You never hear this about tissue repairs but…

Hernia Discussion Forums Hernia Discussion You never hear this about tissue repairs but…

  • This topic has 13 replies, 8 voices, and was last updated 1 week ago by Wim.
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    • #31540
      Chuck
      Participant

      my mesh repair was a disaster…and in looking back on how i came to a decision to use mesh…,i found that the decision was a lot tougher than i thought. I kept reading about successful tissue repairs where the patients were still having pain and weakness years after the repair…one woman said when her dog pulled her desarda repair would hurt for a few days…another shouldice patient said…he could feel it every time he lifted weights years after the repair…i found many many stories like this. I also found some studies that suggested the tissue and mesh repair recurrance rates started deviating significantly after five years…with tissue recurances spiking while mesh held steady….peterson and kang etc. all quote low recurrance rates…but what does that even mean?? they are not tracking these rates long term…a few years at most…how could they do otherwise…my mesh repair was a disaster…and when i try to beat myself up about choosing mesh…i return to my original notes…this was never an easy decision at all

    • #31541
      William Bryant
      Participant

      Definitely not an easy decision.
      I’ve been reading comments on a hernia group, some are fine with mesh, some in bad pain, some won’t even consider mesh.
      Then theres variation in the failure-complication rate in different studies.

      You did what we all do put faith in the surgeon and method that many say is the “gold standard”. Not your fault at all.

    • #31545
      Watchful
      Participant

      The rates of problems with both mesh and tissue repair seem fairly small, but non- negligible. This is the reason some of us postpone the surgery, and do watchful waiting as long as we can. At some point, however, you do have to do it and play the Russian Roulette. It’s extremely hard to say what method is less risky, and there don’t seem to be very reliable statistics.

      My dad had tissue repair for an inguinal hernia, and the hernia recurred years later. Is that counted in any studies or statistics? Nope.

      I’m just watchful waiting for now, but I know I’ll have to fix it soon. I’m leaning toward going with either the Shouldice Hospital or Dr. Kang. It’s an indirect inguinal hernia, and it seems that Dr. Kang’s approach is somewhat superior for that.

      • #31571
        Wim
        Participant

        AFter tissue repair I guess you need to change some habits, e.g. “Inguinal hernias can sometimes appear suddenly after putting pressure on the abdomen, such as straining on the toilet”, so the doctor I visited told to put always counter pressure while “watchfull waiting” (also to the side that is still ok). You never find any info how a re-occurrence happened in literature.

    • #31547
      Good intentions
      Participant

      The most powerful reason to get a pure tissue repair before a mesh repair is what Chuck is experiencing right now. If Chuck had gotten a pure tissue repair and had a recurrence he could very easily go and get a mesh repair. But, because he started with a mesh repair now he has to find a way to get the mesh removed and make a new choice of how to repair the hernia, and hope that the mesh itself and its removal has not caused lifelong damage.

      No surgeon has tried to argue against this logic. The surgeons who implant mesh are gambling with the patient’s welfare that the patient will not have mesh problems. They know that mesh problems are very very difficult to solve. The honest ones will admit this. Others will “pooh-pooh” the mesh problems as psychological or signs of a weak personality, or talk around the problem without really addressing this fact.

      A pure tissue repair as the first choice for hernia repair is the safest and most sensible choice for any person with a typical inguinal hernia.

    • #31548
      Watchful
      Participant

      I mostly agree, although I don’t know enough to be able to say how easy it is to go back in and fix any issues with tissue repair. Also, if you want tissue repair, you have VERY few options out there.

    • #31550
      Chuck
      Participant

      uh good intentions…you made the exact same mistake with bilateral ingunial mesh,,,,saying chuck did x or y…you could use yourself as an example

    • #31553
      Good intentions
      Participant

      That’s why I’m here Chuck.

