Thank God I found this again, need advice
Tagged: anesthesia open center
09/11/2022 at 5:09 pm #32417
Please read, trying to keep it short. Thank God I found this forum again, been gone a long time. I got a ton of good info from this forum before, I hope it has not changed.
I am in a foreign city that is not known for quality health care. I am having problems with a bilateral inguinal hernia one of which becomes incarcerated and blocks movement of gases and food partially in either the bowel or small intestine making it difficult to poop and eat. I have managed to reduce it with a lot of effort of icing and fasting, etc, but it is a royal PITA. This could become strangulated who knows? The trip back to the states is a problem due to the possible aggravation of this hernia and I have no real home base there now and the tremendous rising of rent and other prices there. I am thinking maybe I would book a flight to a hernia center, but the question is: which one to choose? For good reasons after a lot of research, I am only interested in open repair with LOCAL anesthetic and I find it hard to find surgeons experienced in local open anesthesia repairs. I have very good clinical reasons for this choice of operation.
If I have to get the repair done locally, how do I determine if the surgeon/anesthesiologist is capable of doing local anesthesia without complications? So far I have found one who agreed to do it locally but then said he would “sedate me”. So I am thinking he is not being honest about doing it local. Also had an anesthesiologist here lie to me about whether he was experienced in local (he was not).
If any of you can give a REAL, experienced based recommendation for a GOOD hernia repair center in the U.S. that is not just some profit mill and has well qualified surgeons, please let me know. I want a surgeon who has done a ton of local open repairs and has a good track record with NO board complaints and no lawsuits. Thanks for whatever help you might lend. Sorry to sound so negative but I think it’s not that easy to find what I am looking for.
09/11/2022 at 5:35 pm #32419
You will find that surgeons apply sedation in addition to local anesthesia. Doing it without sedation is possible, but not commonly done these days. I don’t think it’s going to be easy to find someone to do it like that, but not impossible.
The Shouldice Hospital in Canada used to do it in many cases without sedation, and I think they still do it that way when the patient asks for no sedation, so that might be an option. The wait time is pretty long, though. I believe it’s about 5 months now.
- This reply was modified 3 weeks, 4 days ago by Watchful.
09/11/2022 at 5:55 pm #32422
ok thanks for that reply. I can’t go to Canada and even if I could I would not :-). Yeah I did not know that sedation was the norm thanks. Neurologists will tell you anytime you put the brain to sleep, even sedation, you’re damaging the brain.
09/11/2022 at 6:01 pm #32423
True – it’s a brain insult and causes some damage. I’m shocked that even colonoscopies are commonly done under deep sedation these days – it’s insane.
09/11/2022 at 6:02 pm #32424MarkTParticipant
I echo the Shouldice Hospital recommendation (I’ve personally had left and right inguinal repairs done there, many years ago, with zero complications both times).
They do their own open no-mesh repair that has been around for many decades, their experienced surgeons average ~50 repairs per month, and almost all of them are done under local anaesthetic (you would actually have to make a special request to get general anesthetic there). I’ve heard that for foreigners, it can be cheaper than many options in the U.S. too.
edit: Just read your “I can’t go to Canada and even if I could I would not” response, so…never mind!
- This reply was modified 3 weeks, 4 days ago by MarkT.
09/11/2022 at 6:10 pm #32426
These days, they use an IV with a combination of midazolam (also known as Versed – it’s a benzo sedative) and fentanyl (opioid analgesic) in addition to the local anesthesia. However, I heard that you can ask them to do just the local anesthesia.
09/11/2022 at 6:24 pm #32427
Another option would be to contact Biohernia. They have surgeons in Germany performing Shouldice, Desarda, and open mesh procedures. You can get a free video consultation, and ask them if they would agree to a surgery without sedation.
09/12/2022 at 9:45 am #32429
09/13/2022 at 11:27 pm #32459
Thanks to all for the good replies. I am in a third world city that is not noted for high quality medical care and I am having trouble getting honest information from some of the “professionals” here. In reference to Watchful’s reply “midazolam (also known as Versed – it’s a benzo sedative) and fentanyl (opioid analgesic) in addition to the local anesthesia.” I consulted with one of the anesthesiologist who actually lied to me when he told me all his hernia surgeries were done “local” because I know that is not done here routinely. He told me he uses Bupivacaine + Isobaric +epinphrine. I am not familiar with those but in lookup say B. is used for spinal anesthesia which the literature says can cause urinary retention and other problems, not to mention them screwing up a spinal injection? It has to be either a better city here in the Philippines or USA for me. I am not completely sold on the no mesh method. I researche this before and the only one I was interested in was Desarda and it’s hard to find a qualified surgeon in the USA that does a lot of those. I think someone here mentioned some shouldice people at Buffalo SUNY I think it was? That might be a possibility if I can stand the weather there even for a few days. Sorry if my posts sound so negative, but I really don’t think this is such an easy nut to crack and it’s still surgery, anything can happen as testimony to the many complaints online of chronic pain, mesh migration, and other complications. Thanks again to all. Great board.
