[drtowfigh]

That was a good video.

He has a hernia recurrence. So mesh removal would not be the typical first choice.

The ulcerative colitis diagnosis is an interesting twist to the story. I’d be curious when he was diagnosed and how it’s being managed.

[drtowfigh]

Thanks.

I keep an open mind. I’m also evidence based and use logic as much as possible in what I do.

I do not consider Desarda equivalent to the Shouldice. It is another tool in the toolbox. I haven’t seen a situation among my patients yet to use Desarda vs another more vetted technique.

[drtowfigh]

I’ve seen patients of Dr Repta. They were all open and mostly abdominal wall, not inguinal patients. He’s helped a lot of patients.

I viewed the videos you mentioned. The 3 layer repair he mentions seems to be a 2 layer repair plus the external oblique aponeurosis closure. It’s unclear what technique he’s using for the repair. It’s not a Shouldice or Bassini. I did not see any opening of the floor, identification of nerves or fascial release. Also, one of the mesh removals was partial and neither of them identified the nerves.

I need to invite him to this forum to help answer some questions 😄

[drtowfigh]

👍🏻

[drtowfigh]

The more inguinal surgery is done through one wound, especially open, the greater the risk of reduced blood flow to the testicle.

That number varies based on the amount of tissue trauma incurred by the procedure, thereby affecting the blood vessels.

I perform a lot of revisional inguinal surgery. My personal rate of testicle loss is less than 1%. In my 20 year career I’ve had only 2 patients who required orchiectomy. I don’t know where Dr Sbayi got his 25% number. It sounds very high. But perhaps that’s his experience.

• This reply was modified 11 months, 3 weeks ago by  drtowfigh.

[drtowfigh]

Not many that I know. I am now on the community surgeon list because there is a paucity of hernia specialists including those who do non mesh repair or that remove mesh.

[drtowfigh]

Retromuscular mesh placement is the best choice.

[drtowfigh]

This is great. Thanks for volunteering. More and more surgeon groups are understanding the importance of patient representation in what they do.

[drtowfigh]

1. no

2. Depends on the technique

3. No

4. weeks to months

5. Lifetime

[drtowfigh]

I’ll repeat what I said in the last post and prior posts:

Direct hernias do better with mesh than non mesh. But that doesn’t mean you can’t or shouldn’t have a tissue repair for a direct hernia. Every situation is different.

That’s why you should pick your surgeon and follow their personalized advice.

[drtowfigh]

It’s a great program. It promotes funding to surgeons who find there is a problem that they can help solve with innovation. It’s surgeon-centric and therefore patient-centric.

[drtowfigh]

Not related.

Many have redundant colon because of chronic constipation. If you have constipation, treat it. It’s a major reason for hernia exacerbations.

[drtowfigh]

Ken,

This horse has been beaten to its death. Go back to prior posts with the same exact discussion at least 20 times over. The purpose of this forum is not to keep repeating the same question hoping for a different answer.

[drtowfigh]

Depends on the situation, original repair method, original hernia size, patient factors, etc.

He needs full evaluation to see if he even needs mesh removal.

[drtowfigh]

I don’t talk in absolutes. Each patient’s situation is different.

If you compare mesh vs non mesh repairs for direct hernias, mesh is superior—even more so than for indirect hernias. Doesn’t mean all direct hernias must be repaired with mesh.

Also, Lichtenstein repairs direct and indirect hernias. It should be protective against future direct hernias, but that is also not absolute. Most recurrences from Lichtenstein are medial, I.e., direct.

Lichtenstein does not treat or protect from a femoral hernia.

[drtowfigh]

Fixation can be associated with chronic pain. Sometimes it’s necessary but if it’s not necessary, then most of us prefer not to use it.

The mesh itself causes an inflammatory reaction that makes it “stick” in place. Also, in many situations where fixation is not necessary, the space is made perfectly to allow for the mesh to stay as it is placed.

[drtowfigh]

One of the unique features of the ACHQC project is that surgeons log in their results and include exact brand names of meshes when used.

[drtowfigh]

I’d like to see more evidence via clinical trials and outcomes based on real use databases. It’s important to note the strengths and weaknesses of a technique so its use it tailored to those patients that would most benefit

[drtowfigh]

The lighter the mesh weight, for inguinals, the more important is the fixation.

Heniford has paper publishing showing chronic pain rate is directly associated with amount of mechanical fixation (tacks). There are also many population based papers which show use of fixation increases risk of chronic pain. That doesn’t mean not using fixation prevents all chronic pain.

Let’s not confound surgeon and surgical technique with fixation vs not fixation. No amount of fixation will counteract a poorly placed mesh or a bad decision making by the surgeon.

Which is why I press that you should find a surgeon who you can trust and allow them to do their job.

[drtowfigh]

How did the SAGES Shark Tank become something nefarious?