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All public hospitals in the Philippines provide hernia surgery options.

For a specialist, consider my colleagues Dr Jose Macario Faylona.

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Regardless of technique: lap, open, mesh, non-mesh, the hernia sac and its contents must be reduced. Traditionally with open surgery, the redundant portion of the sac is ligated. Dr Amid suggested the act of ligation (cut and tie) of the hernia sac (peritoneum) is unnecessary and may contribute to pain after hernia repair. In laparoscopy we almost never ligate. We just reduce the sac.

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Yes

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Dr Ramshaw is among the pioneers of laparoscopic ventral hernia repair. His practice slowly evolved into treating patients with chronic pain and mesh-related problems for both ventral and inguinal regions.

He is currently on sabbatical and it is not clear when he will start treating patients.

With regard to the % quote, it may very well be true that in your surgeon’s experience, their recurrence rate is 30%. These values are very surgeon and technique and patient dependent. To use your home construction analogy, it’s like asking what’s the square footage of the house you build? An average square footage may be provided, but the real number varies per builder.

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Most urologists deal with BPH. It is not a complex problem to diagnose. It Involves an ultrasound, physical examination, and a good history about how many times you have to get out of bed at night to urinate, the urinary stream flow, etc.

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I agree with Dr Brown, many of your symptoms seem incongruous with the plan of care.

– symptoms below the knee is almost never Related to groin hernia. Have they evaluated your spine?
– if you didn’t respond with pain relief by nerve block, then triple neurectomy will not help you.
– CT scan is not adequate for groin or pelvis evaluation after prior hernia repair. It does not adequately evaluate the mesh. You need MRI. That will help determine if there are issues with the mesh placement. It may also identify new diagnoses, inflammation, hip problem, spine issue, other pelvis issues.

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The point is, there are mesh options that are less likely to interfere with your autoimmune disorder and this minimize risk for mesh reaction.

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Unfortunately the Shouldice Clinic will not treat patients with occult inguinal hernias.

Some colleagues of mine In Canada May help. You may have to travel a bit. Go to the America’s Hernia Society webpage Find a surgeon tab and search for them.

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No. Collagen supplements Do not help hernias or healing. The collagen is denatured once it hits the stomach and so it is not accepted to be useful for any purpose.

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– 12-15% chronic pain after inguinal hernia repair, regardless of technique (mesh vs no mesh) at 3 Months after surgery. Any pain is considered chronic after 3 month is no matter how minor or major. This value drops to single digits at 12 months.
– Yes, thank means 85% are pain free within less than 3 months.
– not true that chronic pain was unknown. It has been reported and was in the 15-25% range. People undergoing tissue repair were routinely hospitalized in the US for up to week. It was considered a painful operation. Recurrence was the biggest issue back then. And pain was not really studied as an outcome until more modern times when recurrence dramatically reduced with the mesh repair (Lichtenstein and Nyhus repairs).
– no study has shown acceptable recurrence rates with absorbable meshes. Many studies stopped following patients after 1-2 years, when the recurrences started showing up.
– there are no studies linking use of polypropylene with cancer risk. This statement has been extrapolated from a paper which showed cancer in an area where there was a mesh infection with fistula. We know that certain chronic inflammatory conditions of the skin can cause cancer. This includes the base of some bad burns. But to claim that all inflammation causes cancer and polypropylene causes inflammation so polypropylene causes cancer is a misrepresentation. Based on that logic, all patients with arthritis (inflammation) have cancer. And of course we know there is no such correlation either.

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There is no direct relationship. Repairing one side inguinal hernia will not affect the other side.

That said, there is about a 20% lifetime chance the other side will have an inguinal hernia, as it’s a very genetic problem.

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Choose a surgeon you trust and consider multiple consultations if you need. Incisional hernias require mesh. Laparoscopic and open repairs have various pros and cons. There are a wide variety of mesh options, given your autoimmune status.

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For laparoscopic inguinal hernia repair;

Judicious tacking is not considered that much of a chronic pain risk. The risk is overuse of the tacker (Eg Use under 5 racks, not 20) or improperly placed racks (Eg in the inferolateral portion of the mesh).

Some hernias (Direct, femoral, large indirect) require some sort of fixation. That can Include glue or suture or a tacker.

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We had a great discussion and so many questions were answered with Dr. Turek. Our discussions included addressing testicular pain due to inguinal hernias and also as a complication of inguinal hernia surgery. We also discussed the issue of male fertility secondary to inguinal hernias and inguinal hernia surgery. Lastly, we also discussed risks to erectile dysfunction.]

You can watch the entirety of the video on YouTube: https://youtu.be/w6IVDSQ1-JE

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Hi all
The last Zoom link Didn’t work. I updated it on the original post and also here: https://us02web.zoom.us/webinar/register/WN_AuE4G_WzQpa-p38-QErgfA

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What a great discussion we had. Dr. Janis helped shed some light on the role of the plastic surgeon in reconstruction of the abdominal wall, tummy tuck for hernias and diastasis recti, and pros and cons of components separation technique.

You can watch the entire hour here:
https://youtu.be/ruyocXy1_zc

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Great session with Dr. Bachman. She is among the top specialists in knowledge of mesh properties. We discussed mesh choices, laparoscopic surgery, and the role of hernia specialists.

You can watch it here: https://youtu.be/d4pMOY0ma9g

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I agree with Alephy. It is a theme we have been trying to promote throughout HerniaTalk. There is no one best hernia repair. Or one best hernia surgeon. Everyone has different needs. For example, what would your answer be if you asked someone what car you should buy? Everyone’s needs are different. And every surgeon’s specialty and skill is different.

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Also, as discussed on this webinar, the European Hernia Society has some guidelines provided for patients. They can be accessed here: https://www.europeanherniasociety.eu/patient-info/umbilical-and-epigastric-hernia

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Glad you enjoyed the talk. I will be having more non-US hernia specialists. It is nice to see how different regions see different problems.

You can watch the full episode with Dr. East here: https://youtu.be/eoH_yJ8HOgI

And, yes, Dr. East does treat patients from outside of the Czech Republic.