Watchful

Looking at many studies, I get the impression that chronic pain rates for open mesh and tissue repairs are roughly the same, and higher in both cases than what I feel comfortable with. Some studies show better results for TEP mesh, although that doesn’t seem all that conclusive.

Clearly, these surgeries are something to be avoided other than for…[Read more]

Really sorry to hear that, Bob. It’s very strange that both your testicles are painful. How would the surgery affect the testicle on the other side? Different nerves, blood supply, etc.

Do you know if your surgeon resected your cremaster completely?

I was leaning toward having a Shouldice procedure done, but I’m getting cold feet after reading…[Read more]

There was a study by Schumpelick and others which I cited a while back. It did indeed show a somewhat lower recurrence rate and higher pain rate when resecting the cremaster. The surgeries were performed at two different centers in Germany, so not exactly apples-to-apples.

It is bothersome that you can go back to the Shouldice Hospital in case of…[Read more]

@markt

Regarding the cremaster… There’s a difference between the perspective of the provider and the patient.

We’re talking about a high-volume provider which has done hundreds of thousands of surgeries. From that perspective, reducing overall recurrence by a couple of percent (say from 3.5% to 1.5%) makes a difference of thousands of cases…[Read more]

Who knows with nerve cutting… On the one hand, it seems like a bad thing, and you hear about neuroma, etc. On the other hand, many open mesh surgeons routinely cut the ilioinguinal nerve, and the Shouldice Hospital routinely cuts the genital nerve branch, and has done that in hundreds of thousands of patients. What’s the conclusion? Beats me.

The difference between a sports hernia as she defines it and a regular direct hernia wasn’t clear. When asked, she said it was just fat without intestine, but a direct hernia doesn’t need to contain intestine to be a hernia, so I didn’t get that. I also didn’t understand why the genital nerve would get damaged by the sports hernia. I understand…[Read more]

@Jtk2

You should ask him what layer he skipped. I’m guessing he didn’t want to dissect your posterior wall because you didn’t have a direct hernia.

The local anesthesia is supposed to take care of the pain, so I’m a bit surprised it was very painful when they woke you up during surgery. I guess it’s pretty tricky to get the local just right.…[Read more]

Good summary, MarkT.

There is no evidence that steel wire sutures are bad, but there are issues with them. They sometimes prick the hand of the surgeon, which can cause blood-borne diseases to be transmitted between patient and surgeon. Patients at the Shouldice Hospital are sometimes asked to do a blood test after surgery when the surgeon got…[Read more]

I didn’t dig further into this particular potential complication. It’s just one of many possible complications with inguinal hernia surgery.

If your hernia becomes too symptomatic, what can you do? You have to go under the knife, and hope that the cure will be better than the disease in your case. It is scary that you might be trading a…[Read more]

It is on the list of risks that some surgeons mentioned to me. For example, pain with ejaculation was mentioned, and one surgeon even mentioned that he started tightening the internal ring around the spermatic cord less during surgery after some of his patients complained about this problem.

Bob,

Sad to hear that. It doesn’t sound “normal” for the procedure, but who knows how many patients suffer from something like this and how long it lasts. In reality, no one collects and publishes such information in any reliable or detailed manner.

Do you have pain in both testicles, or just the one on the side where the surgery was done?

Was…[Read more]

Must be what they’re comfortable doing. They don’t mention what version of Bassini they perform. They call it a “Bassini type repair” which would raise questions in my mind. There’s the original Bassini, and there are corrupted versions of it. The Shouldice technique is an evolution of the original Bassini.

William,

Here’s a 15-year follow-up study of Desarda:

15-year Desarda

Dr. Lorenz in Germany has been performing it for many years (over a decade I think). Would be worth considering if you’re interested in that repair, and you’re located in the UK.

We have this unfortunate situation with tissue repairs where the most proven techniques are also…[Read more]

Good questions. I would add a question about recurrence rates as well as chronic pain rates that she sees with tissue repairs in her practice. Is she able to follow up with patients over the long run? What are the results?

It’s good that there’s finally more focus on the issue of chronic pain resulting from hernia surgery.

I’m really skeptical of studies of hernia surgery outcomes, though. They’re all over the place. Pick a conclusion you want to draw, and you’ll find studies to substantiate that.

No word yet, but based on reviews he uses deep sedation with an oxygen mask. It will be hard to find a US surgeon who agrees to no sedation or light sedation. Possibly Dr. Chen at UCLA – I heard he does that. You had to wait around 4 months for an appointment with him last time I checked.

I hope there will be a way to keep them going during that massive construction at their doorstep, or a way for them to relocate, but I doubt it.

There are other issues there. 4 full time surgeons retired over the last couple of years, and more are approaching retirement. Most of the young surgeons there appear to be part-time with jobs elsewhere…[Read more]

@bryan

I read good things about Wiese, Conze, and Lorenz. If you want to go somewhere reasonably close to the UK, I think you wouldn’t go wrong with them.

I was going to have a Shouldice procedure done, but I may go with Desarda instead. Not sure yet; I’ll make the decision soon. I feel that Desarda may make more sense than Shouldice for an…[Read more]

Seems reasonable that it could happen. For example, if something gets damaged in the spermatic cord.

@pinto

They are one of (I think) 3 private hospitals in Ontario. These were allowed to continue to operate when new private hospitals were banned in 1971.