Watchful, could you summarize your experience at Shouldice?

[Amelia Aria]

It is important to thoroughly research and consider all options before making a decision about where to undergo surgery. This includes evaluating the qualifications of the surgeon, the success rates and recovery times of the specific procedure at a particular hospital, as well as any additional costs or insurance coverage. It is also important to have a thorough understanding of the potential risks and benefits of the procedure.

It is important to note that healthcare is a constantly evolving field and what worked well in the past may not be the case in the present or future. It is important to be informed and consult with a qualified healthcare professional to make the best decision for your individual case.

[Good intentions]

Was the “other issue” in the groin known before surgery or discovered during surgery? I don’t want to dig in to the details of your ordeal but it kind of confuses the overall assessment of the Shouldice experience. Did they make the situation better or worse? Could there have been better planning if they had known?

I don’t know how much you’ve disclosed to other people about who you are but, really, we’re all anonymous here. Except for the people who use their real names. Even then, not many people will find the name on a hernia discussion forum.

Your comment about the duration of living with the indirect hernia shows that you realize that your situation is not “run-of-the-mill”. The thought occurred to me that watchful waiting can have the downside of letting the body change to adapt to the hernia, especially for those with direct hernias. Newly stretched tissue. Then when it is finally repaired the body has to re-adapt or go back to its previous state. A much better selling point for hernia repair than “you could die due to a strangulated hernia”. In your case, of course, you had already been waiting since birth so no significant time-based decision to make there. But for other people maybe it matters.

[William Bryant]

That all sounds like good news Watchful and progressing albeit slower than you may want.

From what I’ve read it all takes time, more so after tissue repair.

The healing ridge can take months so don’t despair. Also the numbness, I once had 2 prolapsed discs pressing on sciatic nerve, eventually my leg went numb. It took about a year for normal feeling to return. That was nerve disrupion without major surgery so again in your case I think its a matter of time. As good intentions said, the body continues to heal so every reason to be optimistic.

It’s good you got the other issue sorted, if it’s ok to ask who discovered it and did Shouldice rectify or another surgeon/clinic?

Thanks for keeping us informed it’s very useful and appreciated.

[David M]

And its good to hear that it sounds like you’re doing better on your way to a near full recovery.

[David M]

Thanks Watchful, that is helpful information about Shouldice.

At this point, it’s only academic, but do you have any idea if you were to do it over again.whether you would let the German doctors decide whether to put mesh in after they got in there and looked the situation over,or would you choose tissue repair (or mesh) going in?

[Watchful]

Here’s an update on my condition. It has been about two months since my surgery.

I still have some hard “healing ridge” in the incision area, but it has been growing smaller gradually. Skin sensation in the area is still somewhat abnormal (some numbness and paresthesias), but that has been improving as well. I think my ilioinguinal nerve was disturbed based on all the skin sensation abnormalities, but I hope it goes back to normal with time. If I press in the incision area, there’s some pain, but, again, better than before.

I sometimes get internal groin pain with certain kinds of exertion, but it typically resolves pretty quickly when it happens.

I don’t feel any tightness or pulling or anything abnormal like that internally in the groin. It feels normal. This is a big change for me since I never had a normal groin on that side before – my hernia was congenital.

As I mentioned before, I had another issue in the groin which led to serious pain after the surgery. I’m not going into detail on that because I’m pretty sure it doesn’t apply to anyone else here. It was sorted eventually, but only after going in some wrong directions. That’s a whole story by itself.

I’m still healing, and will write another update in a month or so. I hope the remaining issues resolve completely over the next few months. If I’m lucky, maybe in a couple of months.

[Watchful]

William,

Thanks for the good wishes – much appreciated.

Baris went to Dr. Koch in Germany, and then to Shouldice. At Shouldice, Dr. Alexander helped him. Unfortunately, he retired during the pandemic. He was one of the extraordinary surgeons there. The other great one in recent times was Dr. Degani, but he’s mostly retired now.

Lichtenstein would have certainly been a much easier surgery in my case, but as to what would have been better in the long run – who knows. The main problem wasn’t really tissue vs mesh in my case. I don’t think anyone outside the Shouldice Hospital would have done Shouldice in my case, but that’s just a tangential point that I’m making.

I had another problem in my groin which wasn’t handled correctly, and that created a (non-funny) comedy of errors for me over there. I’m not going into much detail on that because I think it’s irrelevant to others here, but my point on this is that it’s not the right place for complex cases. If you have one of those, be less focused on tissue vs mesh, and more focused on how you can get the right care for a complex case.

• This reply was modified 1 year, 2 months ago by  Watchful.

[William Bryant]

Thanks Watchful, I appreciate you taking the time to reply and look forward to the update.

