[Dudley]

Fair enough. It doesn’t surprise me that he may be of the ilk that leans more into the ‘mesh is a vital tool camp’ than some of the other tissue only/mesh aversion types. (And believe me, I wrestle with a similar concern of the material for a looming AWR reop, so I have significant appreciation for your desire to make your first foray tissue based if possible and certainly can see the validity in that preference. I will just say that I’ve seen a lot of these top name surgeons in the space, and many were more willing than you might think upon first blush to offer a couple of paths. Certainly with a strong preference and “if it were me” often in the recommendation, but not always as cemented to one particular path only. Just food for thought that might be worth the co-pay for a consult was all I was thinking.

[Dudley]

Just a quick comment to the above. I’m not so sure that you can completely infer that Dr. Orenstein would insist on mesh – at least to the degree that it might not be worth the effort to at least go for a consult to be sure of that assumption. He is a very well-regarded Hernia surgeon, and in many past societal gatherings has been a leading resource lecturing on all the different types of mesh’s available and various pros and cons etc. He frequently does the same when addressing different types of hernia’s and atypical presentations. While I do know there are various camps that lean a bit more heavily one way or the other in terms of mesh aversion or the belief it is necessary in most cases…I’m not so sure that we can be sure anyone is as firmly planted in every situation, or that a good surgeon might not be more amenable to offering a couple of options for each individuals particular case. I’ve met with a number of the top experts out there for a unique abdominal wall situation, and have found that while many are very vocal about the recommendation as they see best, many are still open to including the patient in the decision-making process about the various options with and without. Again, not speaking from experience with Dr. Orenstein but it might not hurt to have the discussion before you rule it out. That team there is known to be pretty sharp and specialized.