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Thanks, William. I will indeed give it time before getting more concerned. I think my pain (both initially and what’s lingering) is outside the realm of what is common for this procedure, but I don’t know that it’s so abnormal that I should be very concerned at this point. It’s too bad that the crew over there (doctors, nurses) weren’t more reassuring. I think the big improvement so far is a very good sign, and I hope it will continue, but I live in uncertainty and I’m not back to normal, a situation which may persist for a while. My symptoms right now are still worse than what they were when I had the hernia, so it’s hard to be excited so far.

Yes, I chose my surgeon – this wasn’t a problem actually.

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Mark T,

I think there’s a good chance that I will still end up with a problem-free and pain-free repair. I’m optimistic, but not certain. I’ll keep reporting on how it goes. Thanks for your message.

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Thanks, Chuck. I’m optimistic since there has been a significant improvement since the surgery. I just hope it continues improving all the way to complete resolution, and I don’t get stuck with chronic pain. This stuff is really scary.

I had my hernia since birth, and it got worse over the years. The right time to fix it was when I was a baby. It’s a trivial surgery at that point. My parents weren’t thinking rationally about it, and didn’t do it.

The hernia was bothering me only occasionally, so I didn’t feel compelled to do the surgery. I did notice that it was growing in recent years, and that should have prompted me to do something about it, but I was too busy with other things, and didn’t feel like doing surgery on something that wasn’t bothering me all that much. It started bothering me much more frequently a bit over a year ago, but I took my time researching what to do because I found out that deciding on how to treat it isn’t so simple.

I’m not sure I would have been able to pull the trigger before it started bothering me more, and before I noticed that intestine was going in there, and that the hernia was reaching into the scrotum. As we all know, the risk of complications from inguinal hernia surgery is far from insignificant, so who wants to take that risk on something that isn’t all that bothersome? The risk of incarceration and strangulation is known to be quite small. It’s a tough dilemma, but, yes, for those who want tissue repair, I think there’s a good argument for fixing it sooner rather than later. I wasn’t aware of any of that at the time. There’s probably not as much urgency with mesh.

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Chuck,

Not sure the Shouldice Hospital would be an option for you since you don’t have a visible or palpable bump. As far as I know, they don’t operate on such cases, or at least they didn’t in the past. Things have been changing there, so who knows – you would need to contact them if you wanted to explore that.

You can ask for a specific surgeon, and they try to accommodate that.

I don’t agree that it’s a “very poor choice”. They actually do very well with it over there. People were mostly doing quite well after the surgery, and I talked to a number of people who had one side done in the past, had perfect results, and came back for the other side. My case has not been so good so far, but it wasn’t typical.

I think there’s a fundamental issue with not tailoring the solution to the patient. At the Shouldice Hospital, there are very rare cases where they use mesh. They do that when your tissues are of very poor quality. Other than that, they just do Shouldice. If you’re overweight, they’ll reject you, but if not, you’re fine for Shouldice.

The problem is that there are cases where performing this procedure is difficult because of the specific anatomy and nature of the hernia. Some surgeons would realize that based on an ultrasound or maybe during surgery, and decide to use mesh in such a case, or maybe some other tissue repair like a Desarda. Based on what I know now about the details of my case, I think I would have ended up with a mesh if I had gone to one of the Germans who do Shouldice as well as mesh. I don’t know if that would have been a better outcome or not, but in some cases mesh can be superior to forcing a Shouldice, Kang, or some other tissue repair.

I described in previous threads my reasons for not choosing Kang. It’s mostly about the lack of data, and concern about potentially higher recurrence rates. Also, my hernia was not run-of-the-mill. It was a large indirect with a scrotal component. I wanted to “play it safe” with an established well-proven procedure with a long history. I’m not sure how well the Kang technique for indirect hernias works with a hernia like I had. It may be fine – I just thought it was too much of an unknown. As it turns out, even repairing it with Shouldice has been difficult.

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William Bryant,

Thanks for the wishes for continued recovery. The pain isn’t currently debilitating like it was for the first couple of days after surgery, but I still get the same pain after certain activities, just in a milder form. It has been improving over time, but there are some setbacks. For example, last evening after I went for a walk it was worse than during the couple of days before that. Interestingly, it feels a lot like the hernia pain I used to get when the hernia came out, just worse than the hernia pain.

I let the surgeon choose what to do. He didn’t cut the cremaster in my case.

The food was far from the top of my list of things to be concerned about, but it was excellent while I was there.

See below for the reasons for my choice.

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GI,

I do want to keep record of my recovery in some form and share it in case it helps others. Not sure how much help it is, though, because this aspect seems to vary a lot from person to person. I need to figure out how best to do this. I’ll post here since I feel loyalty to this forum after interacting with a few members here like yourself over the last year, but there isn’t much activity here for some reason, and it feels like there aren’t many readers. The reason for having so little action on this site is a mystery to me actually.