I’m getting the impression you feel mesh make have been a better option in your case?

After operation complications are a worry abroad definitely. I think though at least Dr Kang has done mesh repairs in the past.

Baris woke to find his German surgeon had decided to use mesh. It did cause problematic and Shouldice I believe helped him subsequently.

Clearly no fail safe surgeon or surgery.

I have seen suggestions that mesh is ok or likely to be in elder, 60 plus, patients, no idea if true.

In your own case, I remember Shouldice saying to me if tissue repair goes wrong you can always have mesh after. Might that be something you’d consider of beed be?

I’m still thinking yours is still early days and may settle in a few months.

Wishing you the best.

[Watchful]

I will write an update about my condition when I have some more time.

Meanwhile, in terms of whether I would make the same choice again or not… No, I wouldn’t in my particular case, but my case was complex and unusual. For that, you really need to go to a place with more personalized care, and broader expertise. The Shouldice Hospital is a very focused factory, and that’s not a good fit for anything complex or unusual. It’s also problematic in case of complications, and they don’t have much experience with diagnosing or treating post-surgery pain issues. Ideally, you want a surgeon who is well-versed in that because they know better how to avoid those issues to begin with, and they’re better positioned to help you correctly if something happens.

I think if you have a run-of-the-mill inguinal hernia case, it’s fine to go there as long as you get to pick one of their best and more experienced surgeons (I mentioned some names – Hall, Simmons, Slater). If I had such a case, would I go there knowing what I know now? It wouldn’t be my first choice, but nowhere near the bottom either.

I would go to one of the top German surgeons. I mentioned some names before – Conze, Wiese, Lorenz. They perform good diagnosis and follow-up, they are very careful, and they don’t force tissue repair on cases where it’s not a good fit – they are good at figuring that out, and using mesh if needed. They’re capable of doing Shouldice well, and they do many of those, but they avoid doing it in cases where it’s likely to be problematic. Dr. Conze would be my first choice since he also has experience with treating post-surgery pain issues.

By the way, going far away, and particularly abroad is far from ideal. It’s not at all easy even if everything goes smoothly. If there are complications or other issues, you can be in a very stressful and difficult situation, which may even influence you to make sub-optimal decisions at that point. Unfortunately, there are very few good choices for tissue repair in the world, so local options don’t exist typically.

[William Bryant]

Please Watchful, an up to date resume would be good. I think the pain was easing a bit.

I suppose one question would be if you had to do it again or had time over would you choose Shouldice clinic or go elsewhere?

[Watchful]

GI,

The other issue was known and discussed before surgery. Yes, it should have been handled differently. I don’t think it’s really relevant to others here because it’s extremely rare, so I don’t want to focus on it right now. I mentioned before the lesson that if you have a complex issue, find the best expertise for that (which may even require more than one surgeon working together). The focus shouldn’t be on relatively minor aspects such as tissue vs mesh in these cases.

I did mention a number of times that my case wasn’t run-of-the-mill. I don’t think waiting all these decades caused some kind of an adaptation issue in the groin. Shouldice is an extensive procedure – they basically reconstruct the relevant parts anyway…

What typically happens with waiting with an inguinal hernia (direct or indirect) is that the hernia grows larger. Not a good thing, particularly if you want tissue repair. There are giant scrotal hernias where there’s loss of domain in the abdomen because too much intestine came out, but I was nowhere near something like that.

For Shouldice, a bigger issue than the size of the hernia is actually the nature of your anatomy. The surgery becomes significantly more difficult when the layers are deeper in your anatomy. This is one thing that I wasn’t aware of before, and learned at the Shouldice Hospital. I don’t know what this means exactly, and I never saw it in any papers, but evidently this makes a significant difference for these types of surgeries.

[Watchful]

Thanks, William. I’m very familiar with spine issues as well, unfortunately.

My other issue in the groin was known, not a surprise. I may write about that ordeal at some point, but for now I want to separate it from the hernia repair itself.

[Watchful]

David M,

Some of the German surgeons are really good with ultrasound. I’m told they’re able to tell with a high level of confidence if mesh is needed (by their criteria) based on that.

I’m not sure what they would have said about my case after exam/ultrasound, but my hernia was way outside their guidelines for Shouldice, so I think there’s a high probability that they would have recommended mesh. Also, my deep anatomy made the surgery even more difficult. My surgery took twice as long as it normally takes, and that was with a surgeon who had done thousands of Shouldice procedures.

You will need to ask me again in a few months. If all is good at that point, then my answer will be different than if I have some lingering issues that can be attributed to the type of repair I had. Of course, I could have had mesh and had issues from that as well.

At this time, it doesn’t look like going with a Shouldice procedure (vs Lichtenstein) messed me up, even with my difficult case, but it’s still early days.