[Jeremy B]

As I understand it; Direct hernia occurs medial to the vessels, which is closer to the centerline of the body and very rarely comes into the scrotum and rarely is dangerous.
Indirect glides through where the spermatic cord is and can go to the ballsack and has a greater chance of incarceration.
I found out I have a Direct hernia through ultrasound, It’s not commonly ordered amongst the masses. I’m living with it until I can find a surgeon I am comfortable with doing a quality mesh free repair. I am in MN and have had no luck finding anyone around here; Mesh Mesh Mesh all the way…
-Jeremy

[Jeremy B]

Baris, did Dr Kock just go ahead and use absorbable during the Shouldice or did you request it?
Did he say he had good luck historically with absorbable?

Thanks in advance
Jeremy

[Jeremy B]

Which type of hernia (Direct or Indirect) is more likely to respond to a core based regime as far as symptom improvement and or management?
Thanks in advance for your input drtowfigh.

-Jeremy

[Jeremy B]

Baris, who performed your shouldice repair?
Apparently if PDS slow absorbing sutures are used it will hold and give your body enough time to heal.
Dr. Grishkan will do a two layer shouldice with absorbable upon request.
What type of repair did you end up going with?

Thanks in advance!
Jeremy

[Jeremy B]

So I had an ultrasound done and the results show a Direct Inguinal hernia with bowel (protrusion medial to the vessels) upon Valsalva.
I’m saddened by this news as It seems like the repair will be more invasive (repair of the floor) vs high ligation and a couple of stitches.
The only good thing is that the direct type is less susceptible to strangulation.

#Dr. Towfigh, have you had any luck with a core based regime in people with a direct hernia?
or would it only benefit someone with an Indirect defect?

[Jeremy B]

Hey AGF, yea you definitely don’t need mesh but you will likely have to travel to get Non-mesh repair with a competent surgeon. To answer your question there is a guy in Cleavland, OH, Dr. David Grischkan who will perform a partial 2 layer sholdice with absorbable if you request, I will go to him if mine is a direct hernia, I’ve spoke with him on the phone personally, but am now thinking of going with Dr. Brown since most likely my hernia is an Indirect type and he can perform a more specific technique for that type (marcy repair). I get an Ultrasound tomorrow and hope that I can get an answer.

[Jeremy B]

I too have a comfort Truss by George Hirst and I was part of his testing group, so I have a few of the test models.
They are way more comfortable than any others I have tried, and keep my hernia reduced most of the time. I go Mountain biking and snowboarding so I definitely put them to the test. All praise aside, I’m so sick of having to put on a truss everyday and am greatly considering surgery; Im just sooo afraid of a potential bad outcome that might leave me worse off than my current state.

[Jeremy B]

Thanks everyone for the suggestions, and thanks for the try at home test Dr. Kang; I will give this a go.
At many times in the morning It will stay mostly reduced, It gets more pronounced after a long period of standing, during mental or physical stress.
I acquired this from straining extremely hard on the toilet and felt something quickly pop out and back in. It wasn’t noticeable at first but if I strained or coughed I would get the same popping out and back in sensation. The bulge became apparent over time, with some burning sensations and is closer to my pubic bone than my leg crease. Do any of these symptoms suggest one type over the other? Any thoughts appreciated.
Thanks!
-Jeremy

[Jeremy B]

Good Intentions, thank you for your response.

I am a 37yo male, 170lb thin, 6’2″ diagnosed with a right side inguinal hernia by two local surgeons (both hernia specialists);
Neither of them were able to determine subtype upon examination.

The reason I would like to know the subtype is to develop a plan with a very conscious surgeon who can perform a quality no-mesh repair with minimal trauma. Please chime in with any thoughts or opinions.

If it is a Direct hernia I will try to live with it as long as possible as the surgery is more traumatic and involved.
If it is Indirect then I will travel anywhere to have one of the all time masters repair it:

1. If It is a very small opening in the internal ring, Dr Ponsky has what seems to be the least invasive approach (High ligation Laparoscopic) Yet limited data is concerning.

2. If it is a defect that is larger in size, than Dr Kang and Dr William Brown have methods to isolate just the Indirect defect by high ligation and narrowing of the ring.

3. I wish I knew more details of what Dr. Towfigh offers as I would consider her as well.

I would also be open to documenting (video) the surgery so that others may see and benefit. @Dr. Kang I know that many people would like to see your technique, I’d be honored if you used me as an example.

Thanks!
Jeremy

[Jeremy B]

Thank you Chaunce1234, I will keep up the search for a radiologist that can confidently perform an ultrasound with valsava.

It is so frustrating that the majority of doctors or radiologists here don’t do this or have an interest outside of just opening me up and stapling down some plastic; This sounds terrifying to me.

