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What causes a pure-tissue hernia repair to fail? And how?
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quote UhOh!:Is there a way to address a collagen deficit through medical management or dietary changes either prior to, or directly after, surgery? Would seem to be an interesting study; half the patients randomly assigned to address the collagen deficit, the other half not, and see the results of pure tissue repairs.Also Is it possible to use biodegradable mesh to reinforce collagen ?
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quote drtowfigh:The original Shouldice repair was described with stainless steel suture. Most of us do not use that anymore. At the Shouldice hospital, they still use stainless steel because it’s cheaper—that’s what they told me. They make their own sutures in the back room. I saw their technicians do so. They have a limited stipend provided by the government Lee patient so they have a lot of cost cutting steps. Suture is one of them.The reason why tissue repairs fail is often because of the quality of the tissue being sewn. Most with inguinal hernias have a collagen deficit. Sewing collagen deficient tissue together is less sturdy than healthy tissue.
Is there a way to address a collagen deficit through medical management or dietary changes either prior to, or directly after, surgery? Would seem to be an interesting study; half the patients randomly assigned to address the collagen deficit, the other half not, and see the results of pure tissue repairs.
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The original Shouldice repair was described with stainless steel suture. Most of us do not use that anymore. At the Shouldice hospital, they still use stainless steel because it’s cheaper—that’s what they told me. They make their own sutures in the back room. I saw their technicians do so. They have a limited stipend provided by the government Lee patient so they have a lot of cost cutting steps. Suture is one of them.
The reason why tissue repairs fail is often because of the quality of the tissue being sewn. Most with inguinal hernias have a collagen deficit. Sewing collagen deficient tissue together is less sturdy than healthy tissue.
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Hi chaunce,
i believe the reason they use it is like you said, its biocompatible and strong. When i requested surgery they also said that i had to wait one year after previous surgery as this is the time it takes for the muscle to fully repair from being cut and sewn together and therefore i believe this may be another reason for using these sutures. It keeps the repair in its strongest form up until ffull recovery/ healing.
in terms of the desarda repair, is it still suitable for patients that are big in size? And how succesful is it? Just curious as my previous surgeon said he wouldnt opt to use it as its designed for ‘small framed skinny people’.
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[USER=”2608″]dog[/USER] [USER=”1391″]UhOh![/USER]
I’d be very curious to hear the official reason from Shouldice as to why they use stainless steel sutures, though I suspect it’s because of biocompatibility, and perhaps the strength contributes to their very high success rates.
My understanding is that many metals (stainless steel, titanium, gold, etc) are highly biocompatible and inert in the human body, which is why they are often chosen for stents, staples, pins, sutures, and other permanent implants or scaffolds.
I do wonder if, over time, plastic sutures or plastic meshes would degrade, perhaps that would contribute to hernia recurrence if that is the case. Who knows?
As for the Desarda repair using absorbable sutures, I suspect it’s because the strip of muscle used in the repair just integrates back into the muscle as part of the healing process. But that would also be an interesting question for a Desarda practitioner to answer.
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quote dog:I am just wonder if stainless steel sutures or any nylon sutures can have similar effect on inflammation like we are all here against mesh …it is foreign to body with unknown long term effect [h=2]DESARDA technique using just dissoluble sutures and that is working ok ..WHY ?[/h]
While I’m not a doctor (and don’t even play one on TV!) I do know that surgical-grade steel has a very long history of implantation in the human body.
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I am just wonder if stainless steel sutures or any nylon sutures can have similar effect on inflammation like we are all here against mesh …it is foreign to body with unknown long term effect [h=2]DESARDA technique using just dissoluble sutures and that is working ok ..WHY ?[/h]
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One thing I believe has been mentioned here, by Dr. Kang, if I recall, is a mismatch of defect toe and repair type. Some are suited to direct, others to indirect. For example, a repair designed for direct not only would seem to have more cutting and sewing, but would fail to address the problem of a dialated internal ring.
That’s part of what’s seemed to informed his preoperative workflows (US imaging as standard, selection off repair type prior to surgery) and then size/location of incision.
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You can edit out “supposedly”. I just had a chat with the Shouldice hospital and they do indeed use stainless steel sutures.
I cannot comment on your other questions because I do not know, it’s something I am trying to understand myself.
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