[John Fortem]

How do you do dumbbell presses from a prone position? Help me understand this. Is this where you lay down on a bench with your face down and then with dumbbells in your hands you move your arms up behind your back or up above your head or to the side? I have seen some pictures on Google, but I just want to make sure I understand this right.

So this very small bulge appeared several hours after this event and it’s on the same side of abdomen as the old inguinal hernia repair, but slightly higher up? When you say you felt a tear, did you also hear a crack and was it painful?

It’s been 48 hours since you posted this, how are you doing now? Do you have any kind of pain or discomfort? I am not a doctor, but it seems to me like it might be a torn core muscle caused by overextension. The bulge you see might be from inflammation and swelling of the muscle. I would still recommend that you go see a doctor.

[John Fortem]

Hello! I read the long story version and commented there as well. I’m glad to see you finally got the MRI without contrast, like you wanted.

No surgery is without its risks, unfortunately. Is this the same technique as used by Dr. Muschweck?

Metabolic stress can indeed play a role in triggering or exacerbating Crohn’s disease. Metabolic stress refers to the body’s response to various stressors that disrupt normal metabolic processes. This can include factors like infection, inflammation, and bacterial imbalances in the gut.

Research suggests that metabolic stress can reduce the function of the epithelial barrier in the intestines, which is crucial for maintaining a healthy gut environment. When this barrier is compromised, it can lead to increased inflammation and contribute to the development or worsening of inflammatory bowel diseases like Crohn’s disease.

Additionally, stress hormones such as cortisol and adrenaline, released during periods of stress, can negatively impact the digestive system, causing inflammation and irritation in the intestines.

Are you an athlete by any chance? I know an active football player who has Crohn’s disease. Crohn’s disease itself is not typically life-threatening with proper medical treatment and lifestyle strategies. However, it can lead to serious, potentially life-threatening complications if not managed effectively.

I’m always skeptical about techniques that have terms like “minimalist” or “minimally invasive” in their name. I initially wanted to have my own hernia repaired using a laparoscopic approach, but could not find anyone who would do it without a mesh implant.

I have seen a certain Dr. Kang here cited as saying something like, it’s better to have a failed tissue repair than a failed mesh repair. That catches very accurately the thought that I was guided by. I’m all about conservative and cautious approach to things that can have major and irreversible impact, in every aspect of life. But in modern times, I think we are often too cautious and we set our standards very high, and yet we still suffer. As always, the key is to find the right balance. Having no cut doesn’t count as surgery.

In the end, I accepted traditional, open surgery in my case. Like in the old days. No minimalism here. I was cut open wide and proper. But I found a very experienced and understanding surgeon. He is trained in the Shouldice technique. But he uses a modified Shouldice technique of his own. He’s like Bruce Lee! Meaning, the man is fluid and adaptive. Like we all should aim to be. He does it without a mesh. But he also sometimes uses a mesh. He does it with absorbable sutures. But he also sometimes uses permanent sutures. He told me the same thing your surgeon did, he would make the decision about what materials to use or not to use once he starts operating on me. It’s called intraoperative decision-making.

But my hernia was a proper hernia, not just a fatty tissue hernia. In fact, I have lived with it for about 9 years, and it started aiming for my scrotum. My brother had the same type of hernia, but his already reached the scrotum before he went in for surgery. That took 8 years I think, but he was about 2 years ahead of me, before I also developed a hernia. So he had his for 10 years in total I think. We both had ours fixed by Dr. Koch in Germany and have been hernia free for 5 and 6 years respectively.

I’m really sorry your own experience with hernia repair turned out so badly, despite being so small. What I think happened is your wound didn’t heal properly. Because you complained about having pain immediately after the surgery, and you continued to be in pain as weeks and months went by. That doesn’t sound normal to me. Perhaps you were allergic to the suture that was used, or the suture was not absorbed fully and properly by the body. Perhaps a permanent suture would have had a better outcome. Perhaps making the cut wider and deeper would have promoted faster healing and with less tension. Who knows at this point? There are a lot of things that can go wrong in a surgery, and every patient is different. For what it’s worth, I wish you a continued and full recovery.

