David M
Forum Replies Created
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And I was wrong on the age, probably dues to the camera (or me being stupid). Internet says he was born in 1966.
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Ok, that was hilarious (and accidental). This is the real Dr Koch (I hope).
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Chuck mentioned Dr Koch. I believe this is him. He makes interesting comments at the end about Desarda, which he does but which he says is less strong than the Shouldice.
He looks to me in this video to be in his seventies. I would probably draw the line against him based on age, if he isnt retired.
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And its good to hear that it sounds like you’re doing better on your way to a near full recovery.
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Thanks Watchful, that is helpful information about Shouldice.
At this point, it’s only academic, but do you have any idea if you were to do it over again.whether you would let the German doctors decide whether to put mesh in after they got in there and looked the situation over,or would you choose tissue repair (or mesh) going in?
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Watchful, would you still do it the same way if you had it to do over? How is it currently feeling?
Your case is especially interesting because you were here before your surgery, whereas many come here because they already have the pain. That makes your anecdotal story somewhat more worrisome.
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Thanks, Good Intentions. I actually do feel somewhat like a novice on this, though the truth is that ive started up my study on this 3 or 4 times, only to have to delay it For one reason or another. For instance, I probably posted first here just prior to covid hitting and was delayed due to that and then later for other reasons.
I know, for instance, that you had a mesh removed. Internally, I think. The one quote that sticks in my mind the most was when you told the gentleman who had privacy concerns that after the pain of a surgery gone wrong that a person would run naked through the streets if it would solve the problem. That is a strong warning against the possible pain.If you had it to do over again, I assume that you would not have mesh placed at all? What was your post removal process and result? Did the scar tissue hold it?
Watchful is another amazing poster here. For me, his experience of being so well studied and choosing tissue only to have that not go smoothly is an interesting warning in a sense against tissue repair. Some people find this place because of pain and thus represent the few for whom it goes wrong, but Watchful represents a different class, as does the poster who said he would probably choose someone other than yunis if he had it to do over.
Hopefully, watchful will catch this and give his current opinion about what he would do were he to do it over again.
No easy answers, but my many years of watchful waiting have to end soon, as my hernia is getting somewhat scary.
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I know that experience is very important. I once had thyroid surgery and I know for that it was suggested that one should try to find a surgeon with at least 250 prior thyroid surgeries and.at least 50 or so within the past year.
So, that would be question number one and two., and divided according to each, whether open, lap or tissue repair.
1) How many of each kind can you estimate you have done in your career?
2)How many have you done of each kind in the last year?
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Was your hernia indirect or direct and how big was it?
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Yes, thanks for the attention of those who have been through this and still find time to make a return and give advice.
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So, does Yunis only do the two layer, or did he offer the choice?
How does the two layer work- is it just a double breasting of the transversalis fascia and then a closure of the external oblique?
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I’m just researching myself, but I think that Dr Towfigh, in one of her recent videos….maybe the one on Watchful Waiting, discussed exercise with her guest. I think they both said that exercise was not generally a problem, though they did warn people off of squats and something else. I’d seek confirmation of what was said. I found that particular video to be a good one, btw, and posted a summary of the later half the other day.
I have what I think is a direct hernia. It’s about the size of a tennis ball now. If I’m wearing a truss, I feel no pain whatsoever when I do fast walking for exercise. The truss works, imo. In the morning when I wake up the hernia is reduced, but once I start walking around, I can feel slight discomfort. It doesn’t hurt much, but the feeling makes me distrust walking around without the truss. So, i would consider the idea of a truss when exercising.
In another one of her videos, Dr Towfigh has said that trusses have been shown to be safe and, I believe, not to make a hernia worse. At any rate, I think they have value based on my personal experience, but my hernia is fairly large. And I couldn’t say with regards to an indirect hernia.
What kind of tissue repair does Belyansky do? I would also ask him how many times he has performed the tissue repair and how many he has done in the last year. Whether he’s good or not, I think it’s important to have a doctor with strong and current experience.
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I tried to edit a few phrases and the edit didn’t take. Was this due to timing?
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Thanks Good Intentions for your good comments.
I finally was able to watch the rest of the interview. Here are a few things learned.
Recurrent hernias are more commonly symptomatic than original.
They talk about which hernias are generally ok for watchful waiting. The doctor makes a strong point that femoral hernias in females should not be watched, that 40% of these will end up in the ER or with strangulation.
In general, a primary abdominal wall hernia that is not symptomatic can be watched.
In answer to the question of whether watchful waiting makes a repair more difficult as it grows bigger, whether it can cause it to form adhesions, or make it only treatable by mesh…..
He says this is true if it gets to be a large size. 5% of patients want tissue repair from him, though population studies show a 15% failure rate of tissue repair over time, compared to 1% by mesh. That tissue wears out like the tires on a car.
(I was hoping they would talk about at what point the size starts making a difference.)
He seemed happy to do a tissue repair if a patient asks, though. he does the three layer Bassini as was originally described by Bassini and not the modified Bassini that was imported to the U.S. and that was not nearly as effective.
The Bassini uses interrupted sutures and the layers are sutured to the inguinal ligament. It was a quick description that I may be incorrectly stating. He uses a Bassini because it’s a good repair, and he doesn’t feel as comfortable doing the Shouldice.
Dr Towfigh says that the use of stainless steel sutures in the Shouldice is a financial decision. (Apparently not functionally that necessary, I guess. Interesting)
There have been three trials on watchful waiting. Both doctors disagreed with the conclusion in the UK trial that watchful waiting should not be done due to the possibility of a heart attack or other problem that would interfere with surgery when later needed. Their conclusion was that data from that trial, too, suggested that watchful waiting was mostly safe.
They made comments on surgery being physically taxing. (this might have been primarily with regard to open surgeries.) Dr Towfigh once had a surgery last 12 hours!
Last few minutes were spent on thoughts about nerve problems and how to deal with them.
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I’m about halfway through watching this interview on watchful waiting and the guest doctor just made the comment that he does a lot of surgeries on other doctors, and they, more often than not, choose to have it done open. This seems to have something to do with their wish to avoid general anesthesia.
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Down at the bottom where it list the page numbers would it be possible to put in a jump-to slot. If I’m reading through the pages and I make it to page 20 and close the browser, it be nice to come back the next day and jump to page 21. As it is, I think we have to go through the intermediate pages again. As far as I can tell.
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Those are good questions by Jack.
Considering the weakness of the tissues, I have a related question about the transversalis fascia double breasting in the shouldice. Is it possible that since the tissue are no longer being stretched, that they might actually strengthen? Possibly even fuse given that they are of the same cell structure?
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Ajm, was your hernia direct or indirect, how big was it and what is your BMI?
I want to consider strongly tissue repair and I have a low BMI, am thin, which might favor tissue, but the hernia seems to be direct and seems fairly large,I’m guessing, about the size of a tennis ball. Large directs were discussed by Dr Towfigh and one of her guests and they said they would go with lap in such a case So, these are conflicting suggestions, I think. I am trying to get a feel for whether this size of hernia is disqualified from tissue repair.
Was just wondering about yours since it was post operatively suggested that you should have done tissue.
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I read this on a tablet and the hernia talk banner floats in the middle of the page and is super annoying. I have no idea how to dock it anywhere, if that is even possible, and it’s much too big anyway. My suggestion would be to remove it since everyone can easily tell which site they are on.
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It posted before I could provide the link.