[Jack2021]

Hi Good intentions,

Thanks so much for your reply, much appreciated. I looked on the Cochrane library and found very little.

From your link, assuming that Open Darn Repair and Moloney darn repair are the same technique(???), the meta-analysis from this link (https://link.springer.com/article/10.1007%2Fs10029-019-01892-1) titled ‘Open darn repair vs open mesh repair of inguinal hernia: a systematic review and meta-analysis of randomised and non-randomised studies’ which appears to be based on over 3,000 patients concludes: ‘Our results suggest that open darn repair is comparable with open mesh repair for inguinal hernias. Considering that consequences of mesh complications in inguinal hernia repair, albeit rare, can be significant, open darn repair provides an equally credible alternative to open mesh repair for inguinal hernias. Further studies are required to investigate patient-reported outcomes and to elicit a superior non-mesh technique.’

A link to a Lancet article in 1958 (https://www.sciencedirect.com/science/article/abs/pii/S0140673658910274) states that ‘A personal series of 253 inguinal hernias repaired with
a nylon darn and surveyed more than 5 years after the last operation, with a 76% follow-up, revealed 2 recur-
rences (0.8%).’

I haven’t accessed the full article, as have to pay $35 for it, but this sounds promising!

If it was so effective though, I wonder why it seems to have almost entirely disappeared as a regular option for hernia repair, especially as it would appear to be the most cost effective too.

It would be great to have some insight from the esteemed doctors/consultants/surgeons who frequent this forum, to hear your thoughts and knowledge around this please.

Many thanks,
?Jack?

[Jack2021]

HI Bust3r,
Apologies for the delayed reply. I drafted a long response the other day, but was timed out when I tried to submit it and haven’t had a chance to try again since.

Thanks for your reply, are you in a similar position and looking for a non-mesh repair in the UK?

Re the names you’ve kindly listed:

Emin Carapeti – I ruled out this consultant, rightly or wrongly, due to there being little mention of a specialist interest in hernia repair on the websites he was listed on that I saw. The mention of his having attended the Shouldice hospital didn’t state any training in the technique.
Greg Sadler – oxford hernia clinic – I had’t come across this consultant before and having looked at the website, it appears to advocate mesh repairs.
London Hernia (Largely this is mesh though I think Martin Kurzer may do Desarda or at least a different kind of mesh). – Mr Kurzer kindly exchanged emails with me and has done Desarda repairs, though very few (he was one of the consultants I alluded to in my original post) and he’s an advocate of mesh repairs mainly.
David Nott – I haven’t found much re this consultant, so would need to find more info, though I couldn’t find any details online from an initial search.
Simon Marsh – I’ve not found anything online re this consultant that mentions him doing non-mesh repairs, though that may not be the case.
Aali Sheen – Professor Sheen comes across as a really nice guy and usually offers non-mesh repairs to under 30’s only. He mainly specialises in laparoscopic mesh repairs for older patients.
Simon Bailey – funnily enough I’d found info re Peter Jones before I saw info re Simon Bailey, but I believe Peter retired a while ago now and I was unable to get a response from contact details I found online.

The NHS only consultant who can perform the Desarda repair, is called Duncan Light. He kindly exchanged emails with me and came across very well I thought.

[Jack2021]

Sorry to hear you’ve had a poor follow up experience Pinto. I think the point you raise is a good one, as most people would assume that was a given. I’ll be adding it to my list of questions.

Are you happy to share which country you had/are having this experience in?

[Jack2021]

Hi Scarletville,

I’ve recently joined the forum and not had a chance to search through it fully yet, but like you, I’m UK based and hoping to find a top surgeon who’s experienced in performing non-mesh repairs, in my case, for an inguinal hernia.

Like you, I’ve found details of surgeons in Germany – Dr Ralph Lorenz, Dr Ukrike Muschaweck (who’s operated on many top Premier League footballers), Dr Joachim Conze (who took over from Dr Muschaweck at the Hernia Centre, Munich), Dr Andreas Koch and Dr. Martin Wiese (through Biohernia). Dr Muschaweck ran a UK clinic every month before the pandemic, but isn’t at the moment unfortunately. Her costs seem to be around two and a half to three times more than the others. I know that some of them offer a tailored approach and choose the type of repair during the operation, which I can see the benefits of doing, but I’d like to know for sure that I’d be receiving a tissue repair, rather than find out afterwards that they’d decided to use mesh.

With the pandemic and associated travel issues, plus concerns about follow up appointments, I’m hoping to find a consultant in the UK, though it seems there aren’t many who offer tissue repairs for people over 30, as I’ve only found four so far, despite fairly extensive research. I’ve found some very high profile consultants who’ve operated on numerous elite athletes across a range of sports, but they all seem to use mesh for hernia surgeries.

Of the four I’ve found, from my understanding:
– Simon Bailly apparently practices the Shouldice technique, though I’ve been unable to find out whether he follows the exact same method/a variation, or any information on recurrence rates. I’m going to try and contact him for more information.

– Professor Ernest Schilders, apparently offers a laparoscopic tissue repair. I’ve not come across any research on this technique, so haven’t looked into it further.

– The other two consultants offer Desarda repairs, though both have only done about 10 Desarda procedures each (no recurrences that they’re aware of) and tend to do mesh repairs usually. One of them advocated mesh repairs when I contacted him, though the other said he felt that the Desarda repair was a good equivalent and I felt that he came across very well, so I’m hoping to get a referral to meet him, as he only works through the NHS currently.

I’m guessing with you booking to go to Germany, you weren’t able to find anyone in the UK, or was it more that you weren’t able to find any advocates for non-mesh repairs in the UK who have the experience you’re looking for in performing tissue based repairs?

I’d be grateful for any further information that you or any other members might be able to share about UK consultants offering non-mesh repairs. I’m also very keen to know more about the Desarda technique and how effective it is. I’ve read a number of studies and meta-studies, mainly from Africa/Asia, which appear to evidence excellent outcomes.

Obviously there are numerous studies which advocate mesh repairs, so I’m finding it tricky to evaluate everything I’ve read. Having said that, I’m very clear that I’d prefer to have a non-mesh repair and I want to be confident that the surgeon I choose has an excellent record of successful long-term outcomes.

I may try and post a new thread as well, just in case other people miss this.

Many thanks in advance for any information you or any other members can provide.

Jack