I guess in America we are quick to slap a bandage on the issue and hope for the best. my apologies for the rant, I’m just so frustrated.
Right now my thoughts are, Try to live with this thing or travel to Dr. Brown,Dr. Towfigh, Dr Ponsky or Dr. Kang.

-Jeremy

[Jeremy B]

Thanks for the discussion @Dr. Kang @Dr Towfigh [USER=”2533″]Jimbohen[/USER]

Has anyone developed a way to perform the high ligation and put a stitch in to narrow the deep inguinal ring using laparoscopy?

Also, is the sac usually adhered pretty well to the cord?
Is that why healing a hernia naturally is not possible?
My thought was that if you could “get the sock out of the door” the muscles could theoretically tighten back up.

-Jeremy

[Jeremy B]

Dr. Ponsky would like the following communicated:
“I DO NOT yet recommend this to adults because we dont have enough data yet. We are conducting a prospective trial in Norway and have not had a recurrence yet (about 20 patients so far) but I make it very clear to my older patients that they must understand that we dont know yet who this will fail in”

[Jeremy B]

Thank you Momof4; Yes, this is exactly what I’m in the process to have done. I will keep you all posted on my journey. Crossing my fingers for an indirect hernia.
Dr. Kang, Dr. Towfigh, what is your estimated incidence of Direct vs Indirect? And if It is Indirect, Is there often a weakness in the Direct area?
Thanks in advance!
-Jeremy

[Jeremy B]

I had my phone meeting this morning with Dr Ponsky, I was very impressed with his knowledge and willingness to explain everything and take the time to answer all of my questions and concerns. Like many surgeons on here, he is thinking outside the box in regards to innovate approaches and ideas for hernia repair. I am very excited to potentially have this very minimally invasive surgery. I just need to determine if I have an indirect or direct hernia. Does anyone here know of someone in the states preferably near Minnesota, who can differentiate between the two via sonography or other non invasive methods. Id like to know beforehand vs exploration with laparoscopy. It seems that Dr. Kang routinely orders this before surgery and that seems like a smart idea.

Thanks!
Jeremy

[Jeremy B]

Chaunce1234, Thank you for posting about Dr Todd Ponsky. I talk with him tomorrow morning about entering his trial.
I really hope that I’m a good candidate for the procedure: https://www.youtube.com/watch?v=nsIHTlfhrM4
I just hope that I have an indirect hernia as it seems a less invasive repair can be utilized.

What type is more commonly seen in a fit healthy middle aged male? Direct or Indirect hernia?

[Jeremy B]

Chaunce; Thank you for the reply and the link, I may try to get on board this study.

As far as my hernia, Id say its fairly small to medium, probably mostly fat in there, there have been a few instances where it seems like bowel potentially.
I’d like to avoid surgery if possible, I where a truss and have done exercises to try to strengthen the core and obliques, not sure how much benefit this has had. Im in contact with others that have “almost cured” there hernia so It gave me some hope.
On the other end, I’m so sick of dealing with this thing; Its brought me into a deep depression that has landed me into the hospital twice now.
I’m just so scared of surgery, Nerve damage, chronic pain, reaction to anesthesia or materials, being left worse than I am ect..

[Jeremy B]

Dr Towfigh & Dr Kang; Dr. Brown: http://www.sportshernia.com executes Marcy repair in adults. I believe it must be an Indirect hernia for this repair and maybe some other requirements.
I am very interested in this repair as it seems like it would be much less invasive than anything i’ve seen yet.
Is is possible the unsuccessful scenarios were in conjunction direct hernias?

[Jeremy B]

Would there be a reason to go Desarda vs Shouldice?

What type of tissue repair is done with Dr Towfigh’s robotic system?

[Jeremy B]

Thanks Levi, My plan is to see if I can just get it to a point where it doesn’t require surgery.
If I did go the surgery rout my goal would be as minimal of a procedure as possible. No mesh, absorbable PDS, facia only repair, main nerve branches preserved, maintain a functioning cremaster. (minimal or modified sholdice)

Does anyone know of a surgeon near minnesota that performs a quality tissue only repair?
The seemingly least invasive repair I have found in the states is with Dr Grischkan in OH, two layer Sholdice, does anyone have any experience with this guy? Or maybe a robotic no mesh repair from Dr Towfigh.

Finally is there anyone trying to pioneer a better approach than what exists?
maybe something to facilitate facia remodeling by injection? Prolotherapy?
It seems like Dr Towfigh might be on the forefront in regard to alternatives.

I know this was multifaceted but any replies are appreciated.
Thanks!
Jeremy

[Jeremy B]

Dr. Towfigh, Thank you! I think I will give the strengthening exercises a go.

Given your expertise; Do you think it is it possible for the stretched fascia to heal or regain sufficient integrity if the surrounding musculature can keep the bulge contained?

Do you know of specific exercises that focus on this area?

Sincerely
Jeremy