[John Fortem]

quote Km8888:

Yup, same side. My brother also had a hernia operation on the right side as an infant.
I also remember having “episodes” of strong, sharp pain in the right lower groin area while playing soccer as a kid (ages 7-12) that would go away in 2-5 minutes, similar to cramps, but always on the right side. Those went away during my teenage years. I don’t know if it was gaining weight, or not playing soccer as often after I moved to the US.

I lost a lot of weight over the last year and significantly increased my physical activity, including doing squats with weight at the gym, and squat-jumps without weights on my lunch breaks.
I believe this is what put me over the edge and brought back the hernia, or worsened it to where I now have symptoms and a bulge I can feel whenever I stand for more than 30 seconds.

I have a consultation scheduled for August 20th with Dr. Brown, who I now see actually posts on this forum, so hopefully sometime soon I can get the hernia repaired without mesh and it’s associated side-effects and dangers.

That’s interesting. My brother also had a hernia, also on the right side. Yeah, I know I also gained some excess belly fat in my early 20s. As I recall I was 23 when I got my hernia. I used to train and compete in athletics from when I was 14 years old up until I was 19 years old. So I was definitely less physically active in the years that preceded my hernia formation.

Although, according to some studies the risk of developing a hernia is higher in people who are physically active such as athletes than in sedentary and obese people. They suggest that the fat somewhat acts as padding that suppresses herniation. I’m not sure what to make of that… but I am pretty sure that if athletes are more likely to develop a hernia then it is not because they lift heavy weights, but because they have poor form and body mechanics. It is a common misconception, almost a universal one, that hernias form by lifting heavy weights. That’s a myth! The best recipe for hernia formation is asymmetric overload in the lower abdomen/groin area, especially in a person who already has a weakness there from birth.

I have read great things about Dr. Brown. I think he is one of few surgeons in the US who does mesh free repairs. It’s a smart move finding a surgeon that fits your criteria and not prolonging the inevitable, you should not wait any more than you have to, especially if you already have bad symptoms from your hernia. I wish you good luck with everything and I hope you will get well soon!

[John Fortem]

quote Km8888:

Interesting… I’ve always been able to clench like I’m performing a kegel, and have my right testicle ascend upwards. Now I have a right inguinal hernia.

On the same side, right? This is a sign of weakness, and it’s likely that you were born this way, with inguinal ring not properly closed off. And as we age, the risk of developing a hernia in this area only grows bigger. Especially if you are not even aware of your weakness.

I am convinced that doing certain exercises can aggravate the already weakened tissue and cause a hernia. I know what finally caused my tissue to give in and cause a bulge (which I later learned is called a hernia). I was doing an asymmetrical stretch of my abdomen and legs. At one point I just felt instant pain in the right side of my groin, it felt like a tear, like quickly pulling up a zipper. I could instantly see and feel a small bulge, less than an inch in diameter underneath the skin. It was painful in the beginning, as the hole was still small and the pressure was high. I asked Dr. Google what it was, and that’s when I learned it’s a hernia. I never went to a doctor for this until later in life when I decided to take care of it. Like most men I presume, I didn’t feel comfortable having a doctor examine my junk. I just dealt with it on my own for about 8 years. I had it repaired 2 months ago, without a mesh and without cutting the cremaster muscle.

If you have a hernia, I would recommend having it repaired. Don’t play the waiting game, even if it’s asymptomatic. You will have to do it sooner or later, and sooner is much better. Just make sure you do it as naturally as possible for best possible outcome. First and foremost, that means doing it without a mesh, at the hands of an highly experienced surgeon.

[John Fortem]

quote kaspa:

About your aggressiveness to me, it seems inadequate to the forum, so any dialogue is finished now.

I am not being aggressive, I just don’t agree with you.

quote kaspa:

I don’t mean people who drive Rolls, of course (I thought that was clear). I mean people who plan and build a Rolls Royce.

I can see that now. I’m sorry, but English is not my first language.

quote kaspa:

I’m talking about engineering. What it has to do with hernia surgery? Well, I wouldn’t like an engineer to repair my hernia. I’m talking about perfectionism and yes here they share that with people from Shouldice Clinic.

And “here” is?… at the Rolls Royce factory? UK?

quote kaspa:

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

And “they” refers to Shouldice Clinic…

So let me get this straight…

1. You equate Shouldice Clinic (surgeons!) to Rolls Royce (engineers!). (You made that comparison, not me. I never suggested you would want an engineer to repair your hernia, I thought you were talking about car drivers, not car engineers.)

