drtowfigh

Nice idea.

Any particular times that work best? I may experiment.

That’s helpful.

I looked Into Zoom. It seems to be better for face to face live discussions with patients. And everyone can watch it too. Thoughts?

Wow. Likely your surgery is canceled. But odd that no one contacted you. We are not expecting to be able to offer elective surgery until May at the earliest

Make sure they remove ALL the mesh. Many surgeons leave mesh over dangerous areas (eg, Major vessels). To truly address ASIA syndrome, all the mesh must be removed. If they are too afraid to take off some mesh, then they should have a surgeon do it who feels more comfortable with the anatomy and operation.

1. In my experience, ASIA syndrome and mesh reactions tend to occur early, ie, weeks to months after surgery, not late (years. That said, this remains a poorly understood problem. Note that the syndrome involves multiple systemic reactions, not just brain fog.
2. Regardless, with regard to robotic mesh removal, the only nerves that can be…[Read more]

My take:

OPEN WITH MESH
Pros:
– can be done under local anesthesia with sedation. Ie, no general anesthesia.
– allows for plication of tissue in case of direct hernia.
– allows for reconstruction of giant inguinal hernias with complete pelvic floor blowout
– cosmetically hidden scar in hairline
Cons:
– mesh interacts with spermatic cord and can…[Read more]

Watchful waiting has been studied prospectively for up to 10 years. The risk of needing emergency surgery was 0.18% per year. That’s a very low number, and thus watchful waiting is considered safe in men with asymptomatic or minimally symptomatic inguinal hernias.

– unfortunately, many use the term “hernia specialist” as a marketing ploy and are not true specialists.
– in Crohn’s disease, make sure the mesh is never place inside the abdomen (intraperitoneal). Otherwise, it should be fine. But I agree with @drbrown that I would prefer a non-mesh repair in patients with Crohn’s, if possible, to reduce…[Read more]

– tissue repair is also on more tension than before the repair. You are closing a hole between two potentially weak tissues. There are ways to reduce the tension and muscle does stretch.
– mesh shrinks 10-25%. ePTFE mesh shrinks 40% and most surgeons don’t use that die inguinal hernias. Yes, if placed loose to allow for that shrinkage, a m…[Read more]

Has nothing to do with cost cutting. My feeling is that surgeons and other doctors need to talk to their radiologists more.

Then perhaps you should change doctors. It’s your privilege to be treated by someone with whom you’re comfortable. Doctors are real people and so they have a wide variety of personalities and attitudes just like any other person. If you find a doctor that you don’t like or trust, then change doctors. There is no reason to suffer.

Thank you for sharing.

Please share the surgeons’ names on this forum.

This is great. Thank you for sharing. Please let Dr Weise know that we would love to have him as a contributor to this discussion forum. His expertise would be helpful to share.

The Shouldice clinic recommends cutting cremaster muscle and resuturing it up to the repair. They claim it reduces hernia recurrence rates. Most of us don’t completely cut the cremaster muscle.

If you have an enlarged prostate, the straining to urinate or completely empty your bladder is a big factor to worsening your hernia and may c…[Read more]

No effect.

In my opinion, Imaging is a must to help figure out why patients have pain after hernia repair. Examination cannot determine if there is a folding of the mesh, a fluid collection, bladder involvement, etc. To surgically explore without a plan of action, in my opinion and experience, is not a good idea.

Get a third opinion.

I’m glad someone published this in family medicine magazine. Because they have little insight as to what we surgeons do as surgeons and how the operations we perform (of any kind) can contribute to the symptoms of the patient.

As I’ve written before, Imaging is often misread by radiologists and non-radiologists rarely look at images the…[Read more]

🙏🏻