Tissue repairs – what is the truth

Hernia Discussion Forums Hernia Discussion Tissue repairs – what is the truth

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    • #38752

      There is really no long term record regarding the success of tissue repairs outside maybe the shouldice clinic. And I wonder if even their numbers are completely accurate. I keep coming across reports of tissue repair failures. Most of these have been with desarda repairs. But now we have our friend Kristian. Just how reliable are these repairs long term…and i mean lifetime? Kang says low recurrance –he has been doing his current repair for only 4 years. Desarda says low recurrance. Nut I have found numerous failures of this repair. I see this less with Shouldice –but then there are more reports of chronic pain. Close questioning of people is really needed here —I spoke again to two coworkers who had mesh repairs open….both initially said they felt nothing but under close questioning both recanted and said they did feel it pulling or sticking them. In the end I think you have to go tissue repair simply because the mesh is just too risky and you are never out of the woods. But it seems like everyone who gets a tissue repair is looking at a recurrance down the line. Whether that be 5 years or 30 like Dr Felix. I suppose asking for some clarity here is a wasted exercise.

    • #38753

      You’re never going to get the answer you want. Hernia repair outcomes vary based on surgeon and patient characteristics.

      That said, there are plenty of long term results published for tissue repairs. A simple google search of “long term outcomes” followed by Bassini, Shouldice, McVay or whatever other technique will show you those results. If you don’t want to do the research yourself, just read the European Hernia Society guidelines. They’ve done the work for you.

    • #38758

      Thanks Doctor.

    • #38759

      This is a mysterious area. I found this study which suggests a 10 percent recurrance rate after 52 months for shouldice repair. Dr. Yunis posted a 5 percent recurrance rate for his shouldice repair after 2 years. This is different than what his staff told me they said 1 -2 percent lifetime. What is the answer. I just tried to access the European Guidelines but could not find any good information.

    • #38760
      • #38773

        “Three surgeons experienced in both laparoscopic and open hernia repairs performed all three procedures.”

        Aside from the small sample size and the participant attrition, I want to know more about the experience of the surgeons with each repair before I put much stock in the results.

        If you follow one of their citations to where there is additional surgeon info regarding these repairs, it states “[t]he patients were operated on by three surgeons experienced in both conventional and laparoscopic techniques (>100 TAPP, Lichtenstein and Shouldice interventions each).”.

        Has each surgeon they done more than a 100 of each repair…or has each surgeon done more than 100 repairs each? Either way, greater than 100 does not tell me very much… is it 110…500…1000+? Consider that full-time, high-volume surgeons can easily do 100 repairs in as little as two months (or less), it leaves me wondering how experience the surgeons are in this study compared to what we woudl consider ‘high-volume experts’, which then leaves us asking how comparable are these results to those of the high-volume surgeons?

        As an aside, I found this bit interesting (from the same citation):

        “However, the laparoscopic techniques are more technically complex and have a very long learning curve…It is essential that this fact be borne in mind when one is comparing the results of the different techniques, and for explaining the heterogeneous outcome of studies that are comparing the laparoscopic procedure with the technically less demanding open techniques.”

        Interesting because I’ve heard others suggest the Shouldice repair is more nuanced and difficult, requiring a deeper anatomical knowledge and a high degree of skill to avoid problematic outcomes (e.g., with handling of nerves).

    • #38765
      William Bryant

      Recurrence has always been an issue with tissue I thought. It’s one of the reasons for mesh being introduced. But the pain issue is a worry. I thought it was less likely with tissue. Maybe that’s wrong although it is why some mesh surgeons, the English one who taught Simon Bailey (Peter surname escapes me) and Dr Kang being two, switched to tissue.

    • #38767

      Is there a tissue repair that recurs more than others or hurts more than others? I can’t find any consistent data. Dr. Harris told me shouldice causes a lot of chronic pain. He did not know anything about Desarda or Kang. I plan to see Dr. Towfigh soon but I found out she is quite expensive and she may not have any better information than I can find on this forum.

    • #38769

      How would Dr. Harris know the chronic pain rates for Shouldice? Even the surgeons at the Shouldice Hospital don’t really know, although I’m sure they have a better idea of that than Dr. Harris…

    • #38771
      Good intentions

      The EHS Guidelines were critiqued after they were introduced five years ago and the analysis process was shown to be flawed. According to the EHS’s own web page ten chapters are being “updated” but they do not tell which chapters. How can any chapter be trusted? There seems to be some sort of problem, maybe a disagreement, about what the changes should be, since the updated Guidelines were supposedly almost complete at the end of 2022, and it was announced with fanfare that they would be presented in early 2023. We are now 2/3 of the way through 2023 and not a peep from the EHS or the “Hernia Surge Collaboration” about what is the cause of the delay.

      The Editors of Hernia Journal planned a deep-dive in to the problem of chronic pain from hernia repair in early 2022. Despite the plan, the end result was essentially nothing. No changes recommended, nothing new discovered.

      That is just the reality of the situation. Lots of hope, but little progress.


      Editor’s Corner
      Published: 12 February 2022
      Chronic pain after inguinal hernia repair is a real risk and a major issue
      G. Campanelli

    • #38775
      Mike M

      Considering how many tissue repairs were done before Mesh, when Mesh was not the “gold standard”, and even today. The fact is there are literally millions of people who had no mesh repairs that are successful? over the last 80 years.

      Was reoccurrence more likely based on the type of no mesh repair? The doctor ? The patient type? All are important factors imho.

      That is not to say “mesh” is better or worse. Just a simple fact that the stats show a recurrence has occurred on *every* type of repair albeit perhaps less with Mesh. “Chronic Pain” has occurred on *every* type of repair.

      Let us at least acknowledge there have been *MILLIONS* of successful hernia repairs without mesh regardless of which method, doctor, and if mesh is ultimately the best outcome.

      You can increase your success with the usual suspects exercise, maintaining weight, and diet but you can never *eliminate” failure 100%.

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