drtowfigh
Forum Replies Created
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This is true. Some times genital branch neurectomy can cause hanging of the testicle. It’s not 100%. It may be closer to 1-2%, as the original Shouldice technique and others routinely cut that nerve.
The treatment of the hanging testicle, however, is not orchiectomy. It’s a cremasteric pull-up procedure, where the muscle is pulled up and sutured to the pubic tubercle. I would question any plan for orchiectomy.
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Great hour with Dr. Sheen today. Thank you to all who participated. We discussed groin pain, sports hernias, how to evaluate and treat them, use of MRI, use of mesh, mesh complications, mesh reactions.
If you missed it, you can watch it and share from my YouTube channel: https://youtu.be/VTaT4j3zWv8
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– mesh migration can happen. It’s not common.
– Shouldice does not operate on non-obvious hernias, which are more often among women.
– pregnancy does not cause hernias. The straining with labor can exacerbate a hernia. Most groin hernias do not recur due to pregnancy, but umbilicals may.
– laparoscopic repair is the preferred technique for women with inguinal hernias. -
I hope many of you were able to join us on HerniaTalk tonight. It was super informative. We discussed every thing you need to know about the prostate and how it can affect your hernia and what to do about it. We also dispelled some myths about hernia surgery and the prostate.
Watch and share the session on my YouTube channel: https://youtu.be/HYSCDAWhRao
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Happy to review your new situation via a consultation.
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I don’t understand the question. He’s on my list as surgeons who can offer Shouldice and other tissue repair options. The statement on his website doesn’t contradict that.
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Correct. The Shouldice clinic limits its repairs to small to medium sized hernias in normal weight patients, mostly male.
A tennis ball size is exactly that. If you stand and the hernia is extending well into the scrotum and is larger than a tennis ball size, then tissue repair is not recommended. There just isn’t that much normal tissue to sew together.
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That is correct. I do not transect the cremaster muscle or transect any nerves as part of the modified Shouldice technique.
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Have to make sure the racks are the cause. I inject the area of the tack. If the pain goes away, then you know it’s the tack. Tack pain is very specific at one area.
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That’s great to hear! Dr Toyama was a few years ahead of me at the same surgical residency at UCLA. He is an asset.
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Let’s keep the Discussion civil without personal attacks. Anything less is not fruitful and is counter to the spirit of this forum.
If you have had a great outcome, that is expected, and is the outcome for the majority of patients. It’s important to share positive stories alongside any problems you may have. For the benefit of the forum participants, feel free to share the name of your surgeon.
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Great in-depth discussion with Dr. Jason Snibbe, orthopedic surgeon and hip specialist. We went through the details of how to differentiate between groin pain due to a hip disorder vs an inguinal hernia.
You can watch the whole hour here: https://youtu.be/rj_9S6JR7ks
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I understand what you’re saying. It’s very possible that our data is flawed. We cannot test what we are not measuring. Before mesh, postoperative chronic pain was not tested. It wasn’t until the 1990’s in the US that pain was considered an important vital sign. (This practice is partially contributing to the opioid crisis, I should add!)
Your experience is one scenario. I know and have treated many with the opposite experience: Shouldice repair at the Shouldice clinic vs laparoscopic with mesh and they did better on the lap side.
This just proves that everyone is different AND every surgeon has different outcomes.
It’s often frustrating For patients as we don’t have the perfect answer for them. Some, such as Dr Ramshaw, devote their life to figuring out the puzzle. It’s complicated.
As a Hernia Society, the best recommendation we give is not to choose the technique but to choose the surgeon. A skilled surgeon will always give you the best outcome possible.
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Thank you so much!!
I agree it was a jam packed session full of information about IBS, SIBO, FODMAP diet, diarrhea and other problems seen with hernias, chronic pelvic pain, #endometriosis, etc.
If you missed it, you can watch it here: https://youtu.be/D2B7tnP0N20
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As you know, nothing is perfect in medicine. The complications of tissue repair would involve neurectomy, pain management, and probably need for mesh repair in a revisional operation. My point is that it is not a benign pain-free perfect repair. There is a reason why we moved to mesh—-because the results from tissue repair were not good. I have a book with hundreds of tissue repairs described. Many failed. Some of the same tissue surgeons (eg, Nyhus) moved to mesh because their tissue repair options were not satisfactory.
I do believe we are over using mesh. There are plenty of patients who would do just as well if not better with a non-mesh repair. But we don’t have enough data to choose those patients based on hard evidence. I do it based on my own experience.
And that is why this is a complex system. What’s good for one patient may not be for the other. Bruce Ramshaw is the pioneer for this.
I just want people to understand that we are always learning because we never know the best answer.
And as for the ACHQC: their data is published on a regular basis.
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The round ligament is one of 5 suspensiry ligaments of the uterus, and the weakest of them.
There is no evidence that shows cutting the round ligament in anyway affects the uterus or pregnancy.
I am very interested in this topic as I treat a lot of females. I’ve queried scores of specialists in obstetrics, gynecology, Urogynecology, female urology. All supported round ligament transection with no negative effects.
The purpose of transecting the round ligament is to reduce hernia recurrence, as it results in a flatter hernia closure or patching.
As with any surgery, there are risks. The surgeon must be aware of the anatomy and prevent nerve injury.
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Just want to remind patients that non-mesh inguinal hernia repair is not a benign operation. There are risks with it as with any other operation. And also that there is risk of chronic pain after tissue repair, such as Bassini.
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Sorry to hear about everyone’s pain after tissue repairs. It just goes to show that non-mesh tissue repairs also can result in chronic pain. And all surgery has its set of complications. It’s one reason why we recommend watchful waiting until the risks of surgery are outweighed by its benefits.
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What is the question?