drtowfigh
Forum Replies Created
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Thanks everyone for your comments and concerns. I agree that there is a growing sense of anxiety, and bombardment that is taking away from what has mostly been a respectful and productive conversation among peers.
I definitely don’t like the tone HerniaTalk is taking. It’s not why o started it.
Hang in there with me. Also, message me directly so that I can hear more of your thoughts.
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Sounds like my suspicion was right. You had a direct hernia. This was repaired. Now you have a recurrence.
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Kinda agree with @nfg12
If it ain’t hurting’, let it go. It’s small and likely won’t cause a problem. You should be able to weightlift and keep it under control. There is no exercise limitation with these hernias.
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It should be up by tomorrow
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Sounds like you had an inguinal hernia, maybe direct type and/or a small indirect type , and it was repaired. Pain 5 years later is a hernia recurrence until proven otherwise. A sportsman’s hernia would not act like this. And you would need to be quite athletic to get such injuries.
If I were to see you, I would get a dynamic MRI or review your ultrasound. If the hernia has recurred, then an open repair with mesh or a redo of the mesh repair would be indicated.
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With larger hernias, there is a wider gap and more thinned tissues. So, trying to pull all that together will result in higher tension at the suture line than for smaller hernias. That tension can result in chronic pain, as you’re in a constant state of trying to tear it apart. So, I assume there would be less chronic pain with a mesh based repair in these situations.
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Every patient has their own set of risk factors and findings and so the best repair is different for each patient.
Thin active male with small inguinal hernia: I would recommend tissue repair.
Thin active male with large inguinal hernia reaching down to his upper scrotum: I would recommend laparoscopic repair with lightweight mesh.
Elderly male with scrotal hernia: I would recommend open repair with mesh.
So, the answer for best repair, in my practice, changes depending on the needs of each patient
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Exercise is protective of hernias and not contraindicated.
Search through HerniaTalk.com for more discussion about this. We’ve reviewed it extensively.
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Does not.
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I offer open, lap, robotic. As a hernia specialist it is important to know as many techniques as possible so that you can tailor to the needs of the patient.
If mesh removal in the groin is necessary AND putting in mesh is relatively contraindicated OR the patient does not want another mesh repair AND a tissue repair is feasible, then it depends on the tissues, type of hernia, size of hernia which type of tissue repair I choose. There is no one size fits all. But I mostly repair normal size hernias with the Shouldice repair in these circumstances. But as I mentioned, all options are there and I may choose Marcy, Bassini, or Nyhus or McVay repair if other circumstances
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To clarify: tissue repairs are always tighter than mesh based repairs, by definition. But there are fascial releases that can be performed to help with this.
I have not singled out the Shouldice. Also, I tailor the repair to the needs of a patient. For most who would benefit from a tissue based repair, I recommend and perform the Shouldice. But I also offer the McVay, Bassini, Marcy and Nyhus repairs.
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Yes, it is common to repair a contralateral asymptomatic inguinal hernia when going in laparoscopically for a symptomatic inguinal hernia. That is a discussion you can have with your surgeon. It is also surgeon preference.
Also, please refrain from disrespectful language. As you know, this is not a forum that tolerates it.
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It all depends on the patient, type and size of hernia, surgical technique, etc.
Tissue repairs can loosen up over time.
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All tissue repairs are tighter than mesh repairs.
Shouldice is the best repair option from a recurrence standpoint. But it’s not necessarily the best for small inguinal hernias in women (I prefer March for those) and it’s not for femoral hernias (McVay is more appropriate). Bassini is another options especially in revisional repairs where tissue planes are hard to assess.
We usually add a fascial release if the standard tissue repair is too tight.
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Every physician and hospital has their own billing practices. Mine is more similar to the Shouldice Clinic. To know how it works in your specific situation with your insurance, you can call or email my office to help explain it for you.
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Just to clarify. I offer Marcy, Shouldice, Bassini, McVay, and r-IPT (robotic Nyhus-Condon) repairs.
It all depends on the needs of the patient.
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Just fyi, it is a mandate by the American Board of Surgery that all surgeons must collect outcomes data. There are a handful of approved databases. I’m not sure if the SRC database qualifies as a Board-approved database. So, the SRC is not offering any more rigorousness than what is demanded of all Board-certified surgeons.
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fascinating.
Some corrections:
– Drs. Brown & Kingsnorth are retired
– Dr. Bendavid has passed
– Dr. Novitsky is in New York
– Dr. Cobb is in South Carolina
– Dr. Voeller is in Memphis and not part of UT
– I am not familiar with Dr. Kang Kim -
I’ve had my own share of bad outcomes. There is no perfect surgeon. We are all human. Specialists should have lower risks of complications. And when we do have complications we are usually much better at knowing what to do next.
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I stand behind all the surgeons who I’ve had in as guests in HerniaTalk LIVE. It’s my quiet way of showing my preference for them as the chosen ones from whom you may choose to seek consultation.
Also, just because I don’t like their surgical technique doesn’t mean they are bad surgeons. These surgeons have excellent outcomes.