Which surgeon would you go with?

[pinto]

@momof4, thank you Susan for that. I was surprised and not surprised that testing is available but not reliable. At least it’s a start. You are brave for what you are going through. I hope things brighten up for you. You distinguished two things–allergy and foreign body response. The testing you mentioned was for the former, which probably means there is none for the latter? I wonder how the both are distinguished medically as you have both.
My understanding from HT is that after mesh removal, scarring typically covers over the previous hernia. Does it?

[Tracy Principi]

My surgeon was Andrew Iranahi in Newport Beach CA. No mesh. He does both mesh and no mesh and gave me a great belly button because he does cosmetic surgery. He also understand anatomy because of this.

He has tons of Youtube videos which is how I found him. All very informative. Explains everything in detail.

https://www.surgicaloasis.com/dr-iraniha/

[Momof4]

Thanks @pinto! I know Dr. Towfigh and her team have done research and published on the topic of allergy testing for mesh allergies. I don’t think the tests are very reliable and have a high false negative rate. That being said, I had allergy testing before having polypropylene removed and I had a severe skin reaction. I also reacted to the hybrid with a polypropylene component. After removal and recurrent hernias you deal with in a few months time I was tested again. The allergist I saw close to home said something that I think summed it up pretty well. He said that skin testing for an implant isn’t reliable. If you react to something on the skin he certainly wouldn’t implant that material, but if you don’t react, that doesn’t mean you won’t react when the material is implanted! Like I said, we thought I wasn’t allergic to polyester so that was the implant used for recurrences. Now that I’m reacting to that mesh too it seems that I don’t have a pure allergy but a foreign body response too!
My best!
Susan

[pinto]

@momof4, sorry to hear your mesh misfortune. Let me ask you as you might know: Can’t we be tested for allergic reaction to mesh in advance?

[Momof4]

Jon,
I hope you find the right surgeon for your situation. It is a very complex issue for sure. I’m wondering why you had a mesh removal recently and didn’t have the hernia repaired then. Was it not present at the time of removal? If you are pleased with Dr. Chen, why are you looking for another surgeon? If you had a problem with mesh the first time around I think you should be very careful about another mesh repair! I had polypropylene mesh removed due to reaction that was thought to be allergic in nature only. After 4 months and 4 new hernias, I had polyester mesh inserted and am having same, plus some, issues with this mesh. I have foreign body response in addition to allergies. You mention that you have psoriatic arthritis which is autoimmune in nature. I’m pretty sure someone with allergies and/or autoimmune disease should not have mesh implanted due to high risk of rejection or reaction. I agree with Herniahelper about Dr. Towfigh! She is the most comprehensive hernia specialist that I’ve seen and I’ve seen a lot of the top specialists! Also, if you have a problem, she will not abandon you until the problem is resolved! Best wishes on finding the right doctor for your current situation and keep us posted!
My Best,
Susan

[paul]

I had my bilateral inguinal/femoral hernia mesh REMOVED by Dr.Chen on 7/28/21. the mesh was implanted here in bend oregon by dr mastangelo June, 2019. pain was killing me for 2 years. I found dr chen after research on removal docs and chose him for initial consultation. he assessed what he suspected was the issue, mesh folded/clamshelled, he ordered a new MRI to be sent to him so he could see. had video conf with him 4 weeks later and he showed me the MRI and described it as riding too high and possibly folded/clamshelled, but tough to discern w/o seeing first hand. scheduled robotic surgery. another pre-op conference went over all risks and procedure itself. I’m 5 weeks and 2 days out from removal and while sore from removal in abdomen, all mesh was removed, no nerves cut, swelling down 90%, a little testicular sensitivity, but diminishing incrementally weekly. all this to say that I am very happy thus far with dr chen. yes, he has a very small waiting room at UCLA, smaller given seating restrictions courtesy of COVID. he is very friendly, down to earth, comprehensive in his description of what he believes may be the issue, is not a zealot for mesh although he does use it, can do non-mesh, but depends, uses robotic, although probably does laparoscopic as well, he’s head of the Lichtenstein Institute there at UCLA, covered under Medicare and BC/BS if that’s an issue. fyi, I’m 68, and have been dealing with Psoriatic Arthritis for 5 years as well, so my recovery may take several more months before I can jump on my road bike and train for the TDF! hope this helps.

[Herniahelper]

Personally I would skip Dr. Harris. While he is a thoughtful and very experienced surgeon I sense he feels there are others more specialized in hernia repairs and revisions than himself and that people would be better served seeking the advice of those experts.

Dr. Chen runs a very very busy clinic. The waiting room is packed tight with patients in very rough shape. I did not feel as though he had the time to think specifically about my case. I got general big picture statement doing a very brief interaction. I got the impression he would just sort of figure it out in the OR.

The person whose name I think you really should consider that is conspicuously absent from this list is Dr. Towfigh. I traveled around the country, I saw many of the big names. Out of all of them she was the only one who examined me carefully, listened to me, reviewed my imaging and spoke to me about my problem in a way that demonstrated any understanding of it.

I don’t know what her outcomes are like, or how they compare to the others on the list. If I could turn back the hands of time she would be my choice for primary or remediation.

Personally I would not get hung up on prestige. It doesn’t correlate with good outcomes.

Shouldice has an excellent reputation for good outcome under certain circumstances. If they think that you are a good candidate for their repair, go for it.

I think in experienced hands laparoscopically people are having great outcomes too.

I know many incredibly active people that have had both open and laparoscopic mesh repairs and have absolutely no problems.

To a degree it’s a roll of the dice. Try to find someone who has operated on someone you know, that is similar to you, and has had the outcome you want. Some surgeons have no complaints from their 60-year-old patients but all of their young ones are getting them redone elsewhere.

[Jon]

My key criteria for reputation are: 1) patient satisfaction, and 2) respect among their peers. I’m not so concerned with which procedure they use in this particular post, just those two things. I feel that two surgeons can perform a particular method, with one doing it very well, and the other perhaps not so well. There are potentially a lot of criteria one could consider that are very contextual, down to the the patient’s own medical history, the surgeon’s beside manner, etc. But it is a legitimate point to make about a surgeon who has a financial interest, as they may steer the surgery in that direction.

[Good intentions]

What are your criteria for reputation? You’ve covered quite a range of methods in your list, from open pure tissue to open mesh implantation to laparoscopic mesh implantation.

The last name is interesting. He is an inventor/entrepreneur. Beware of people who have a vested interest in seeing a product sold. Cognitive bias is a powerful psychological force.

https://surgery.ucsf.edu/faculty/general-surgery/hobart-w-harris,-md,-mph.aspx

https://surgicalinnovations.ucsf.edu/spotlight/innovator-profiles/hobart-harris,-md,-mph.aspx