Watchful….the minefield of options

Hernia Discussion Forums Hernia Discussion Watchful….the minefield of options

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    • #32754
      Chuck
      Participant

      Watchful….these were the types of studies i kept running into when i was trying to make my hernia repair decision….most of the studies showed lap mesh to have lower pain and recurrance risks than open mesh….and both to be superior to non-mesh repairs. Of course despite my detailed study i still got probably permanently ruined by Dr Carvajal…who said lap tep was easy…and claimed to have performed 5000 surgeries…a figure which i am now certain was a lie. I dont know where the non mesh statistics were gathered from…but there arent many surgeons doing non mesh repairs….so can we assume these non mesh failures and chronic pain cases are from Yunis?
      Koch? Kang ? Grishkan???? If you chose a non mesh repair…in an effort to avoid chronic pain….you are going against all these studies? I worry that if my hernia returns…i will have to go through this process again…i still think Kang is the best option….but who knows?
      Many studies were performed to prove the effectiveness of Lichtenstein over other tissue repairs. One such study was done in 2002, which gathered information from electronic databases. It had conducted 62 relevant comparisons in 58 trials which included 11,174 participants. Among them, 6,901 had individual patient data, 2,390 had supplementary aggregated data, and 1,883 had published data. The analysis showed that 88 in 4,426 of the mesh repair vs. 187 in 3,795 of the non-mesh repair had a hernia recurrence, and 120 in 2,368 in the mesh group vs. 215 in 1,998 in the non-mesh group had persistent pain concluding that the mesh repair is associated with a low recurrence rate and less persistent pain than the non-mesh repair [45].

    • #32755
      Chuck
      Participant

      boston hernia claims their open mesh repair has a chronic pain rate of .003 percent….of course its probably a lie….in fact i am sure it is…how can these doctors ever know for sure what the rates are….they simply cant track down all the patients…i dont know how anyone gets a decent hernia surgery result…i really dont with all the lies….and selling….

    • #32759
      Watchful
      Participant

      Chuck,

      My understanding is that you don’t have a recurrence, and your surgeon said you’re unlikely to get a recurrence. Why not cross the bridge if and when you get to it?

      Regarding your questions. There are two aspects: the technique and the surgeon. To minimize your chances of trouble, you want both to be really good. Note that you can still get a bad outcome. It’s just a matter of minimizing the risk of that. The only way to guarantee avoiding a bad surgical outcome is to avoid doing the surgery, but that isn’t always a good option either.

      Studies are of somewhat limited value. One problem is that the results don’t seem to be all that consistent across studies. Another problem is that the studies aren’t really studying your specific surgeon doing your specific procedure.

      My reason for preferring tissue repair is that I want to avoid the possible complications of mesh, and the risk of needing mesh removal. Also, I was told by a number of surgeons that tissue repair is a better approach in those who are good candidates for it (not overweight, etc.) These are rare surgeons who do both mesh and tissue repairs, and are truly good at both.

      I explained before why I picked Shouldice over Desarda and Kang. I don’t love the Shouldice technique, but it works very well in terms of repairing the hernia and avoiding recurrences. Chronic pain is more questionable. A lot depends on the skill of your surgeon and how careful they are with identifying and protecting the nerves.

      It’s very confusing that there are two versions of Shouldice, and then there are some surgeons who call what they do “Shouldice” even though it’s different. Leaving these aside, you’re left with the original Shouldice as practiced at the Shouldice Hospital (and a couple of other surgeons), and the modified Shouldice as practiced by a number of surgeons in Germany as well as Yunis, Towfigh, and some others.

      The technique as practiced at the Shouldice Hospital is really extensive. A large incision, searching the whole area for hernias, a complete removal of the cremaster and the nerve and vessels that go with it. I can’t say for sure, but this seems like overkill, and a number of surgeons consider it to be overkill. When you do all that, there’s an impact on recovery, numbness, pain, discomfort, etc. Also, staying at the hospital for 4 nights in a shared room is something that would make my recovery harder, not easier. On the other hand, they use light sedation there, which is better for your brain than the deep sedation you get in other places.

      I think the sweet spot is the modified Shouldice that I mentioned. Even if there’s a slightly higher recurrence rate with it, so be it. I don’t think it’s a big issue in my case because I only have an indirect hernia.

    • #32761
      Watchful
      Participant

      I meant complete resection, not removal.

    • #32763
      roger555
      Participant

      Any data on how often at the Shouldice hospital they find unknown hernias after the large incision? Must be enough times for them to keep doing it? What about doing an ultrasound to find unknown hernias like Dr Kang does? Which method makes more sense?

    • #32764
      Watchful
      Participant

      They were saying 14%. Doing a proper ultrasound and a more limited scope surgery would be my preference. This is what some German surgeons do, and also Kang as you mentioned.

    • #32766
      pinto
      Participant

      You’re kidding. Testing before surgery is not standard? A guy finds out he has an IH, locates a surgeon, books a surgery and that’s it? The surgeon takes for granted that the patient knows what he’s talking about and proceeds accordingly? No way, Jose.

    • #32767
      Watchful
      Participant

      To be fair, they don’t really need to image with an ultrasound for what they do. They don’t operate on people who don’t have an obvious hernia on physical exam, so an ultrasound is irrelevant. During the operation, they see all the hernias because they explore the entire groin, so again, an ultrasound is irrelevant.

      An ultrasound isn’t all that great, actually. For example, it’s not very good for determining if a hernia is a sliding hernia.

      • #32771
        notanewbeeok
        Participant

        Most surgeons can tell just by looking or palpitating the area.
        (turn your head and cough-us military standard). It’s only the unusual/complicated one that requires imaging.

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