shouldice, as I qualify for weight and general health. Eliminate Mesh as an option.
And I should do the Shouldice procedure in a specialized hernia clinic with an expert surgeon specialized in the procedure, who has a high volume Shouldice procedures experience.
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This discussion was modified 9 months, 1 week ago by
Steve.
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This discussion was modified 9 months, 1 week ago by
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1 Reply
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List of surgeons doing Shouldice:
Dr Yunis, Dr Sbayi, Dr Reinhorn, Dr Fronza, Dr Towfigh, Dr Nakhjo, Dr Iskandar.
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