2. You like Rolls Royce for its perfectionism. Therefore, you align your preference in surgeons to your car/engineering preference. (Shoot for the stars! I get that, and I don’t blame you for wanting the best.)

I can finally see what Rolls Royce has to do with hernia surgery. Perfectionism! Like I said, I don’t blame you for wanting the best. But don’t ask me to agree that Shouldice Clinic is the best. Especially not on the basis of one single patient report of bad outcome and at the expense of one surgeon’s private clinic. And we have not even filled in the missing details of this patient report, or heard the other party (surgeon).

By the way, I don’t think that Audi engineers are any less of perfectionists than Rolls Royce engineers. If we are going to compare things, then we should make sure to compare apples to apples and oranges to oranges. Both groups are perfectionists, simply because they are engineers. It’s in their nature. In order to become an engineer you have to be more interested in things, and less interested in people. In order to become a doctor (of medicine), you have to be more interested in people than things. And I don’t think Dr. Koch is any less competent, any less skillful or any less interested in people than any one of the surgeons that work at the Shouldice Clinic. I don’t understand why someone would even question that. Based on a single case report?

Why do we even trust the Shouldice Clinic so much? Are they really above everyone else? Are they really the top authority when it comes to hernia surgery?

quote kaspa:

So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

You have to understand that Dr. Koch clinic is not a one-man shop. You can’t do surgery without a team of people. I don’t think he is any less of a perfectionist than the surgeons who work at the Shouldice Clinic.

I think the Shouldice Clinic is a good option for people who live close to it or who can afford the treatment at this clinic. Not many people do. But honestly, I think the Shouldice Clinic is glorified too much. That’s not without reason of course. It has played an important roll in pushing back against the “mesh empire”. It is still influential that way.

The name “Shouldice” is one of the main selling points for the Shouldice Clinic, along with its low recurrence rate. To the point that people avoid other clinics unless they use the “original” Shouldice technique. But remember, Shouldice would be nothing without Bassini. Which serves as an excellent example of that single doctor who went against the establishment at the time and paved the way for what later became known as the Shouldice technique, and fast forward a few years and you have the Shouldice Clinic. Was Bassini wrong?… did he make a sound argument for his technique? Why didn’t other surgeons pick it up until after his death?

quote kaspa:

You’re happy with your repair, and I appreciate that. But many people here are still making decisions.

I understand that. But suggesting that the outcome is much better if they receive the original Shouldice treatment at the Shouldice Clinic is not doing them a favor. So what? We should all travel to Canada and have it done at the Shouldice Clinic? That’s just silly, and not everyone will be able to afford that, and even if they did, it does not guarantee a positive outcome. There are no guarantees in surgery. At best there are some statistics and there is probability. Let me know when the recurrence rate at the Shouldice Clinic drops down to 0%.

quote kaspa:

It seems clear that Baris case was perhaps complex (not that sure), but it’s a surgeon’s task to explain that to patient (before surgery) and even reject it if they feel incapable to repair it. I’m sure surgeon already had a lot of info from Baris even before they met.

We still don’t have all the details, and if you want to be the judge you better gather as many details as possible, and you have to hear out both parties.

A surgeon cannot know what the eye can’t see, and neither does the patient. Some things are only understood in the middle of a process as you are doing it. Which is why my brother and Dr. Koch agreed to decide on surgical technique and suture material intraoperatively. Yes, my brother had his hernia repaired by Dr. Koch as well, and his hernia went all the way down to scrotum, but he is fine now.

quote kaspa:

No one feels much comfortable about Baris case, as you can understand. For people who are deciding, all experiences are worth the same, and it’s good yours is positive.

Agreed! But they should be uncomfortable for the right reasons. Not that I want them to feel uncomfortable of course… and I have given them more than one reason to feel comfortable about going to Dr. Koch.

I have said it before, but I don’t mind repeating it again. What really made my decision easy is when I read about a number of cases of mesh repair where one surgeon would put the mesh in but refused to take it out because of the difficulty of such operation, so the patient would travel to a different surgeon to have the mesh taken out. I can assure you that Dr. Koch is not one of these clowns who put the mesh in and then refuse to take it out or redo the surgery. Mr. Baris reported himself that Dr. Koch worked on him more than once. In fact Dr. Koch is one of the surgeons in Europe that people come to visit when they want the mesh to be removed. During my visit in fact, he had one such difficult case of mesh removal, where he had to transport the patient to a university hospital in a different city so he could remove the mesh. I know because he told me so, and he was late for my checkup. He had been gone for almost entire day.