09/14/2022 at 1:41 am #32461
Dr. Robert Tomas in Fort Meyers, FL has done thousands of Desarda procedures. He does them with local anesthesia plus sedation.
09/14/2022 at 3:01 am #32463
Thanks again so much Watchful. It’s been several years since I researched Desarda surgeons. Apparently more have
joined the group. That other surgeon whose video interview was impressive and came with patient recommendations here was Dr. Sbayi out of Stony Brook, Long Island (not suny sorry). But post as of this month says he is no longer with
his past place of employment and offers no additional info. I will check out Dr. Tomas in Ft. Myers, thanks.
Do you know anyone here or elsewhere that gives details of surgery with him? Thanks again for that referral. Surgeons aside, I’d much rather go to Ft Myers than Long Island, 🙂 Do you have anything further to say about the
anedotes here and elsewhere about breakthrough pain with local anesthesia and how they might handle that?
Did you perchance see the video of Dr. Desarda doing hernia surgery from several years ago. I wonder if he is
still practicing. That was a video of a MASTER surgeon, I don’t need to be a doctor to know that.
09/14/2022 at 6:47 am #32466
I believe Dr. Desarda retired from surgery.
You can also consider Dr. Jonathan Yunis in Sarasota, FL. He does it all: mesh (open, lap, robotic), and tissue repair (Shouldice, Desarda). He agrees to local plus sedation for open surgeries.
Sedation as practiced in these surgeries in the US is pretty deep. I think the sedative used is propofol. You shouldn’t experience pain – you’re unconscious, but breathing on your own, potentially with the help of an oxygen mask. This is different from the relatively light sedation that’s typically used at the Shouldice Hospital (with midazolam). With that, you have to rely more on the skills of the surgeon with the local anesthesia. You may experience pain, but you’re likely to forget it because the sedative used causes amnesia. If they notice that you feel pain, they may try to increase the amount of sedation. Some people do experience pain and remember it, though. Hence, most surgeons prefer to use deeper sedation. Also, no one wants you to move around during surgery…
09/17/2022 at 1:25 am #32513
I remember the DeSarda video. 80’s yr old patient. Asked to cough after completion of surgery to check the repair. So he was fully awake. Honestly the USA sedation you describe is unacceptable to me, it’s almost the same as general anesthesia. Neurologists up on the research will tell you this is destructive to the brain especially in old patients. I will live with my hernia before I allow them to fuck up my brain to fix it.
Also I check on the guy in Ft. Meyers. He might be good, but I found at least three serious complaints about him on healthgrades. I am not here to defame anyone so I won’t go into details on it, you can visit the reviews at their site. Also he is an Osteopath. I prefer and M.D.
I will take a look at Yunis, see what I can find on him.
09/17/2022 at 1:46 am #32514
Still no word from Dr. Towfigh nor Dr. Sbayi about where he disappeared to? Did he get fired or did he quit?
09/17/2022 at 5:08 am #32515
No word yet, but based on reviews he uses deep sedation with an oxygen mask. It will be hard to find a US surgeon who agrees to no sedation or light sedation. Possibly Dr. Chen at UCLA – I heard he does that. You had to wait around 4 months for an appointment with him last time I checked.
09/17/2022 at 5:33 am #32516pintoParticipant
A few years ago I read a positive review, probably here, about a non-mesh doc in the Philippines. Also you should consider Dr. Kang in South Korea. Being so close, you would be foolish if you did not consider him. His chief assistant Stephen, I’m sure, will be happy to consult with you by email: [email protected]
09/20/2022 at 11:27 pm #32582
I tried emailing his supposed secretary Theresa and got an auto reply from back in august. Apparently she is not attending her email over august-sept. Unprofessional imo. Also I found out Sbayi previously to he recent video here, was not noted for specializing in hernia surgery but other kinds of surgery. Also he went to medical school in, get this: The Dominican Republic. Good talker but no thanks. I am changing my mind about local anesthesia and also about no mesh. I don’t see top notch surgeons mentioned here doing either.
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