Why is Dr. Reinhorn never mentioned on this forum?

[Chuck]

He specializes in open mesh surgery but places mesh in the posterior position. As I understand it this is where mesh goes in a lap repair but he does it open. Wouldnt this require a signficant and deep incision? But he claims that his patients recover without minimal pain in just days. I have never seen a negative review for this surgeon and there are lots of reviews. Yet he is never discussed here. His approach gives you the best of open and lap surgery but maybe the mesh he uses is smaller than lap mesh? Any thoughts on this procedure Watchful? I am surprised that you did not consider this given the size of your hernia. I know Reinhorn says he wont take patients outside New England…but there are ways around this –Air BNB or just tell him you would pay cash. The quality of reviews is the best i have seen for any surgeon. Almost every patient says they were doing calisthenics within a week of surgery. He does shouldice too.

[Chuck]

looksd like reinhorn uses the same huge pieces of mesh that are used for lap surgery

[miner]

I had a shouldice repair done by him. He and is staff are very accommodating and very knowledgeable and go out of their way to help you. He was also genuinely nice. That may be some of the reasons for no negative reviews. Unless your seriously screwed up you probably would just not leave a review. I’ve been happy with my repair no pain feels rock solid. I had another medical issue come up several months later with something in my abdomen all the specialists said it wasn’t related to the hernia surgery. Reinhorn was happy to review my MRI months later even though the problem was unrelated to the hernia operation. Although maybe he just wanted to look at his repair. But that gives you an idea of there responsiveness. I technically live in New England but was like a 4 hour drive, he expressed a lot of concerns about me sitting for so long to get home. I took literally no pain medication after the surgery. Allergic to NSAIDs can’t take tylenol because of a liver disorder and never asked for narcotics. Used ice only. The dude knows what he is doing. Enough of my ramblings.

[Chuck]

Miner thanks so much for posting. Agree Reinhorn seems like a good guy…curious why you went to him for a shouldice though. Even he encourages people to go to the shouldice clinic. I think he has done maybe 300 total…the number that a shouldice surgeon might do in half a year.

[miner]

He said he does about 100 a year of shouldice surgeries. Don’t know how many he has done total. He indicated he does more each year. He instilled a lot of confidence in his ability. I also liked his attention to detail, he originally was a engineer. I could tell. Pretty sure shouldice clinic would not have touched me with a ten foot pole. While I’m skinny and fit I have some strange allergies, genetic issues, and an anesthesia risk. Most Dr’s get very skiddish when they start looking at my medical file. He did not, just saying it will take longer to schedule no big deal. I also talked with Dr Thomas he scared the crap out of me i would not trust my dog with him. And of course a local surgeon who claimed mesh is the gold standard blah blah.

[Watchful]

miner,

Congratulations on the good result!

Did Dr. Reinhorn cut your cremaster and genital nerve branch?

[Chuck]

Thanks miner….do you mean dr Tomas at the desarda clinic in florida? Why did he scare you. Tomas says desarda technique is least associated with chronic pain…and shouldice is a overly invasive technique. I heard he is kind of scummy…checking out other patients wives….i know that may not have a bearing on surgical ability…but still leaves a bad taste

[miner]

To my knowledge my cremaster and genital nerve branch were not cut. There was no mention of them being cut in the surgical report.

Yes I mean Dr Thomas in Florida. He seemed very unprofessional I had video call with him. He was in shorts with his shirt half open outside during the call. Appeared to actually be drinking an alcoholic drink, but I could be wrong about that. I had asked him to review my ct scan which he immediately said you cant see a hernia on a ct scan, this after I sent it. Two other doctors could see it Thomas refused to look at it. Said I needed an ultrasound. My hernia was small and I had concerns over him not being able to find it. The ct scan was for something else but the hernia was visible in it. He also rambled on and on about useless garbage that didnt pertain to my hernia.

[Chuck]

Thanks miner…good to know…i have heard nothing but bad stories about him. If i wanted a desarda i would go to germany or india…i just dont know enough about whether a Desarda is a solid repair…Kang and others have me scared of shouldice…but its the repair the surgeons go for. I wish i had met the folks on this forum before my disastrous mesh decision. Its still would have been very hard to trust forum members over doctors…who all said mesh was totally safe….and lap was least risk of chronic pain…how did you see through all the BS to make the right decision,…kudos to you…i looked at it hard…just thought all the cutting and sewing would ruin me forever

[David M]

Here’s a video with Reinhorn. His section starts at about the 17 minute mark and he talks about the cremaster and genitofemoral nerve shortly after that. Apparently, he does do it as part of the original Shouldice.

[miner]

I suspect he followed whatever was done at the Shouldice and Im just not understanding my surgical report it uses big words instead of cut here and there. He seemed like a very meticulous individual and suspect he followed whatever was done at Shouldice.

