[MarkT]

It really depends upon the underlying problem as to which method is best.

AFAIK, the usual order of imaging tests for groin pain is ultrasound, then CT, then MRI (and at least some of the reason for that is cost, time, and the expertise/equipment needed).

Dr. Towfigh uploaded a HerniaTalk on imaging a couple of months ago, which includes discussion on a couple of papers she and colleagues have published on the topic (including how the expertise of the person reading the scans is critical):

https://www.youtube.com/watch?v=jJcu8kHPkgA

In my case, a physical exam, ultrasound, and contrast CT have revealed nothing…next step seems to be MRI.

[MarkT]

I think I found the answers to both questions:

1. Yes, MRI is the next imaging step when ultrasound and CT are negative/inconclusive. Dr. Towfigh’s MRI protocol can be found at the 36:00 mark of the HerniaTalk 67 video from Aug. 17, 2021: https://www.youtube.com/watch?v=jJcu8kHPkgA.

2. Tissue repairs are possible for occult hernias. Other factors, such as body weight, tissue quality, etc., may still be relevant though.

[MarkT]

I have read that surgeon’s long blog post before and have problems with a lot of it. I may write a more detailed reply later, but I’ll say two things for now:

1. She ignores that the surgical community has not ‘moved on’ because the Shouldice method has been judged an inferior repair…in fact, it seems to have moved on primarily due to outside influences and pressures to public healthcare systems.

2. She is largely not approaching this from a patient perspective. The bulk of her criticisms are irrelevant for many individual patients, especially to those who meets Shouldice’s patient criteria.

[MarkT]

Just last night, I watched the HerniaTalk Live with Dr. Samer Sbayi (Stoneybrook in NY) as guest. He trained for 1yr at Shouldice and offers that repair.

Shouldice does use stainless steel (316L), but seems to ‘fallback on Prolene’)? Dr. Sbayi uses the exact same stainless steel, but he also uses Prolene.

https://www.youtube.com/watch?v=SnyI5qgYFEY

Start at the 10:00 mark…at 16:55, they discuss environmental allergies, including nickel and manganese. Dr. Sabyi also mentions having removed stainless steel in a patient who had a reaction and replacing with Prolene.

• This reply was modified 2 years, 6 months ago by  MarkT.