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The choice to do tissue repair pinto cpk Alan
Guys I made the decision to repair my hernia with lap mesh. It was a huge mistake of course. But this is hindsight. At the time every doctor was telling me tissue repairs were inferior. Painful long healing times prone to recur. Todd Harris said 20 percent failure rates. Voeller said every longterm study showed tissue didn’t last whereas mesh did. Sure the tissue docs said they had low recurrance rates. But few are doing any follow up at all. Fb forums were full of people complaining about pain from shouldice or desarda. Dr towfigh an obvious authority on these issues dismissed the kang and desarda repairs as not well supported. Shouldice she said tended to be too tight. She favored lap mesh. How did you guys cut through the noise to make the right decision? In pintos case he had a quick recurrance but stayed the course for a second repair. Most guys it seems just do open mesh and seem to be fine. Just curious about how you guys saw through the propaganda to make the right decision to go to kang.
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15 Replies
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Fixing a tissue repair recurrence with another tissue repair is possible, but considered problematic. Higher recurrence rates, hard to see and protect the nerves because of the scar tissue, etc.
The Shouldice Hospital does repair recurrences with tissue repair, but it seems that the thinking there on what’s best has shifted on this. I asked there what I should do if my hernia recurs, and was told that lap mesh would most likely be my best option at that point.
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I believe Dr. Felix said his initial tissue repairs lasted him 20-25 years. He got them when he was younger and likely a good weight. I am sure a lot goes into how long they last. Weight, age, activity level, overall tissue health, quality and type of repair. I know my grandfather got a tissue repair in the late 70’s or early 80’s when he was in his mid to late 50’s possibly. As far as I know it lasted him the remainder of his days (lived to 91) but can’t say for sure as we never talked about it. If he had a recurrence in his very old age he probably wasn’t bothered by it and didn’t mention it.
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Roger…no doctor told me that a recurrance was a simple fix…in fact it was the opposite…and one of the reason i went with mesh….of course its possible even probably they were lying…but they all said recurrant hernias were problematic to fix…you wanted to get it done right the first time. I am very much into natural health and didnt want plastic junk in me…but there didnt seem to be any good options….i thought by doing mesh it would be one and done….rather than doing tissue then having to come back and do a mesh repair in a few years…I feel monumentally stupid for trusting doctors..especially hernia surgeons…as i have learned they are very motivated by money…
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As far as I know there is no data that shows that recurrence risk increases with time with a kang repair. Maybe with Desarda, Bassini and Marcy and obviously not with Shouldice since that is the repair Watchful got?
If there is a recurrence with a kang repair the fix is as simple as the original repair at no cost for the surgery. You just pay for airfare and hotel unless you can use free miles.
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I was diagnosed with three hernias with cough test and ultrasound about 19 years ago. I had no bulges, just sharp pains in three areas. Was sent to see a surgeon who did cough tests and said he didn’t need to see the ultrasound. He said he would fix them with three meshes. That was the first time I had heard of a mesh and decided not to get it done. Didn’t like the idea of having three meshes installed.
It then occurred to me that I had been sleeping on my side in an almost an abdominal stretch position for about a year before the pains started. This was streching my abdominals and when I went back to sleeping in a fetal position the pains went away. I got my hernia little over a year ago while doing some side stretches. Over the past few years I saw tv ads about mesh lawsuits and I knew somebody who worked at thecsame company I worked who had some very serious problems with her hernia mesh and had to get it removed. She died a few months later.
So for me, not getting mesh was a no brainer. Dr Kang was by far the best option for me based on his very positive results, location and cost. But I can see how people go with mesh since it works for most and is recommended by doctors.
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My dad’s had a hernia for 4 or 5 years. He carries and lifts and it doesn’t seem to bother him but I worry it will get incarcerated. He is 90, never had it repaired. He saw my hernia and said his was much larger. But at 90 the surgery could be hard going for him.
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I think my dad was in his 50s when he had the surgery. The recurrence wasn’t caused by activity, but he was significantly overweight.
He never fixed it again after the recurrence. It’s crazy large now. He’s in his mid 80s now. I think it recurred about 15 years ago – I don’t remember exactly.
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Do you recall how old your dad was when he had the repair Watchful?
Might age and activity have something to do with it?
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I think you should actually ask them in 10+ years. The recurrence risk with tissue repair increases with time.
My dad had tissue repair of an inguinal hernia, and his hernia recurred after a few years. I’m not sure how long it was exactly, but it was around a decade I think.
Dr. Felix also recurred years after tissue repair, and went to Dr. Chen for lap mesh to fix that.
The long-term risk of recurrence was the main reason I didn’t go with Dr. Kang, and picked Shouldice. I realized the risk with Shouldice would still be higher than with mesh, but still quite low based on long-term studies.
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Totally agree, GI. And the funny thing is, no one can tell patients how long mesh repairs are supposed to last. 30+ years may be unrealistic for mesh without complications. No one is bothering to track that. It’s just assumed they’re ‘forever.’ If someone did a good study, it could potentially be shown that tissue far outweighs mesh in terms of the very long term complication rates and even recurrences. But of course no one is looking at that, nor are they really able to yet as mesh hasn’t been the gold standard long enough.
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By definition I think that he is being disingenuous when he talks about mesh repairs. An honest assessment of his pure tissue repairs would talk about the quality of life for the 40 years that he had with a pure tissue repair, not just the recurrence at the end. Ignoring the quality of life issue is willful ignorance of the main problem of mesh.
But, it would interfere with his goal of having his name tied to laparoscopic mesh implantation as one of the “inventors”. His legacy.
I sometimes wonder if his high level of activity, traveling the world spreading the 10 Golden Rules, is because it takes his mind off of the discomfort of the mesh implants. Who knows. Maybe he’ll become a convert someday.
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Correction – he mentions later the details of the tissue repairs. First hernia repair lasted 30+ years! Second one he says was 15-20 years.
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I was basing that on his interview he did with Towfigh. At the 39″ mark all he says is that he had tissue repairs done 30 years ago and 40 years ago that both eventually failed, and had mesh repairs to fix. I can’t glean from this how long the repairs held because I don’t know when he got the mesh repairs, and I don’t know the precise dates when he got the original tissue repairs and if they were similar in timeframe. Do you happen to have another source?
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That was one side. The other side recurred more quickly for Dr. Felix.
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Recurrence rates increase with time with Shouldice as well. There’s a paper showing an increasing recurrence rate graph. It increases with time, but still stays under 2% if I remember correctly. I think this was based on Canadian insurance data for the Shouldice Hospital, so presumably independent data about the procedures performed there back then.
Studies of Shouldice performed elsewhere showed worse results, and who knows what more current results would be even at the Shouldice Hospital because the surgeons are different and they aren’t all adhering as strictly to the original way of doing it.
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