Yes, they do have the leeway now to modify the procedure, at least in terms of deciding whether to cut the cremaster entirely, and whether to use steel or prolene sutures. Not sure about other aspects of the procedure – I didn’t see any indication that they deviate in additional ways.

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Do you know if it was purely a Marcy repair, or a hybrid with another repair like Desarda? I consulted with him before he retired, also with an indirect hernia. I couldn’t get him to explain clearly what he was going to do in the two consultations that I had with him. Glad it worked out well for you. If it was indeed just a Marcy, then you managed to have it fixed with minimal procedure which is awesome.

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Cutting the genital nerve branch is common practice in men in some tissue repairs such as Shouldice and Muschaweck (you must be talking about Dr. Echo who does the Muschaweck repair.) The Shouldice Hospital cuts it in thousands of people every year, and so do other surgeons who follow the original Shouldice procedure such as Dr. Sbayi and Dr. Reinhorn. I’m not sure if and when it’s cut in women, though.

It seems excessive to do it in everyone, and there’s no agreement among surgeons on this subject. Just one thing among many where there are conflicting opinions, and no good answers. Have surgery done only if you really need it because it’s fraught with danger, and the “cure” can easily be worse than the disease. Definitely not an easy decision in many cases.

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That is indeed a strange statement. How does lowering expectations optimize outcomes? Is chronic pain any better if you know that it may happen? Perhaps what will improve outcomes is if fewer people decide to have the surgery done when provided with this information. The cure can be worse than the disease, and in some cases watchful waiting is the better option.

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One interesting thing is that Dr. Chen at UCLA tightens the internal ring with stitches when it’s loose. He does this as part of his Lichtenstein procedure, so the mesh is in addition to this Marcy-like step. A natural question is whether the mesh is really needed if all the patient had was an indirect hernia. Maybe tightening the ring is enough?

I don’t know the answer, and the strange thing is that such a simple approach isn’t really practiced or studied (other than by Kang and one Japanese study), so surgeons are quite possibly performing much more radical procedures than needed.

I actually asked a couple of top hernia surgeons about this. One didn’t have an opinion, and the other said it might work ok, his hunch is that it would work better in young people, and more research is needed. Seemed pretty shocking to me that this is the state of knowledge after so many decades of hernia repair.

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If such a lipoma can be treated with a simple tissue repair (sounds like a Marcy) instead of an extensive Shouldice, why wouldn’t the same apply to a small or medium size indirect hernia as well? I find it all very confusing.

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With hernia repair, every aspect is all over the place. I’ve heard surgeons claiming no chronic pain, 0.5%, 1-3%, 5%, 12%, and a range of 10-30% is mentioned here.

It’s good that they realize that exploring the other side without evidence of a hernia isn’t a brilliant idea.

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@kls007

What kind of hernia did you have? Do you know what technique was used in your surgery?

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I’m not a lawyer, and I don’t know with certainty, but I think a lawsuit in California would need to be filed within a year of the injury.

By the way, I consulted with Dr. Brown before he retired, and didn’t get a good impression. I couldn’t get him to describe what procedure he was going to perform exactly for repairing my hernia. It seemed like some mish mash of techniques which included something that sounded like a Desarda. He was actually getting angry as I was trying to get him to clarify what he was going to do exactly. I consulted with him a second time, and he was even angrier, and I got no additional insight. I felt like I dodged a bullet there.

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I wouldn’t even dream of having surgery done on an asymptomatic or minimally symptomatic hernia. Watchful waiting is the standard recommendation in such cases these days. I would just wait and see if anything alarming happens.

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I did post the link for you. Scroll back a couple of posts. Canada dropped this requirement.

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Without knowing the statistics based on a good study, how can you say that the chronic pain or discomfort cases are rare? That’s my point – we don’t really know how rare or not rare these are.

I’d like to see another statistic which never seems to be studied which is what percentage recover to 100% normal – zero pain, discomfort, numbness, twinges, tightness, etc. How rare or common is that?

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None of us know the real statistics. There is certainly reason for concern. The observation that the incidence of chronic pain is higher than expected came directly from the chief surgeon at Shouldice in his interview with Dr. Towfigh. They’ve been doing a major study of this as a result of noticing this problem. Let’s wait for the results of this study before concluding anything – hopefully they’ll be published.

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Other than your case, I also haven’t seen any “100% back to normal like the hernia and surgery never happened” cases. There always seem to be at least some minor issues. My dad is a good example. Successful tissue repair, but with some minor discomfort that never went away completely. Unfortunately, the hernia recurred eventually, possibly because he’s overweight.

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Some will fix a recurrence. It gets a lot more problematic if another complication happens such as chronic pain.