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Forum Replies Created
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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.
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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.
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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 doing other procedures.
I’m not sure what was sold exactly for only $14M in 2012. Maybe just the hospital without the land? It seems like the land was sold for $47.5M in 2016, and now resold for $188M. Nice real estate investment.
The interesting thing is that there is so much demand for this hospital. I think it’s mostly unrelated to tissue repair vs mesh. Canada is just very under-served in terms of medical providers and facilities. They would have a lot of demand even if they did lap mesh, which is something that was mentioned as an area of exploration by their chief surgeon.
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@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 indirect hernia. Shouldice works for that too, but seems like overkill to me. The problem with Desarda is that there aren’t a lot of long-term studies, but I found a couple, and they look good.
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Seems reasonable that it could happen. For example, if something gets damaged in the spermatic cord.
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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.
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Plenty of demand, but it’s no cash cow. Hernia surgery doesn’t pay much, and most patients there are covered by the health insurance plans of the Canadian provinces. These pay little. Self-pay patients are a minority, and they don’t pay all that much either. I read that the place hovers around breakeven – sometimes a little in the green, and sometimes in the red.
Private hospitals aren’t even allowed in Canada. This one is one of very few exceptions that were grandfathered. In other words, once it’s gone, it’s gone.
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These towers will not just materialize. It’s years of major construction with staggering amounts of noise, dirt, dust, and other pollution.
Who knows when the construction will start, and no issue until then, but during the years of construction, I can’t imagine how the hospital will continue operating.
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No, it was bought by the city to do massive residential development plus some green space. The hospital building is supposed to remain in the shadow of the towers. Take a look at the plan:
Even though the hospital has a 16-year lease, I don’t know how they’ll be able to continue operating during this massive construction project of 5 towers of 18-35 floors in close vicinity to the hospital. This is Phase I, and it looks like there will be redevelopment of the block where the hospital is located in a future phase.
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William,
There are a few excellent tissue repair surgeons in Germany. It seems like that could be a good option.
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I believe Dr. Desarda retired from surgery.
You can also consider Dr. Jonathan Yunis in Sarasota, FL. He does it all: mesh (open, lap, robotic), and tissue repair (Shouldice, Desarda). He agrees to local plus sedation for open surgeries.
Sedation as practiced in these surgeries in the US is pretty deep. I think the sedative used is propofol. You shouldn’t experience pain – you’re unconscious, but breathing on your own, potentially with the help of an oxygen mask. This is different from the relatively light sedation that’s typically used at the Shouldice Hospital (with midazolam). With that, you have to rely more on the skills of the surgeon with the local anesthesia. You may experience pain, but you’re likely to forget it because the sedative used causes amnesia. If they notice that you feel pain, they may try to increase the amount of sedation. Some people do experience pain and remember it, though. Hence, most surgeons prefer to use deeper sedation. Also, no one wants you to move around during surgery…
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Dr. Robert Tomas in Fort Meyers, FL has done thousands of Desarda procedures. He does them with local anesthesia plus sedation.
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Not worldpeace, but I did hear that #3 can happen (rarely). I don’t think #4 is correct.
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Another option would be to contact Biohernia. They have surgeons in Germany performing Shouldice, Desarda, and open mesh procedures. You can get a free video consultation, and ask them if they would agree to a surgery without sedation.
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These days, they use an IV with a combination of midazolam (also known as Versed – it’s a benzo sedative) and fentanyl (opioid analgesic) in addition to the local anesthesia. However, I heard that you can ask them to do just the local anesthesia.
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True – it’s a brain insult and causes some damage. I’m shocked that even colonoscopies are commonly done under deep sedation these days – it’s insane.
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You will find that surgeons apply sedation in addition to local anesthesia. Doing it without sedation is possible, but not commonly done these days. I don’t think it’s going to be easy to find someone to do it like that, but not impossible.
The Shouldice Hospital in Canada used to do it in many cases without sedation, and I think they still do it that way when the patient asks for no sedation, so that might be an option. The wait time is pretty long, though. I believe it’s about 5 months now.
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It’s unfortunate that there’s no discussion of the Desarda tissue repair. That’s the most significant and innovative development in inguinal hernia tissue repair in recent times, and it has been picked up by a number of surgeons around the world, including the US and Germany.
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@mikem
Did he tell you whether he was going to use the mesh or not in your case, or was it going to be decided during surgery?
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Indeed, it is disappointing that they feel compelled to make statements like that.
The Desarda technique, though, seems really good based on all the studies that I’ve seen, and also the many patient reports that I read. It definitely has some advantages when compared to Shouldice, including being easier for surgeons to master. Also, it’s a faster surgery, recovery is reported to be quicker, and the cremaster, its associated vessels, and genital nerve are preserved.
I think it’s not discussed at conferences much because almost all the surgeons who practice it or know much about it just happen to be not the type to speak at conferences. This includes Dr. Desarda himself (who is now retired).
It’s surprising that most visible tissue repair experts (including Dr. Bendavid when he was alive) never comment on it with the exception of one or two in Europe. There are some studies, though, including a study from Poland with a 15-year follow-up with great results.