Look! I am not Dr. Koch’s lawyer. If it makes people feel better, more comfortable, knowing that they received the “original” Shouldice treatment and they can afford it, then by all means, have them travel to Canada to get it done at the Shouldice Clinic.

[John Fortem]

quote DrBrown:

The cremasteric muscle does not have to be cut during hernia repair. I agree that the shouldice clinic advises cutting the muscle, but I do not feel that cutting is necessary.
Regards
Bill Brown MD

As someone who had an inguinal hernia repair done 2 months ago, I can agree on that. I had the “fake” (as some patients on this forum will suggest) Shouldice repair done in Germany, without steel sutures, without a mesh and without cutting the musculus cremaster. I’m a male in my 30s and I train 5 times a week (strength and conditioning), and I have not once had a problem with my testicle migrating up into the abdomen. And let me tell you, I should know what that feels like, because as a young teenager I used to play ping pong with that thing, my testicle would slide up into my abdomen and drop back out as if it was nothing! It’s only later in life that I got my hernia and that I learned that this is not exactly normal and something to consult a doctor about. It’s not something to laugh about and have fun with, that only aggravates the condition.

The take home message here is two-fold:

1. Cutting the cremaster muscle contributes nothing in preventing hernia recurrence. If anything, it should be cut long before a hernia develops in the first place… which doesn’t help someone who already has a hernia, and when the repair is done right there is no reason to cut the muscle if you’re a skillful surgeon. I would argue that if the cremaster muscle contributes to hernia formation at all, then it does so in the very early years in life, and in cases where the internal inguinal ring is not properly closed (which is the primarily what we have in indirect hernia cases in males).

2. Migrating or traveling testicle is an early warning sign. It’s a sign that this person may develop hernia later in life and therefore it should be taken seriously. I strongly believe that if insightful and knowledgeable advice is given at this early stage, it may help someone prevent hernia development later in life, or at very least postpone it. Like many ailments, hernia develops cumulatively. But clinically, it only becomes a “hernia” once it’s too late to prevent it. That’s all the more reason to catch the early warning signs. After all, prevention is the best medicine! And finally, of course, if we ask the Shouldice clinic, any young person that presents with a traveling testicle should have the cremaster muscle cut… just in case! It tells you something about the medical community and especially the Shouldice clinic. But who knows, at this stage, cremaster cutting may even be effective.

Disclosure:
I am not a doctor. I am just an average John. I know just enough about the topic to get by. And then there is my own personal experience of course, which gives me some insights that average doctors don’t have. Then finally, there is that thing called common sense… which sadly is no longer as common as one might think.

[John Fortem]

quote UhOh!:

But isn’t that an anatomical feature exclusive to men? Is there a female equivalent? Otherwise, wouldn’t apply to the OP.

Exactly! That’s anatomical feature in men. I wouldn’t know what the equivalent female version of that is, but the only reason that’s even brought up in discussions is because inguinal hernias are primarily a male problem. Primarily! But apparently women can also get inguinal hernias, but it’s far less common then in men. I can see now that the poster did report having an inguinal hernia, I didn’t see that at first or neglected that fact (lost in details).

I did a quick web search and found some interesting information:

“The cremaster develops to its full extent only in males; in females it is represented by only a few muscle loops.”

“In female humans, the cremaster muscle is smaller and is found on the round ligament.”

So as it turns out, women also have the cremaster muscle and while it’s anatomically or even physiologically different then in men, it’s situated in roughly the same area.

[John Fortem]

Spot on! Recurrence is often used as the primary outcome measure in these statistical studies of hernias. When what they should be using is as primary outcome measure is pain and other long term complications. Of course, reinforced concrete is much stronger than just concrete alone! But should you ever have complications from bad reinforcement and decide you want to get those rebars out of your concrete… well… good luck getting that out without damaging the concrete.

Don’t look only at the recurrence rates. That’s the trick! You have to look closely at other factors and take them into account.

