David M
Forum Replies Created
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Yeah, most open inguinal surgeries are supposedly under an hour. I think the average for a shouldice is around 45 minutes. Lichtenstein is less than shouldice. Kang is less. Still, several of these could add up to a tired day.
I imagine the 12 hour surgery was almost certainly some other type of more complicated surgery.
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This reply was modified 1 year, 3 months ago by David M.
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This reply was modified 1 year, 3 months ago by
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MarkT, While you are correct about projection being a part of my judgment concerning fatigue, I also had in mind this conversation between Dr Towfigh and her guest. I had even summarized this video in its thread. Check out the video at the 57 minute mark.
https://m.youtube.com/watch?v=RpulDqYVy5A&t=19s&pp=ygUKSGVybmlhdGFsaw%3D%3D
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Mark, you are correct that we are projecting somewhat. It really is still the opinion of some of us to be wary according to our own understanding.There is nothing wrong with that. It’s how people make decisions.
Surgeons are human and they most likely do get fatigued. And surgeons with good reputations are going to probably have more surgeries than they can handle. So, you will have cases where some of them are not doing the surgery from start to finish.
Your last paragraph seems to say that you want a balance between experience and volume. I think that is all that those of us who are somewhat wary of the highest volume surgeons also mean.
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GI, your original post ended with this question:
“Why would you avoid somebody who has done hundreds or thousands of the same repair, ten times a day, for years? Doesn’t really make sense.”
I think I answered your question and gave you one of the reasons why a person might choose to avoid the highest volume surgeons. As such, I don’t see why you say it missed the point. Experience Is important, but it’s not the only consideration.
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I get that experience is very important. But would you rather be operated on by an experienced surgeon of 2000 inguinal surgeries who is fresh and at his/her prime, or a surgeon of 5000 inguinal surgeries who is fatigued? I would choose the 2000 experience with a fresher mind and body.
I think even learning is more difficult when you are fatigued. So, there might not even be an experience advantage.
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There probably comes a point in the day where fatigue overtakes the diminishing returns of experience. I had thyroid surgery and they would say to choose someone who does at least 50 thyroid surgeries a year and 500 altogether. Beyond that, I assume you’re initially probably getting some benefit, but not as much.
Meanwhile, thinking about driving your car on a trip for 8 hours vs 2 hours. By that 8th hour, you’re going to be far more accident prone (sleepy, etc.) than you were on the 2nd hour.
Someone who does 10 surgeries a day probably has a good reputation, so there’s that, but one might question whether and why they are pushing against their limitations.
So, good experience and not being overworked probably both count.
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When you say “fairly large”, are you talking golf ball, bigger, tennis ball?
The problem comes down mostly to there being no consensus here about how to proceed. It probably depends on the individual. Looking broadly at results, it’s hard to come down as one method being preferable. The study stats seem to say that Lap is slightly the best, but the board would almost certainly have a different consensus, as there are a disproportionate amount of lap removals around here.
Dr Yunis has had a talk with Dr Towfigh. I imagine that you know this. If not, it would certainly be worth a watch. Having said that, I think there is a strong opinion here that if you have the means, you should probably travel to the overall surgeon and method of your choice.
As far as the cremaster, I can’t verify exactly the differences. I believe that the original Shouldice splits it around the middle like around the trunk of a tree, then uses the two “stumps” to suspend the testicles for the lower stump, and help create the internal ring for the higher. I think a substantial number of Shouldice surgeons no longer totally seperate the two parts of the cremaster.
Other methods open it up to remove hernia sacs in the case of indirect hernias, but probably don’t go so far as Shouldice. Still others may do nothing to it all if it’s a direct. Those are just my impressions, though.
I don’t think cutting the ilioinguinal nerve is common, as it is usually on the outside of the spermatic cord. Always important to ask, I guess. The genitofemoral is often found inside the spermatic cord, I think. It may get cut by Shouldice. This would be something to always ask for tissue or mesh.
I wish I knew more, because like you I have paralysis by analysis. If you didn’t have the insurance change, I would allow yourself some time to come to your decision.
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Ben,
Why fix it at all? 1cm by 1 cm sounds quite small, and if it isn’t hurting, why take a chance on doing damage.
