David M
Forum Replies Created
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I think that the study referenced by Dr Towfigh and her guest in the above post is the same study listed in the first video, the difference being the follow up time. In the first video, it appears that the 9% recurrence rate was at 18 months, with that number growing to 17% after 3 years.
Here is the link to the 3 year follow up.
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Dr Towfigh and her guest talk about Phasix at the 13 minute mark in the following video. In whatever study they reference, the recurrence rate at three years was 17%, which they say was a little higher than permanent synthetic, but not a lot higher.
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Because the plug is in such disrepute, I havent bothered to research it much, but isnt it used for inguinal hernias, and does this mean that BD expects for the Phasix products to sell in that market?
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Thanks for the corrections. Indeed, I flubbed the fact that Gore is independent from BD. I had read previous posts about phasix and confused Gore with Bard. I will edit that if it is still possible.
Also, it does sound like the complex hernia study may have been some kind of combined surgery.
Wish there was more info on(or availability for?) Phasix for inguinal hernias.
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So, two basic questions.
How common is the use of Phasix for inguinal hernia repair?
Does insurance even cover the use of Phasix in inguinal hernia repair?
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434400/
This is a study that the authors claim was the first for Phasix in inguinal hernia. Only 15 patients with no recurrences. Done lap with TAPP. Surgeon(s) used tacks because of concern of glue not sticking to pelvic bone.They reported that it was technically difficult to do requiring a patented technique. (?)
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In this study of complex big hernias, the recurrence rate was 4 out of 70.
https://journals.lww.com/prsgo/fulltext/2019/11000/when_the_mesh_goes_away__an_analysis_of.21.aspx
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Yeah, my post about the scar tissue was not clear. I just meant that any surgery that you dont really need compromises the tissues such that it’s more dangerous for later surgeries. Maybe that’s not important enough to factor into the decision, but it’s something that might be important to consider.
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Chuck, what is the hurry? Is the pain that bad or debilitating? Because of the scar tissue issue, I would be reluctant to have a anything fixed that wasn’t really due.
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Let me rewrite that sentence.
I know that in one of the herniatalk videos it was discussed that contrary to some belief that these nerves have no motor function, that if one of the nerves in that area is cut that it can indeed cause a loss of core function -
I know that in one of the herniatalk videos it was discussed that contrary to some belief that one of the nerves there being cut can cause a loss of core function. Now that may have been with lap surgery where the nerve is damaged more upstream. Not sure and I don’t know which nerve it is.
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Peter, I highly recommend that you watch the 12 minute Desarda video. Not saying that it will answer all your questions, but what you will see there is Desarda creating “leaves” that wouldn’t be considered “flaps” and then using them in overlapping fashion. When he uses the word leaves, he’s only cutting the aponeurosis inline with the fibers, but not the other two cuts that you think Brown made. I think youre referring to a flap as meaning having three sides of a rectangle detached. I’m not saying that Brown didn’t make the other two cuts, forming flaps instead of leaves, but Desarda shows that the external oblique aponeurosis can be overlapped without making “flaps”
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Yeah, Peter, that description of your surgery has so many things that seem odd. The three things that stand out to me are 1)the cutting of the external oblique against the fibers 2) suturing that first flap to the transversalis fascia ( in the video Desarda sutures his version to the muscle) and then 3) closing the other external oblique flap below the cord, leaving the spermatic cord on top.
In the Desarda video, he only cuts the external oblique in line with the fibers. I assume you believe that by cutting against the fibers,the fibers permanently lose their strength?
I mean, your situation does seem pretty bizarre to me. Doctors that might wander in here and read this could possibly wonder whether maybe you’ve misinterpreted the report.Would you be willing to post the actual report?
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Peter, I tried to read the earlier description that you made of your surgery with Dr Brown. I dont understand the part about the flaps, but I recommend you try to watch the ten minute video of the Desarda tissue repair that can be found on YouTube performed by desarda himself. It’s actually a pretty good video as far as these videos go. Desarda cuts out a section of the external oblique and uses it to support the posterior wall of the inguinal canal. This seems similar to what you described happened to you. The main difference being that after cutting out the section to use as a support for the posterior wall , Desarda reattaches the remaining external oblique to itself. Apparently when it’s done right, it works for some hernia repairs.