I could also have done my hernia surgery for free in my home town like most people that live here. But the surgeon I met could not even tell me what kind of mesh would be installed in my body or what material it was made of. So much for “discussing” the “options” with my surgeon.

I have a relative who had a hernia repair with mesh, open surgery, and he told me he never had any issues with it. He did his several years ago and he is in his 60s. But why play dice? You need to know what the risks are if things go wrong. This is something that upsets many people who had mesh repair that are now against mesh repairs. They were never told of the disabling complications that can arise from mesh implants.

I went out of country for my surgery. And what really made my decision easy is when I read about cases where one surgeon would put the mesh in and refuse to take it out. There was one woman from my own town who got mesh implant for urinary incontinence, and she had to seek help out of country to get that thing out. The first surgeon refused simply because the procedure was too risky? Dear God! So I knew right then what I had to do.

[John Fortem]

quote jzinckgra:

I’ll spare you my long story, but yes, I had lapro mesh repair in June 2016 for left side IH. Two weeks later, started feeling and seeing right side issue. Drs all said no hernia, CT scan showed otherwise. Didn’t do anything about it then cause it sorta went away for over 2 yrs until this yr. Started getting dragging feeling, bulge, some pain in right side. Ended up getting open mesh procedure two weeks ago to fix it. Oddly and somewhat frustrating to say, I’ve had pain again on left side and hoping I don’t have recurrent one. These hernias are a PITA. In case you’re wondering why I went open vs lapro 2nd go-around was because I heard recovery time and pain levels were slightly less with open procedure. I can tell you for me, that was not the case. While the open wasn’t/isn’t terrible, I have more pain during recovery mostly due to the 1.5″ incision at 2 wks post-op then I did with lapro.

I did open surgery but without mesh. It’s been almost 2 months now since I had it fixed, and I have no pain or discomfort. I had it for about 8 years.

My reasoning in the beginning was to do minimally invasive laparoscopic surgery. But as I continued to do my research and learned about the possible complications of mesh implants, I started steering away from both meshes and laparoscopic surgery. I quickly realized then that if I want to do this “my way” I will have to travel abroad. I did look at different “absorbable” mesh options, but I finally decided that it was a futile approach and an experimental product, so I decided to go all-out open surgery and not hold back.

What I wanted to achieve by minimally invasive surgery, and what is often advertised as being the pros of this type of surgery is that it causes less pain because the incisions are smaller (but there are more of them) and that recovery time is shorter.

I decided to throw out all this fancy technology (meshes that “disappear” and surgery without cuts or pain…) and listen to that little voice in my head that told me to go with open surgery, without mesh. “As God intended” if you will… or as it was traditionally done for centuries. Surgery is surgery, is surgery.

I honestly think that open surgery is frowned open more than once, for no good reason, especially in the West where access to advanced technology like laparascopic equipment or even the robotic surgery equipment is more easily accessible. Now let me tell you about this latest cool thing called mesh… dear God!

My incision is just about 4 cm. That’s closer to 1.6 inches. Sure, I did have some pain. It’s surgery! You know the saying, no pain, no gain? I believe that applies here as well. But I was not dying of pain. I did take 12 tablets (6 small ones and 6 bigger ones) of painkillers for the first 3 days, as prescribed by the surgeon. After the first 2 to 3 days I was told to only take them on a need-to basis. I didn’t really have to take them the first 3 days either, it was not that much pain really. I never took the opioid, this one very strong tablet I received.

The way I see things now, I would never trade in open surgery for laparoscopic one, not even robotic surgery. Laparoscopic and robotic surgery come with their own unique set of limitations and issues. And have this in mind! Just because the incision holes are small to an external observer (patient for example) does not mean that a lot of cutting is not going on on the inside and that a lot of difficult cuts and suturing is not performed. Quite the contrary!

So why not make your surgeon’s job much easier by allowing him or her to cut you open so they can properly see and reach in and fix you right up the first time, and improve the outcome of your surgery? Fear? Everything you want is on the other side of fear!

Anyway! Those are my reasons for going with open surgery, and of course part of the reason is that I wanted to do the mesh free, suture repair. To me, that’s the only reason to ever do open surgery anyway. If I wanted a mesh repair I would be indifferent about the access mode. Mesh is mesh, is mesh. Mesh does not become less of a mesh by doing open surgery. I don’t buy that. Sure, having easy access and good view might help you install the mesh correctly, more so than laparoscopically, but if you already have a patient open up right in front of you and everything is so easy to see and reach then you should have a very good reason for installing a mesh in the first place. I believe meshes should be reserved only for very extreme cases, and of course in laparoscopic surgery due to the very nature of that kind of surgery with restricted access, bad view and all that follows with it.