On the other hand, with a hernia that size, a tissue repair is probably more successful. So, there might be a limit to the size for the watchful waiting.
Have you watched the Desarda video. It seems to depend on a healthy external obliique. Since you still have a small hernia, your EOA might be in good shape.
I don’t think the Desarda has been studied for longevity as much as the Shouldice. Meshes might have already taken over the field by the time he developed his technique.
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Mark H,
Not being from England, I have to ask what is a stroppy?
Did your GP think you didn’t have a choice because tissue repairs don’t exist in England or because your hernia was big? I talked to a surgeon who told me that he can’t tell the difference between indirect or direct on look and examination, but I can’t see how mine is not direct, as when it reduces you can feel it going directly back into the abdomen in a lower part of the abdomen. I would think an indirect would have to go somewhat laterally before it reduces.
Watchful, if you read this, can you tell us what it felt like to reduce your hernia?
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Hello PeterC,
Sorry to hear things have not gotten better, but good to hear that you are still here. Not that he was a great philosopher, but the words of George Harrison always sort of stand out when I hear travails like yours. He said something like “Expect nothing and everything in life is a bonus.” That’s kind of true.
I hope that doesn’t come off as annoying.I do think you need to take your hernia report to someone with extensive knowledge of the core anatomy. I can’t help but think there is a missing piece that might help you. I also will add that as an outsider it seems like your depression is taking you further down than you have to go.
I will add that I remember the last time you were posting that you said something about your spermatic cord being left above the external Oblique. I thought that was odd, but since then I read that that was one of the major repairs to inguinal hernia used back in the day before Shouldice. I think it started with an H, but I’m not sure.
Anyway, keep posting….
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I am definitely not someone who knows, but your description sounds like it could be the genitofemoral nerve.
“I got discomfort, pain, shooting sensation and even some burning in my adductors, testicles, groin onbviously and even higher up (like halfway up towards my belly button).”
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Totally serious when I say that you have excellent English skills being from Hungary.
Don’t fume. It won’t help! I don’t know what the effectiveness is, but don’t they have some means of identifying which nerves are being traumatized?
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I’m also someone with no knowledge of medical, who is here because I have a problem. My problem is different from yours in that I have a very visible hernia, but no pain and have had my hernia for 15 years.
I think what the doctors are saying makes some sense, in that if you don’t have a hernia and you do the lap, it may not solve your problem. So I would be cautious about whether anything should be done. Has it gotten any better or worse since you first noticed the problem in January?
I would like to ask how much the pain is actually interfering with your life? Could you go for a fast walk for exercise without it flaring up? Does it interfere with your means of making a living? Does it prevent you from concentrating when relaxed?
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This reply was modified 1 year, 3 months ago by David M.
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This reply was modified 1 year, 3 months ago by
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I’m not a doctor, but I feel certain that it is virtually impossible to remove the Shouldice stitches from a posterior approach.
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William,
Got to thinkng about the impact of intestines on the hernia. I wonder if bowel movements might feel different to a left sided hernia than a right sided. I assume that most of the “number 2” accumulates on the left side before being passed. My hernia is right side and I dont usually notice excretion making that much difference. There are times, however, when it is much more resistant to being reduced. I will start checking the reduction before and after to see if there is a difference.
I think it’s small intestines that protrude, though ive also read that the bladder can affect this. On the left side especially, though, I imagine a full large intestine could be pressure.
We need to find a video of the intestines through the day cycle. Unfortunately, I doubt there is one.
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This is an earlier review of Grischkan on herniatalk and it’s a devastating review, overall. As far as the 2 vs 4 layer, the poster thought he was getting a 2 layer modified, but the surgeon’s report talks about 4 lines of sutures.
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I guess he calls it a standard Shouldice:
“The Modified Shouldice Repair allows the surgeon to proceed with a standard Shouldice repair but reinforces the repair with a small latest generation mesh”
A four layer Shouldice plus mesh almost sounds like subtraction by addition, if that’s what he means by standard shouldice.
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….so, skipping layers 3 and 4 of the regular Shouldice?
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Thanks, Dr Towfigh. What is he actually doing, then? The first two layers of the Shouldice topped by the mesh?