[John Fortem]

quote drtowfigh:

It means different things to different people. The classic “darning” is using suture to recreate a hernia mesh effect. It is also possible that they just means suture repair.

For a seamstress it means to patch a hole in a sock; for a surgeon it means to patch a hole in a sack. :rolleyes:

[John Fortem]

quote Tilda:

Dr. Slooter in the Netherlands.

Gerrit D Slooter? From Maxima Medical Center?

[John Fortem]

quote dog:

Here is very respectfully doctor’s onion below !

The Desarda technique is very simple and seemingly sensible as a way to repair an inguinal hernia. However, as a responsible academically driven hernia specialist, I am responsible to data driven decisions. The Shouldice repair is also an elegant repair with a history of 70 years of success. It has been studied extensively and clearly remains the gold standard for a non mesh inguinal hernia repair. While it is more complex than the Desarda technique, the results from Shouldice are consistent with a long history of safety and patient satisfaction and long term recurrence rates of 2-4 %.
While initial results may be excellent from the Desarda repair, long term data does not exist.
For this reason, the Shouldice repair remains the gold standard for non mesh hernia repair.

Jonathan Yunis MD FACS

http://www.centerforherniarepair.com
941-953-5917

All valid arguments. But in Shouldice, they use a steel wire for suturing. Unless it’s a modified Shouldice technique with absorbable wire.

[John Fortem]

My hernia is retractable as well. When I lay flat on my back, about an hour later it goes completely back in. So I usually go to bed with a hernia and go up in the morning without a hernia. It can take anywhere from a couple of minutes of walking around to several hours before it begins to bulge out. The longest I have gone without the hernia is 3 full days. Not having it bulge out was a great feeling. But when it starts to bulge out eventually it can be discomfortable, but not so much painful.

Of course, I would also much rather have it repaired. But there is not a perfect solution for it. Just like you, I was only given the option of mesh repair. Mesh repair is the new normal all over the world. I really resent the idea of a piece of plastic inside my body that holds my intestine in. So I said no to the surgery. I am glad that I said no at the time. I am much better informed now, and if I had to go for surgery now I would take my chance at non-mesh repair, using my own tissues to hold my intestine in. But these surgeons are not easy to come by.

The best advice I can give you is to do your research. There is definitely much more to this than what your GP or a general surgeon will let on. But given your age, and the fact that your hernia is asymptomatic watchful waiting is definitely an option. I also got my hernia in my 20s, and I have had it for about 8 years now. It did increase in size slightly. But it’s not the size of a football. If it was the size of a cherry at the beginning, it is now the size of a golf ball maybe. And then there are also those days where it is completely tucked in and is zero-sized.

The important thing is not to stop questioning…

[John Fortem]

Not that seeing a surgeon always helps… I mean I saw one and he just looked at it and confirmed it was a hernia. Well, since there is a bulge in my groin, any layman will tell you what you have. He was not specific about what kind of hernia it was. It is a groin or inguinal hernia alright, even I know that. But is it direct or indirect? He said I should have it repaired if it is bothersome, and that I will have to do it eventually.

I said no to surgery back then.

A) I resent the idea of using a permanent mesh to cover the defect, and that’s the only way he would do it, because that’s how it’s done today. I had no other option. Other than to say no and live with it. I have lived and survived to tell you the story. I have had it for 8 years now and I have not had any major problem with it, least of all strangulation which is sometimes used as a form of scare tactic.

B) I don’t have respect nor confidence in a surgeon who doesn’t want or know how to set a proper diagnosis by palpation, or by ordering ultrasound, CT or MRI scans.

[John Fortem]

First things first, you have to establish if you have a hernia or not. There are rare cases where diagnosis is not all that simple, but these cases are very rare by what I understand. It sound like this is such a case. Get a third or even fourth opinion if you have to and then make the call for surgery. If they just open you up to see if they can find and repair a hernia, then that’s explorative surgery and should be reserved for only urgent and very complicated surgeries.

[John Fortem]

You can edit out “supposedly”. I just had a chat with the Shouldice hospital and they do indeed use stainless steel sutures.

I cannot comment on your other questions because I do not know, it’s something I am trying to understand myself.

[John Fortem]

I may be wrong, but I think Desarda is the only tension free, mesh free repair. It is my believe that it is one of the best mesh free repairs, if not the best. That is my opinion. Note that I am not a doctor nor a surgeon. I have had an asymptomatic inguinal hernia for about 8 years now. I never repaired it because my hernia is retractable and asymptomatic so I was able to live with it for good 8 years and I may continue to do so for another 8 good years. On top of that, I really resent the idea of using a plastic mesh inside my body. I don’t want a Coca Cola bottle in my groin, no thank you.

So I have been reading up on these alternative, more traditional approaches, and Desarda seems to be the next step in the evolution of mesh free repairs. That’s a very much welcome addition to this art. It really is an art. Any novice surgeon can patch up a hernia with a piece of plastic mesh at the expense of misery for the patient. Only a true master of the craft like Desarda, Bassini, Shouldice, et al, pass on a heritage and have a technique named after them with great outcomes for the patients.

Patient first! Profits last! In many healthcare systems the focus lies on cutting down costs, time, and decreasing re-operations. If patients complains of chronic pain, they just tell them its in their heads and hand them some painkillers. Who cares about a single individual? The larger collective comes first. Then there are also the companies that make mesh products. They are also in it to win it. It’s a billion dollar business for them. One which will only increase with growth of population and sedentary lifestyle. Then there are also the hospitals and insurance companies. Everyone is chasing the dollar. It is the harsh reality of things.