[John Fortem]

quote Hiway40blues:

Hi-my first post here. I had an IH open-with-mesh repair last Fall (October) on my right abdomen. I decided on ‘open’ for various reasons, including a strong fear of general anesthesia. Anyway it went well, still have occasional tenderness, etc., but I’m back to my usual routine, including lots of walking/hiking. In December I started getting pains in my left side, and in January a bulge appeared there. I was very upset and disappointed: I got myself through the first surgery by telling myself -‘get it repaired and get on with your life’. Now I have to ‘psych’ myself up to go through it all again. Out of curiosity, has this happened to many people here? After getting an IH repair, did you develop one on the opposite side? I wonder if it was there all the time, and nobody noticed it because there wan’t a bulge there.

I had open surgery without mesh, but with general anesthesia.

Getting a hernia repaired and getting on with your life is the right attitude. I wish I had done mine years ago.

My hernia was on the right side as well. While I don’t have a hernia on my left side, I will tell you this! I have read that hernias can migrate from one side to the other, and I have witnessed this on myself.

To put things in perspective, I had my hernia for about 8 years, and during the first 2 to 3 years I had it disappear on the right side and appear on the left side at least 3 times. My hernia was reducible where it goes back into the abdomen when I lay down on my back during sleep, and I would simply notice in the morning when I go to the bathroom that the hernia is on the “wrong” side. Whenever it was on the wrong side it would feel very uncomfortable, as if pushing on the wall so it can pop out. Thankfully, it would move back to its normal location in the days that followed. It’s been probably about 5 years since the last time it appeared on the left side, the “wrong” side. Ever since, it has been on the right side. And now it’s fixed, for good, I hope.

It’s been almost 2 months now since I got it repaired and I have no problems with the left side and there is no sign of bulging or discomfort there. So I don’t think I will get a second hernia on the left side anytime soon. But since I did have a bulge or a migrating hernia there, I might have a weak spot there that may become compromised later on in life. But I will cross that bridge when I come to it, and I know now how to deal with it. It’s much better to deal with your problems as soon as possible than to play the waiting game and procastinate.

My point is that while you may not have a bulge on the opposite side, it’s quite possible that you have a weak spot there as well if you already know you have or have had bulge/hernia on one side.

[John Fortem]

What kind of hernia do you have?

I don’t know what this “long lasting local “numbing” anesthesia that lasts several days” is. You could ask (the other doctor) what this is.

As for painkillers, I think I used 2 x 6 tablets, 6 smaller ones and 6 bigger ones. I received several blisters of both types and 1 which I think was a strong opiate for severe pain, which I never used. I didn’t really have to use the others either, but I took them as I was told to take them at least for the first 2 to 3 days after surgery. Sure, I did have some pain after surgery, but it was not something I could not tolerate. If you can tolerate the pain, there is no need for painkillers really.

For the record, I’m a male in my 30s and I had open inguinal hernia surgery without mesh, and I had it done under general anesthesia. For me, having general anesthesia was just like falling asleep and then waking up and wondering when I would go in for surgery, only to be told that it’s all done. So it was like nothing. You don’t know what you’re made of unless you go find out. I also never had any surgery before, this was the first time for me, and I honestly would rather do it again under general anesthesia than having to watch and listen to the doctors working on me. I had no adverse effects from the anesthesia.

As for cutting… well, something will have to be cut if you’re going in for surgery. If you want to limit the amount of cutting then the minimally invasive, laparoscopic approach is probably the way to go. However, that nearly always entails mesh repair. In other words, if you want no-mesh repair, then you have to do open surgery. If you want minimally invasive i.e. laparoscopic repair, then you have to get a mesh. Dr. Towfigh is to my knowledge the only surgeon who offers laparoscopic repairs without mesh. There may be others, but she’s the only one I know of.