So, I’m wondering if Dr Brown got in there and ended up trying to repair a hernia.
For the record, I’m just a layman researching some of this because I have to get my own hernia fixed.
Stay strong,
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Watching the Desarda performed by Desarda, it doesn’t look difficult at all to learn.
Dr Koch actually said that he and another surgeon had helped to introduce the Desarda surgery in Germany, but that he preferred Shouldice because the tissue used in the Desarda was often weaker. Desarda uses the external oblique aponeurosis for the posterior wall reinforcement. In the video, it looks strong, but Desarda also characterized it in that operation as a good specimen.
Mesh being easy and quicker to perform probably has a lot to do with Lichtenstein being done versus Shouldice.A surgeon performing a Shouldice on YouTube gave that as the reason he mostly did mesh now. I think he said it was about twice as fast as the shouldice.
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I watched a video on YouTube with Dr Koch and he mentioned tissue strength being the drawback with the Desarda. It was towards the end of a 20 minute video. A guest of Dr Towfigh also mentioned that and Dr Towfigh agreed. it may have been the one with Dr Muschaweck.
Now this surprises me because the tissue in the video of Dr Desarda doing his operation looks much stronger than any transversalis fascia that I’ve seen used in Shouldice videos.
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The link to the Desarda video…
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Dr Towfigh thank you very much for taking the time to help with our understanding.
Let me follow up on the question about “dissecting out” the spermatic cord. I put that in quotations because I’m not sure whether my lack of understanding is due to semantics, whether I’m misreading other sources, or whether there are differing opinions. Here’s a quotation from Dr Brown from earlier in the forum in which he says that the cremasteric muscle does not have to be excised (for direct hernia):
“A few patients have a bulky cremasteric muscle that can make the repair of the inguinal floor difficult, in those patient I sometimes remove the cremastic muscle. If the cremasteric muscle is excise the testicle does not retract in response to cold and during intercourse.
If there is a lipoma of the spermatic cord or an indirect hernia, the cremasteric muscle can be split to get access to those structures. The cremasteric does not have to be excised.
I do not routinely cut the nerves. Once cut there is no way to be sure that it will grow back.
Regards
Bill Brown MD”And here is interesting video (for anyone curious about the Desarda technique- by Desarda himself, I think), in which at about the 2 minute mark Desarda lifts the cord outward. He skips the part where he cleans it away from the tissues below. I’m not able to say whether more was done to this or whether the cremasteric muscle is still there.
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Ive enjoyed reading Dr Kang’s posts. He sounds sincere, concerned for his patients and probably proficient.
I think the reference to Nuremberg was overdone and too negative and I’m not sure why Herniated used that reference. However, I think it’s doubtful that there is racism involved.
I do agree with the more general point that it is a bit of a red flag that Dr. Kang has been slow to share more about his techniques with his professional peers. I may be wrong on whether he has done that or not, but that has been my impression.
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William, I haven’t had surgery yet. I guess I’m more or less in the same boat as you with my indecision.
I’m gonna reread the posts by Dr Kang, but I doubt I’ll go that direction. As honest as he sounds, I still would like to have more outside verification of the trustworthiness of his method.
I’ll probably rule out lap surgery. Calling it minimally invasive seems like a misnomer. Gall bladder lap surgery always sounded minimally invasive, because the opening sounds less invasive and nothing stays in. But with mesh, the mesh itself is the invasion of the tissues and scars up the the things it touches. Plus, I’ve had a heart attach and also have an irregular heart beat with some normalish bradycardia. I’m not in bad health,really, but those facts make me worry about the general anesthesia. Also, I’m trying to stay on the thin side and and have some worry about noticing the internal mesh due to that.
I would be leaning to the shouldice, but my hernia is probably direct and probably larger than normal. Makes me question my tissue strength. I also have some reluctance to have the cremaster dissected if it doesn’t appear that I have an indirect, as well. These two facts limit my willingness and accessibility to choose that.
Alas, I want to get it right and there is no path that I feel confident with.