[drtowfigh]

Dr Reinhorn’s mesh based repairs are similar to the original Kugel patch description. We also call it TREPP (trans-rectus pre-peritoneal)

[Dr. Michael Reinhorn]

Based on my experience of over 5,000 hernia cases, I have developed an interest and expertise in inguinal hernia surgery and anatomy. This has resulted in me traveling internationally to learn new and sometimes better procedures than the standard operations offered today. Based on my training as an engineer and a surgeon, I know that posterior mesh placement results in the best outcomes for patients, followed by non-mesh repairs and finally anterior mesh. Mesh plugs in particular as well as mesh in both the anterior and posterior layers have been quite detrimental to patients with inguinal hernia. Below are links to our published work and a surgical calculator that we developed to guide patients as to how we think about which operations may be best for them. We practice individualized care, which is why we have various surgical options for inguinal hernia repair. There is no substitute for a consultation with an experienced hernia surgeon.

Comparing TREPP to Lichtenstein
– Full Paper
Comparing TREPP to TEP,TAPP,rTAPP – Full Paper
Comparing TREPP to Shouldice – Coming soon
Hernia Surgery Options Calculator for BostonHernia

While we were committed to caring for our local community during the covid pandemic, we have returned to seeing patients from all over the country. For those traveling and looking for a concierge level of service, we are now happy to offer this.

[drtowfigh]

Welcome to the Forum, Dr Reinhorn! I hope you can provide some guidance to our participants.

[Good intentions]

Looking forward to the Shouldice study. Is there a thought on when it might be published? Also, can you describe your Shouldice method? Is it one of the “modified” methods or does it follow the original path? I posted the link to your “no-mesh” page below, showing that you’ve been to the Hospital, but not mentioning the details of your method.

https://bostonhernia.com/education/no-mesh-hernia-repair/
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The TREPP method does seem to make a lot of sense. But, of course, it is still limited by the choices of similarly problematic mesh devices. As far as anybody can tell all of the synthetic meshes on the market today cause problems in the body. Do you have any data showing a difference between the types of mesh as far as quality of life of the patient? Have any of your patients had a “mesh reaction”? Could you tell forum members what brand and type of mesh that you use?
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I also noticed something in the Options Calculator that doesn’t seem right. A five foot tall ten year old boy weighing 145 pounds has TREPP mesh or lap mesh recommended as the repair methods. My understanding is that mesh is contraindicated in any young person who is still growing, Typically through the teen years. Certainly a ten year old should not be getting a mesh repair.
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Thank you for contributing. It is a tough time to be a hernia repair surgeon.

[Dr. Michael Reinhorn]

Some quick replies to all the above questions and I will add more in the coming months:

A TREPP/OPP in my experience is less invasive than a lap leading to better short-term and equal long-term outcomes. Only the external oblique is cut and there is no other cutting. Please read out papers if you need more details or data.

I do a 4 layer Shouldice as described here. The differences from the original are:
we use polypropylene sutures instead of stainless steel, dissolvable sutures for the skin, and send patients home the same day. I consent patients to have mesh if I find the primary hernia is femoral given a high failure rate for femoral hernias without mesh, or if tissues are not adequate for the repair. This happens about 1% of the time.

My engineering brain tells me that Desarda is just a Lichtenstein but with natural tissues, so likely to have higher failure rates over time and ignores a femoral in 1-3% of cases. Shouldice hurts more than posterior mesh, is a beautiful, elegant repair that has been around for 75+ years. I spent 48 hours there learning from Drs Bendavid, Shouldice, and several others in the operating room. I also learned the workflow, quality control, and business model. I love performing and teaching it.

I hope this helps. I will chime in more in the coming months.

[Dr. Michael Reinhorn]

And one more thing – It’s great to be an inguinal hernia specialist. I continually learn new things as I try to get better. Through publication and teaching, I hope to teach more surgeons the anatomy that I learned after my formal training. I am hopeful that we will be able to reduce or almost eliminate chronic pain through surgeon education. While the focus has been the mesh itself, I’ve used the same product (ventrio ST) for the 15 years with very few instances of chronic pain.

[Dr. Michael Reinhorn]

Thank you for the comment on the surgical calculator. It was never designed for kids since I don’t treat kids – but I added a line to our disclaimer. It’s a rough guide to how we triage. It’s far from perfect. Since every patient is different, we tailor the care to what we feel are the best options for the patient after we examine them.

[Good intentions]

Thank you for the reply Dr. Reinhorn. I have not seen anyone talk about using Ventrio ST for inguinal hernia repair before. Of course, “Ventrio” refers to ventral hernias.

Here is some information about it for anyone wondering.

https://www.bd.com/en-us/products-and-solutions/products/product-families/ventrio-st-hernia-patch#overview

And here is something about the absorbable coating.

https://static.bd.com/assets/product/Documents/Surgery%20(SU)/sepramesh-ip-composite-product-brochure.pdf

[Good intentions]

This document seems to describe the qualities of the material better.

https://www.henryschein.com/assets/Medical/1242427.pdf

[Author]

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