Watchful

I mostly agree, although I don’t know enough to be able to say how easy it is to go back in and fix any issues with tissue repair. Also, if you want tissue repair, you have VERY few options out there.

The rates of problems with both mesh and tissue repair seem fairly small, but non- negligible. This is the reason some of us postpone the surgery, and do watchful waiting as long as we can. At some point, however, you do have to do it and play the Russian Roulette. It’s extremely hard to say what method is less risky, and there don’t seem to be…[Read more]

Dan – My understanding is that the Shouldice Hospital doesn’t operate on these small “occult” hernias because they don’t believe surgery is warranted for those. I don’t know if this is valid or not, but that’s their view, which I’m guessing is based on their experience.

The big concern for many of us considering that place is primarily that you…[Read more]

@worldpeace: Thanks for the detailed response. I understand your thinking, but I think my choice would be local anesthesia and Shouldice. The thing that bothers me a bit with Dr. Yunis is that even though he’s willing to do that, he prefers to do general anesthesia and Desarda (your procedure). I feel a little hesitant as a patient to nudge the…[Read more]

I hope all goes well, and you recover quickly. Seems like the least bad procedure available. I may follow you soon.

Mike M… Sounds like you’re going to have it done by Dr. Kang. Let us know how it goes. I think a number of people here are thinking about doing the same thing, including me.

Is there surgery that isn’t major? The body didn’t evolve in a way that’s friendly to repairs by surgeons, unfortunately.

The 4 days isn’t the major issue there. The major one is not being able to choose the surgeon. Then there’s the removal of the cremaster and cutting of the genital nerve branch.

In general, the Shouldice procedure seems a bit…[Read more]

It’s based on what they say – I actually asked them. You can’t do much more than that for verification of what you’re going to get, other than maybe go to the Shouldice Hospital, but that has its issues too. Maybe you can be more certain that you will get the exact procedure, but how well it’s performed depends on the surgeon you end up getting,…[Read more]

This Goretex mesh surgery is pretty far from Shouldice. I was referring to the modification by Yunis, Reinhorn, Towfigh, etc. They adhere to the original (other than the steel sutures) There’s no mesh, and they leave the cremaster and its nerve.

Mike M… I think the modification in the “modified Shouldice” is simply that the cremaster muscle and the genital nerve branch aren’t cut. I don’t believe they do anything to eliminate the need for this – they just don’t do this part. There’s a tradeoff there, and whether it’s a good or bad tradeoff is controversial – there’s no consensus on that…[Read more]

MarkT… I don’t know how the body would be able to pull the testicle up if the cremaster muscle and the genital nerve branch are gone. I don’t know if that’s a big deal or not, and I’m not saying that it is a killer issue, but I am curious about how the cremasteric reflex could possibly still work.

Seroma was mentioned to me as a risk by a robotic mesh surgeon that I talked to about my inguinal hernia. He made it sound like it was pretty common if I remember correctly. He said that if this happens, you wait and it goes away eventually. It was yet another thing that I learned about hernia surgery that made me not want to do it…

MarkT… The numbers mentioned by Dr. Netto from the Shouldice Hospital were quite different from 1/1000 or 1/2000. He was estimating 5% for chronic pain (not necessarily debilitating). They are still studying this topic, but he said that they now realize that the number is higher than they expected. He said 1% for chronic debilitating pain.

Glad to hear your repair is holding up so well after all these years – that is awesome.

The cremaster keeps coming up because it’s a controversial part of the procedure. Some surgeons don’t believe in doing it. Also, patients tend to prefer not to have a muscle and nerve cut if not necessary. Some people do complain about a low hanging testicle…[Read more]

I started experiencing much more frequent episodes of large protrusion of the hernia after I started doing core exercises. It comes out more frequently, and I have to lie down to get it back in. Fortunately, it’s still reducible.

It could be a coincidence – maybe it would have happened anyway. I had noticed that it was getting a bit bigger and a…[Read more]

Are core exercises really a good thing with an inguinal hernia? Mine got worse with these excercises. I think applying muscle pressure in that area where you have a defect and a hernia can backfire. It did for me (unless it was a coincidence). My hernia started giving me more trouble after that. Pushed me from watchful waiting to seriously…[Read more]

MarkT – You are correct. The thing with the Shouldice Hospital, though, is that things get a bit complicated because you aren’t really selecting a specific surgeon, you’re selecting the hospital. You may get a surgeon who doesn’t actually have many of these under their belt, or even a trainee under supervision. Also, they have 3 or so doctors…[Read more]

MarkT… That’s great. Did they give you surgical notes? Do they say that they cut the cremaster muscle and genital nerve branch?

More importantly, how are your repairs holding up? Any long-term pain, discomfort, or other issues?

Mike M… The Shouldice Clinic cuts the muscle and the nerve, and so does Dr. Sbayi. I believe this is regardless of whether the hernia is direct or indirect. My understanding is that they need to do it to visualize and access the entire area, not just for the tighter repair.

If I remember correctly, Dr. Kang said that he does some minimal…[Read more]

Mike M… I’m not a surgeon, but my understanding is that the cremaster muscle is part of the cord, and it is sometimes dissected, or “shaved”, etc. in tissue repair procedures. The genital nerve branch is there as well, and it is cut in the Shouldice procedure (at least the original one).