As for pain as a result of suturing, that’s only the case when suturing is done in a way that causes tension, i.e. tugging and tearing on the tissue. There is more than one way to make incisions and suture tissues together. These are the surgical techniques that are so often discussed on these forums. So here is an important question you can ask the surgeon/doctor, what type of surgical technique he or she uses.

[John Fortem]

Wow! Another happy end I see. Good luck dog!

[John Fortem]

quote kaspa:

I appreciate very much Fortem’s reports and am happy he’s doing well.

Thank you! It’s been close to 2 months now. The scar is even less visible now and the “sausage” underneath the skin (along the incision line) is almost completely gone now. The absorbable sutures are likely more than 50% dissolved by now and I still don’t have any signs of reccurance.

quote kaspa:

However, Bari’s case can’t be disregarded and there seems to have been not much dialogue there.

Let me add that any type of “alternative repair” is better than the “one size fits all” approach done world-over using meshes. Be it Shouldice, “not so much original Shouldice”… whatever! I have said what I think about the “originality” of these different techniques.

As for this particular case, first of all, I really hope that this person gets the help he needs and deserves. As I recall, the operation at Shouldice clinic is already done with by now. I hope he will report back about the results. If you want to be scientific and objective about this then you want to make sure to document the Shouldice side of the story here. It’s one thing to talk loudly about this and that, how one doctor is doing it wrong and the others would never dare to… but let’s see some results please.

Now, the very first thing that came to my mind while reading Bari’s report is the number of hernias he had. Did he in fact have 2 hernias? Two indirect hernias? As I recall he even had a third one? I posted these questions before and I am still waiting for answers. Also, did the hernias go all the way down to the scrotum?

Sadly, this strikes me as a difficult case, and yes, Dr. Koch does do mesh repairs where he finds that it is inevitable or in other words where he does not feel confident to do it without mesh. And yes, surgeons will sometimes go against what was discussed previously with the patient. A bad surgeon will do that irregardless of what the patient wants. A good surgeon will only do that when the current situation forces his hand to do so and he sees no other option, other than aborting the operation. Look! When the patient is breathing through the laryngeal mask and his abdomen is cut open, he has nothing to say about what is to be done. His life is in the hands of the surgeon! Now, if the patient is so paranoid that he does not want a mesh implant under any circumstances then this should be agreed upon beforehand. Then the surgeon can just close him up and send him off to a different surgeon or whoever the patient thinks will fix his problem his way… the “original” Shouldice clinic or whatever.

It’s not easy being a surgeon! It’s a fine line you have to walk. But when it comes down to following the wishes of the patient, vs. saving the patients life, wishes of the patient have to be put on reserve. First priority becomes saving a life. I understand this is a more dramatic example, but nonetheless, the surgeon has to take charge, not the patient. This is just common sense. Unless of course the patient wants to operate on himself or expressly states that he does not want mesh implants under any circumstances, because the surgeon can then abort the operation if he finds that a mesh must be used.

It also seems that the patient was not patient enough. If the surgeon tells you everything is normal, and you have to wait for the body to heal properly, then you do what you’re told. You don’t immediately start pressing his buttons to do something about it and then complain how the Shouldice clinic has told you how they would never have used mesh and how they would never have done a second or third surgery without allowing at least several months to pass before they re-operate. It becomes apparent here that Dr. Koch was giving in too easily and bending to the wishes of the patient. Sorry to say this! But this is the picture I am seeing here, given what was said previously.

As for Cremaster muscle, Dr. Koch will not cut it unless he has to. The “original” Shouldice repair as done at the Shouldice clinic does that routinely, as a preventive measure, even if the current situation does not call for it. So that’s keeping up with the tradition for you. In my case, Dr. Koch did not cut the muscle. But my hernia was not scrotal. In my brother’s case he did make a cut. But he had waited for it to go down to the scrotum before having it repaired. Same surgeon! Different patients (brothers!)! Different clinical presentations! Different approach!

This is all the more reason for people with hernias to get them fixed as soon as possible! Don’t play the waiting game. I did that for about 8 years. I still had to have it done! In the end, most of us end up getting the surgery, and I think it’s better to do it sooner than later. I was lucky that my hernia was not extensive and did not go down to scrotum.

quote kaspa:

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

I don’t understand the Rolls Royce reference. Are you saying that people who drive Rolls Royce cars are paranoid? Paranoid about what exactly? And what does this have to do with hernias or surgery? If it makes your mind at ease, Dr. Koch drives a sporty Audi. I’m not sure if that makes him paranoid… by your definition.

