William Bryant
Forum Replies Created
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Hello Ash, in afraid I dont know enough about that hernia, but you could search this forum using Spigelian.
Dr Towfigh will be best to answer I’d think but she does post regularly as surgeons tend to have loads to do! But she may have some answers for you when she does
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Yes Dave And Ajm, and also if they are improving Watchful.?
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I think it may have been a pantaloon hernia. It’s of interest to me because of the mixed diagnosis I’ve had with my ultrasound saying direct yet every consultant, and I’ve seen 3, saying indirect by touch/cough etc.
The consultants say it doesn’t matter as surgery is same regardless???!!!
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Thanks Freeman for the information and glad to hear it’s gone well. Did you know it was one direct and one indirect before you got to Dr Wiese?
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If, and it’s a big if, as I’m not best on deciphering these studies, I am right it’s saying laproscopic has higher rate of recurrence, indirect at least.
Again I thought consensus was the opposite.
So if its more likely to cause chronic pain (Dr Sadler) and likely to recur (Shouldice), why do popular?
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Very best of luck Oceanic. Hope everything goes really well for you and if you can post how it went and type of repair, when you’re up to it.
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Thanks Oceanic. Slight difference. I’m thinking maybe Dr. Lorenz is between those two prices.
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Harry, I think the oxford surgeon wasDr Sadler. It surprised me that he held that view as I thought the consensus was lap lead to less chronic pain. What’s perhaps just as surprising, if not more so, is that there seems to be no conclusive studies.
It’s reminiscent of the surgeons who saw the damage causes by mesh and went back or turned to tissue repair.
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Costings! Can anyone help with how much the various German centres charge approximately…
Biohernia
Dr Conz
Dr Lorenz
Many thanks
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Good luck, LC, most posters are reluctant and hesitant about mesh so you’re in good company. Your earlier repair backs up the experience my colleague had who had a non mesh repair years ago then spent working life lugging tvs and videos around. These were heavy at one time. Very.
Could you ask about your medical records to see what the old repair technique was?
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Hello Pinto… Yes I write a lot but say very little!!! I know! It’s a ‘gift’. But it is good for insomniacs I suppose.
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Are there any reasons for each method?
What would be the decision process between Shouldice, Bassini or Marcy for example.
That would be really helpful to those who are facing just such a choice – and who have not had benefit of medical training or experience.
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I just type really fast! Posts might be semi literate, unintelligible and riddled with errors but not been timed out – yet.
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Wow that surprises me. You’d certainly think it was possible to compare the two fur chronic pain. Can this not be done even in countries that have registers?
It’s a very lax approach really in my opinion.
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No offense taken Good Intentions, it isn’t the mesh options I was interested in. It was the Bassini description and his quote about it being stable and satisfactorily used for 100 years that were salient to the thread I felt. I did try to direct people to the menu button, select info booklet and it opens that pdf. That’s where all the stuff about chronic pain is.
I’m not pushing the doctor or his mesh strategies. Out of interest I thought convention was laproscopic was less likely to lead to chronic pain. (This surgeon doesn’t think so which is interesting, not that I’m considering mesh).
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He also says I relation to chronic pain… whether open or keyhole, “mesh or no mesh, there is always a potential to develop long term pain after the surgery. We will take all possible steps to try and ensure that this does not happen and if it does, we will endeavour to try and remedy it for you. However, despite all these efforts a very small number of patients will have pain that proves difficult to remedy, it is an unfortunate rare longterm downside of hernia surgery”.
I did notice the mention/praise of one type of mesh… I understand he is very pro mesh but it was really the quote about Bassini being the standard repair for a century claim that was interesting in the context of this thread. I thought so anyway.
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There’s quite a lot on chronic pain Good Intentions…
” Putting tension on the inguinal ligament through stitching this up to the muscle (the Bassini Repair is a tension repair) may also lead to this problem. Neuralgia Another cause of chronic discomfort can be chronic pain from dam aged nerves. The nerve may be caught up in scar tissue or the nerve may have been cut and the raw end form a neuroma (a swelling on the end of the nerve) or the nerve could get caught with a stitch (this is potentially one advantage of not stitching the mesh in place). Experience, careful surgery and attention to identifying nerves during the procedure will help reduce this problem. Neuralgia is less common but more difficult to treat than osteitis pubica. It may respond to one or all of the following; steroid injection, reoperation and dividing the affected nerve (neurectomy) or very rarely actually removing the mesh. Mr Sadler is not aware of any of his patients ever requiring mesh removal. To try and reduce the chances of chronic pain we favour the use of a mesh that requires no stiches to hold the mesh in place, this has both the advantage or performing a tension free mesh repair and avoids potentially catching nerves with stitches. However, we still have pa tients who have discomfort that comes on after surgery (usually os teitis pubica) this appears to be about 2% of inguinal hernia patients. It still means that most patients don’t have any problems at all with a mesh repair. Chronic pain after umbilical, epigastric or femoral repair appears to be rare. If you develop chronic pain, then obviously Mr Sadler will be happy to see you in clinic to discuss treatment options. “.
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Greg Sadler oxford clinic on chronic pain
” Chronic pain or discomfort can occur after hernia surgery. The most common cause appears to be inflammation around the attachment of the ingui nal ligament to the pubic bone. The area becomes very tender to touch and the condition is called osteitis pubica. It is possibly caused by scarring around the inguinal ligament (coloured orange in the figure) causing tension on the ligament, result ing in a ‘traction injury’ to the bony attachment of the ligament (very similar to ‘Tennis/ Golfer’s Elbow’). The discomfort often doesn’t start for 39 months after surgery and prior to this everything can be fine. Patients are usually aware of an initial slight discomfort, sometimes in certain positions like driving or sitting, often walking around or standing up straight relieves the discomfort. There is no associated lump or bulge. The discomfort is often similar to the ache patients had from their hernia in the first place and they may worry that the hernia has come back. The good news is that the problem is usually fixable through a com bination of a small steroid injection and massage (much the same way that Tennis Elbow can be fixed). If the pain is not relieved, then a second injection may help and in very rare cases it may be necess ary to release the attachment of the ligament off the bone. This problem still exists with ‘no mesh’ surgery and may actually be more likely because of the increased ‘tension’ in the repair. Having a ‘nomesh’ repair will not remove the chances of having chronic dis comfort. Surgeons performing the Bassini Repair were often taught to put the first stitch through the bone to secure the stitch, so osteitis
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Here is the praise for Bassini and a mention of chronic pain, Good Intentions… Bassini was the ….
“standard way of fixing an inguinal hernia for the next 100 years until the “tension free mesh” technique was shown to be more effective in reducing recurrence rates. Any operation that we perform for over 100 years must be a good one! There are many people walking around with Bassini Type repairs that they had performed many years ago and we are happy to repair your inguinal hernia with this tech nique. However, having a Bassini Type repair without mesh will not remove the possibility of chronic post op pain and the chances of your hernia returning are significantly higher. This is possibly more likely if you have a direct hernia”.
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https://www.sciencedirect.com/science/article/pii/S2405857221001066
More about Bassini efficacy