Watchful….did you consider this repair?

[Watchful]

Chuck,

I considered it briefly, but didn’t do much research on it because I didn’t have a surgeon who would do this. Reinhorn wasn’t taking patients from outside New England at the time. He probably still doesn’t.

I remember reading somewhere that this surgery has its own set of non-trivial risks and potential complications, but I didn’t go deep into it.

One of the things I didn’t realize while researching was that in the rare cases (2% or so) where they do mesh for inguinal hernias at Shouldice, their preferred technique is posterior mesh (like Kugel), not anterior (like Lichtenstein). I learned that only when I was there.

[Good intentions]

What is described on that web page is essentially the Kugel patch procedure (the initial subject of the Bard class action suit). Or, it might be the Prolene Hernia System (PHS) used, which combines preperitoneal and onlay. The hole is created, the space for the mesh is cleared with a finger (typically, from what I’ve read), and the patch is pushed through the hole and allowed to spring open. If you look at the two references on the Boston Hernia page, they are about laparoscopic TAPP and TEP mesh procedures,and the “Guidelines”, not the procedure they describe. There are many Kugel and PHS references out there. Kind of disingenuous to not show any.

Here is a description of the Kugel patch method. You can see the same terminology used.

https://www.bd.com/assets/documents/pdh/initial/Kugel-TG-with-Onflex.pdf

[Unknown Member]

Just so hard to know whether tissue repairs last….seems like many start failing in 5-10 years except shouldice clinic….but that is a very invasive repair…my friend saw reinhorn…he really believes his repair is he best…but dont they all