Of course, Dr. Koch is highly untrained and he has no team?… that’s just rubbish! If the majority had to decide, then the Bassini technique would never have happened, and since Shouldice technique is derived from Bassini, the Shouldice clinic would never have seen the light of day.

quote kaspa:

They don’t simply follow original Shouldice teachings, hopefully. They even do mesh repairs in selected cases, less than 2% according to them.

Well, of course they don’t! They “only” use steel sutures and cut the Cremaster muscle routinely. And sometimes, they also use mesh. Go figure! For starters, you have to define exactly what the “original” Shouldice technique is.

According to them, yes. In the end, we all believe in what we want to believe in. Humans are biased by nature. Do whatever you think is good for you, and do your own research. But there is no good reason not to get rid of your hernia if you have one, free yourself of this problem and move on with your life.

[John Fortem]

When was it upgraded? What in particular is wrong with it?

I joined in 2018 and I seem to remember that it was better before. I think it was running on vBulletin and now it runs on WordPress. I was absent for about 4 years, and I logged back in just this week after resetting my password. I have noticed a few problems caused by the migration. For instance, clicking on certain old links returns a zero, a plain and simple zero on a blank page. I think it was a notification link in this case, so viewing content I was notified about 4 years ago is not possible. But at least they didn’t nuke and pave, and that’s honorable.

[John Fortem]

Yeah, that must be it. I seem to remember they had something like a white powder poured in and mixed with water. I think I had Gadolinium myself at one point. But I think I did a CT scan, not MRI. Not sure if they use the same stuff for both CT and MRI. They injected something in my vein, and I remember feeling all warm inside. They did warn me that it would have that effect, and that it might make me want to pee.

[John Fortem]

What was the suture thread made of? Absorbable sutures don’t last longer than 3 months, and by then they have lost most of their strength. If they last longer than that, then they are probably permanent sutures.

[John Fortem]

Where are you getting these numbers from?

On average, people are exposed to about 2.4 millisieverts (mSv) of natural background radiation per year. This exposure comes from various sources, including cosmic radiation from space, terrestrial radiation from the ground, and small amounts of radioactive materials in the air, food, and water.

In some places, the average annual exposure can be higher due to factors like altitude and local geology. For example, people living in areas with high levels of radon gas or at higher elevations may receive higher doses of background radiation.

https://en.wikipedia.org/wiki/Background_radiation

The amount of radiation you receive from a CT scan depends on the type of scan and the part of the body being imaged. For example, a typical CT scan of the abdomen and pelvis exposes you to about 10 millisieverts (mSv) of radiation, which is roughly equivalent to 3 years of natural background radiation.

Different types of CT scans have different radiation doses. For instance, a head CT scan exposes you to about 2 mSv, which is equivalent to about 8 months of natural background radiation.

So, while CT scans do expose you to more radiation than other imaging tests like X-rays, it’s not quite as high as 7 years’ worth of natural background radiation in a single scan.

https://about.cmrad.com/articles/ct-scan-radiation-dose-understanding-msv-exposure-levels-by-scan-type

[John Fortem]

Good question! Was this in Germany?

My brother was pretty much refused an MRI scan if he didn’t take
Gadolinium. At one point, he came so close to getting on with it. He came to the hospital for his appointment, and they brought out the stuff. I drove him there so I followed him in. I may be confusing something here, because when I google it now I see that Gadolinium is injected into one of your veins. I remember they had a pitcher and a cup on a serving tray. He had to drink it. He was hesitating and refused in the last minute. He had to take it some time before he went in for the scan.

This was some years after his indirect hernia surgery and he complained about some abdominal pain, and the doctors thought it might have to do with his hernia surgery, which he had in Germany actually. Thankfully his symptoms cleared up after about a year or two, he told me. I spoke with him about this a few weeks ago.

[John Fortem]

Do you guys have an MRI machine at your clinic? If you do an MRI scan without contrast, can you assess possible hernia recurrence?

[John Fortem]

I never got around to thank you for your reply. It confirmed my suspicion. So for what it’s worth, here I am, 6 years later. Thank you!

I went back in time to find the Twitter post you mentioned:

https://x.com/Herniadoc/status/1025234860045025280