    • #31562
      Jack
      Participant

      My 2 cents, as someone who’s done research but has still been too anxious to get surgery. Every method has some risk of complications most notably pain. A strong argument for tissue repair (assuming you have low enough bmi), is that it doesn’t “close a door”, if it recurs your can always get a mesh repair later. Personally if I had unilateral hernia (which I don’t) I’d probably lean toward traveling for a tissue repair, knowing that the recovery will be harder than lap. But that decision could be harder with bilateral hernias or if your personality is very anxious (as mine is) and you want to recover at home. I personally don’t think it’s dumb to get a lap/mesh repair, but what is really key is to find the best possible surgeon, one who specializes in hernia and is well respected by peers. Some high volume surgeons are also apparently the same names who show up on patients later needing mesh explants, so volume itself isn’t enough. One thing that’s hard as a patient is to know the doctors skill and outcomes. It’s a hard choice. I know I’ve struggled with it.

    • #31564
      William Bryant
      Participant

      The anxious bit, totally understand that. Plus I hate travelling… But I am going to force myself to. Eventually!

      Not sure how long I can go on as I get odd sensations now.

      What would make you get surgery? Worsening symptoms?

      Very sensible comments, especially about choosing surgeon. Thats one thing patients can decide on.

      For me though, that’s making it just as hard to decide as it’s an added pressure.

    • #31565
      Jack
      Participant

      William, this is my personal take for me, not meant as advice of anybody, and not sure it’s even right for me:)

      Physically I think it’s time for me. I know the risk in incarceration is low but I’m starting to feel discomfort. Last week’s hernia talk live was all about watchful waiting, and the expert (Fitzgibbon?) made the comment that when you can only play 9 holes of golf rather than the 18 you normally did, it’s time to fix the hernia. That’s me.

      The bigger thing for me is mental. I went deep down this rabbit hole of research, scientific papers, Dr consults, and social media. I took it too far and catastrophized something that for most people, especially with a good surgeon, has a good outcome, and frankly it has been a big negative on my quality of life being so anxious and ruminating on hernia so much. Bad outcomes are very real and can be horrible, and obviously if you’re in the (making a number up) 6 percent of people who get a bad outcome that outcome is 100 percent for you. So personally I need to get to a place mentally where I can feel good about a doctor, and where even though I will be nervous and scared, I will have some feeling of being at peace with the surgery and be able to visualize a positive outcome. Honestly I think the surgery and healing will be better that way. That may sound like mumbo jumbo but that’s where I am.

    • #31566
      Mike M
      Participant

      One thing to “debunk” – “low BMI” is not a requirement for pure tissue repair with a reputable doctor practicing a sound tissue repair method. Every top notch doctor from Kang to Grischkan will operate on patients outside of the ranges indicated by facilities like the Shouldice Hospital in CA. The Shouldice Hospital uses doctors you cannot select as well as have trainees assisting major parts of the procedures which makes sense as to why they want to cherry pick their patients. Additionally most facilities that put those restrictions in place will not properly test BMI correctly using proper equipment either. Half of the incredibly low BMI athletes in the world wouldn’t qualify by the Shouldice Hospital CA own metrics of height / weight. Shouldice Hospital has great results from certain specific doctors in their reviews and they should considering their restrictions. However some of their other doctors at the same facility have not so stellar reviews regardless of the patient meeting their “criteria”.

      Additional BMI can complicate the surgical field but an experienced surgeon can still provide a solid repair without complications regardless. This is within reason of course. You don’t want to go into a place morbidly obese and expect the impossible. That is not going to work either.

    • #31567
      William Bryant
      Participant

      Mike M, what a coincidence, I was looking at weight/height chart for hernia repair on Dr Sbayi site (hope I have name right it also has a good easy to understand resume of hernias and repairs by the way).

      What I found interesting was according to that site/shouldice I’m within ‘good’ weight but according to nhs bmi (not hernia related granted) I’m at ‘bad’ end and would need to lose a stone and half to be in the excellent range. Bizarre really.

    • #31570
      MarkT
      Participant

      As Mike M mentioned (and has been widely discussed elsewhere) BMI charts are not appropriate for use with all populations.

      Shouldice does not adhere to the chart as gospel, so no one should be scared off from going there if they don’t fit neatly into one of the categories unless they are very obese. Shouldice will indeed ask people who are overweight/obese to lose weight before they will operate, but someone whose BMI deviates from the ‘norm’ due to something other than obesity (like being an athlete) is not going to be turned away.

      A note on bad (and good) reviews…beware comparing the raw number of reviews between surgeons without adjusting for volume and timeframe. Two surgeons might both have the same number of bad reviews, and yet one has performed 10x as many repairs overall, for example.

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