Good intentions
Forum Replies Created
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Fifteen patients in that study. That’s a terrible attempt at a scientific study. It’s worthless. There is a lot of bad science in the field of medicine. You have to be careful about what you read and dig deep in to the why and the how of the publications.
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Also found the original thread.
https://herniatalk.com/forums/topic/marcy-repair-in-adults-with-inguinal-hernia/
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I found an old comment from Dr. Kang and Chaunce1234 that includes Dr. Ponsky’s method.
https://herniatalk.com/forums/reply/7505/
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It might be worthwhile to contact Dr. Ponsky. He showed good results for his laparoscopic pure tissue technique all the way up to patients aged 41 years. If you have weak tissue it’s going to affect any type of pure tissue repair.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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Even in open no-mesh surgery there are different methods. Some cut nerves and some don’t.
Can you give more details about the method used? And the type of hernia?
I don’t have any experience in your type of problem. Just mesh implantation and removal, both laparoscopic. Healing can take quite a while. I found at times that more activity actually helped the pain, rather than rest. You might experiment and see if the pain stays constant, gets worse, or maybe gets better, with increased activity. It seems counterintuitive but physiologically I think it makes sense. The damaged tissue needs good fluid movement to resupply the tissues with oxygen and remove damaged materials. New blood vessels need to grow in to restore the balance.
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I don’t think that running increases the odds of getting a hernia. Certain types of lifting do though, I think. Using the Valsalva maneuver to lift more weight for example.
Since Dr. Belyansksy is primarily a laparoscopic mesh implanting surgeon you’ll want to find out what pure tissue method he uses and what his results are. He probably has a small number to work from though. You might ask him if he has a recommendation for a surgeon for a pure tissue repair. Who knows, he might be more confident in someone else’s skills in that area.
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Has anything been determined about Dr. Sea’s Topic, and his disappearance from the forum membership? Did he ask to be removed? Did Dr. Sbayi ask to have the Topic removed? You said that you would follow-up. Without a follow-up the void can be filled with conspiracy theories, to mirror the news of the day.
As you can imagine, it’s disturbing to see a person’s efforts destroyed so thoroughly. Many, most, of the posts were very thoughtful and took some work to produce.
Thank you.
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It is interesting how the surgeons seem to view their bodies differently than their patients’ bodies.
Here is an old tweet on the watchful waiting topic. Even though they could die or end up in the emergency room from an incarcerated hernia they choose to wait. Very strange.
The choice of surgery method is not the same as what you saw though.
https://twitter.com/Herniadoc/status/1114246402950012930
Fascinating audience polling by @DrMicki of laparoscopic general / hernia surgeons. Here are 3 questions:
Q1: how many of you would have your minimally symptomatic inguinal hernia repaired?
A: 56% choose watchful waiting. pic.twitter.com/oZ0RCpcknH— Dr. Shirin Towfigh (@Herniadoc) April 5, 2019
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Dr. Krpata might be worth consulting with. I’ll post some links.
https://my.clevelandclinic.org/podcasts/butts-and-guts/chronic-groin-pain-clinic
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In the Shouldice repair the cremasteric muscle is completely removed from the spermatic cord. Any surgeon who does a Shouldice repair should be able to examine the cord and muscle and remove any staples if appropriate, without major concern, I would think. Maybe that’s why you came to a hernia repair site.
I would find a good hernia repair expert who understands the Shouldice repair. If you browse through the forum posts you’ll find several comments about surgeons who do not have a good understanding of the anatomy of the inguinal region.
There are thousands of surgeons out there who will try to help you, many just for the challenge of something new, but many who will not actually have the expertise to do so. Be careful.
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I don’t have any suggestions Daniel. Just wonder if staple/clip removal is possible or has been suggested. Since the cremaster muscle is actually a muscle that moves and slides against surrounding tissue in the inguinal canal it seems to make sense that a metal clip would cause problems after activity.
And, if you’ve seen Watchful’s Shouldice thread you’ve seen that cremaster function after Shouldice is a big topic. Have you noticed if the scrotum is able or unable to lift the testicles? Maybe you could comment in his Topic. Good luck.
Here is is:
https://herniatalk.com/forums/topic/where-would-you-go-for-shouldice-surgery/
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That is a good suggestion David. I had the same problem then realized that I could put the page number in the web address box at the top of the page. Might be hard to do on a phone but pretty easy on a computer.
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Sounds like the nerve that controls the cremasteric reflex is being impinged. I actually just posted an article about it in Watchful’s Shouldice discussion. I will link it below. It’s old but it describes several case studies, similar to your problem.
You didn’t say what type of mesh implantation you had 20 years ago, open or laparoscopic. Also not clear if any mesh was removed when the recurrence was repaired. Dr. Towfigh says that new mesh is never laid over old mesh but you can find several reports of this being done around the various internet sources. It sounds like you had another piece of mesh placed to fix the recurrence but the old mesh was left in place. I would guess that you’ll need more work done to fix the testicle retraction problem.
This paper will be informative, I think. Good luck.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1979762/pdf/brmedj03205-0028.pdf
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Also just saw this on the Shouldice site. Visiting Vancouver n late September.
https://www.shouldice.com/remote-clinic
Shouldice Hospital is returning to Vancouver!
Hernia Examination Clinic September 26, 27, 28 & 29
For further information call 1-844-712-1362 -
If I had an indirect hernia I’d talk to Dr. Ponsky. He seems very rational and very well-informed. Even though he is primarily a pediatrics surgeon, he also works on older adults. He might be open to repairing an adult hernia via his laparoscopic procedure.
You might be find that his method makes the most sense and you can move on from considering the Shouldice repair.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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I would study more about the actual function of the cremaster muscle. My shallow reading is that it serves a dual function. One is the rapid protective retraction of the testicle in cases of danger. The other is the temperature regulation function. Which is also a function of the scrotum. The scrotum might also pull the testicles up, rather than just going along for the ride. Somebody has probably studied this.
So it might be that all that is lost is the speed at which the testicle moves. Not the actual range of movement up and down.
Sometimes when I see these concerns I also wonder about boxers versus briefs. Brief wearers spend most of their day with the testicles high. Boxer wearers not so much.
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Don’t overlook the scrotum. The body often has redundancy (e.g two testicles). Here’s a couple of references and one that I pulled from the Wikipedia entry about the cremaster muscle.
https://www.verywellhealth.com/scrotum-anatomy-4782407
https://en.wikipedia.org/wiki/Cremaster_muscle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1979762/pdf/brmedj03205-0028.pdf
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When talking about mesh you have to include the solution to the chronic pain problem if it happens. With mesh it’s mesh explantation. I have not seen anything that suggests, realistically, that the pain clinic remedies actually “cure” the problem. They cover it up and create new pharmaceutical based problems. A person could be on pain meds for life. The same with neurectomy. A new risk of new problems.
I like your summary but the discussions of risk almost always end short, in my opinion. You have to consider the long-term.
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That is an excellent find, thank you for that. Everybody should read it, whether they are looking at a Shouldice repair or not. Dr. Netto covers the inguinal hernia repair in whole in his remarks. With some very interesting comments about why mesh is so popular today. Save the link immediately. The battle continues. It’s like a civil war.
I would be very interested to know how, exactly, the Shouldice Hospital uses mesh. Dr. Netto seems to have fallen in to the trap of referring to all types of mesh and ways to use it as “using mesh”. It’s the great confuser of the hernia repair field.