If I had to go for surgery tomorrow, and I had a choice, I would go for a mesh free, tension free repair. Be it Desarda, Shouldice or a combination of the two or other techniques.

[John Fortem]

I am in my 30s now and I got my inguinal hernia in my 20s. I have had it for about 8 years now. You might be thinking why I have not fixed it yet. I am holding out for a record. Just kidding! Even I know I will have to fix this thing one way or another. But I really resent this idea of fixating a plastic mesh inside my body. It is such a sensitive and active area of the body. It’s incredible how complex this seemingly simple problem is, despite falling into the category of “general surgery” and despite the fact that over 20 million people worldwide have a hernia surgery every year, most of which are inguinal hernias.

Hernia repairs without the use of a mesh is not the commonplace. You have to use a lantern to seek out clinics and doctors that perform mesh-free repairs. Some of them have sought refuge in Canada where you find the Shouldice clinic, the last stronghold of the skilled masters of the art of mash-free repairs, where mash-free believers travel to like pilgrims every year. Thankfully, like any good Karate school, they have sent out their scholars to all corners of the world to preach their mash-free believes. But you will still find that most places in the world perform mesh repairs using polyethylene (PE) or polypropylene (PP) material. The stuff that Coca Cola bottles are made of. It allows ordinary and inexperienced surgeons to perform hernia surgeries. It’s no big deal they say, it’s one of the most common type of surgeries they say. But you should not take any type of surgery lightly.

I understand the challenges that bioengineers face when trying to engineer that perfect mesh material. But they have tried and failed again and again. That is not to say they should stop trying. But there has been very little progress since the earliest plastic meshes were introduced some decades ago, from the horrific products from leaders in this “market” (it is a billion dollar business) to the latest “laced” and “dual layer” meshes and even absorbable meshes that supposedly promote neogeneration of supporting tissue through means of mechanical forces and tissue in-growth, and subsequent absorption of the mesh material. I have had the time to read all about it. It’s an area of active research for a great number of applications, not just meshes for hernia repairs.

I strongly believe in the body’s ability to heal itself. So instead of trying to invent biocompatible synthetic meshes, we should look at how nature does it, how our own bodies do this. If the body cannot heal these defects on its own, we have to give it a push. Not by putting in foreign objects in it. Come on! We are living in the 21 century. How about tissue engineering? I mean growing required tissues in a lab using stem cells and stuff like that. It’s technically possible. But it may not be economically feasible or of interest to all parties involved, especially not mesh makers.

What’s your hernia like? Is it large? Painful? Is it in the groin? In the scrotum? Does it prevent you from performing certain tasks? Is it reducible? Every hernia case is unique and so is each patient. There are many factors to consider. I am no doctor, but just know that not doing anything about it or putting it on “watchful waiting” is another option. This is something you can discuss with your doctors. I have had mine for 8 years and had pretty much zero issues with it. I know I will have to fix it eventually, but I might as well get another 8 good years out of this waiting game. Don’t rush to surgery.

[John Fortem]

quote dog:

Dear Dr drtowfigh can you please give a link to those exercises you kindly tell us about ?

See if this might help.

https://www.mayoclinic.org/healthy-lifestyle/fitness/multimedia/core-strength/sls-20076575

[John Fortem]

As I said, it was just playing tricks on me. By the end of the day it eventually started pressing on my abdominal wall and some time later it was out. But it’s interesting development still. I have not had these episodes come and go so frequently. Going on 3 days straight without a hernia was a great relieve. But when it eventually starts poking out it is very uncomfortable. I would much rather have it get out to its usual resting place when I get up in the morning. As I said, my hernia is asymptomatic. Having it stay in and then start pressing to come out slowly is much worse. I don’t know what has changed, but it’s a new development. I did lose a bit of weight over the past month.

I agree, it’s practically impossible for the hole to heal up on its own. Maybe, just maybe if the hole is very small. But that means you would have to catch it early on. Strengthening your core is supposed to promote healing. That’s something I have read at least.

[John Fortem]

That would be Dr. Joachim Conze, yes. From what I understand he is the chief physician at the center at the moment. I’m not sure if Dr. Muschaweck is still operating at this center. Either way, this seems like an excellent place for high quality treatment.

[John Fortem]

This should be the website of the hernia center she founded:

https://www.hernien.de/

[John Fortem]

There are indeed people who specialize in removal of such meshes. You can look for places or doctors that do the mesh free repairs. They should be able to remove the mesh and repair the hernia without using a mesh.

This thread was posted earlier:

https://www.herniatalk.com/8117-no-mesh-shouldice-hernia-surgery-in-germany-europe

One doctor named Ulrike Muschaweck is mentioned in it.

[John Fortem]

Hey Jeremy!

How you been? Is your conservative approach working?

I share your sentiment. Don’t rush to surgery unless your hernia becomes strangulated which is extremely rare, or you have big problems with your hernia such as constant groin pain or it becomes very large or passes down into scrotum. I have had mine for 8 years now and I am still staying away from surgery. My hernia is reducible, meaning it goes back in when I lay flat on my back and it has not enlarged by much (if at all) over the years. So it is possible in such situation to lead a normal life, with hernia, and without surgery.

Moreover, I have had episodes where my hernia would not poke out in the morning when I get up. Right now I am in my day 3 without hernia. I’m sure it will poke out again eventually. I hope of course that it would stay like this, but I think it’s just playing tricks on me right now. I wrote more about this over here, you can check it out:

https://www.herniatalk.com/8181-can-…ithout-surgery

Wishing you good health.