[mst3k]

thanks for the advice. I have read so many bad stories of that 3D Max mesh, I hope it has been pulled from sale. One thing I hate about this is the constant changes they make for marketing purposes to add unnecessary gadgets and gizmos like multiple layer “systems”, plugs, shaped or rigid mesh, expansion springs, etc. None of this was ever for patient benefit.
The lack of suture options is frustrating. Shouldice hospital is one of the last bastions of high volume suture repair left, that is amazing to me. If not for them, there may have been no high volume data left that could demonstrate that a suture can be effective in the right hands. It makes me feel like I must be crazy for considering a mesh-free repair.

[mst3k]

the majority of mesh implants will be permanent, and hopefully will never need to be removed.
I didn’t mention mesh vs. non-mesh in my first reply because it is a much bigger issue as you can see from other posts. You will find the overwhelming majority of surgeons will use mesh these days, and it will be polypropylene or polyester which is a permanent implant.

[mst3k]

Start with PCP, however sometimes I have found if you call and just ask for a surgeon they will give you someone close by to you, but you will want more than just convenience. So make sure you ask for who they recommend themselves and who has your PCP’s other patients have had good results with.
I assume you don’t know anyone who had this surgery, because obviously if you find anyone who had it, ask how it went and get a surgeon’s name if they had good results. I got a name (turned out to be the same doctor) both ways.

I thought this website looked useful: http://www.amino.com
you can find surgeons based on condition, and based on insurance info the site can tell you if the surgeon is very experienced in treating it.

In general for hernia you ideally want a doctor that has been doing this for many years and should have thousands of repairs under his belt.

[mst3k]

I have read a little about your experience on this board and unfortunately you are not the only one I’ve seen that had to go through that. Your experience is probably what I would fear most: having to go through removal once it has been incorporated in tissue. I don’t understand what causes the mesh in some people to fold up and get rock hard and that scares me. Cases like yours really weigh on my mind and are why I haven’t done anything for over 4 years.

I had planned for the last several years to go to Shouldice when the time came (before the Dr. in Stony Brook was an option). But since this summer, I really tried to read all I could from different perspectives. I really wanted to understand why almost all Drs. want to use mesh. I read the HerniaSurge international recommendations, the EHS recommendations, and considered their advice on using mesh. I watched the Shouldice repair a few times, and in a small way I “saw the light”. It looks like a complicated surgery just to fix a hernia and there is a lot of blunt dissection and cutting, pretty much down to the floor of the inguinal canal, and then a lot of suturing to recreate it. You lose the cremaster function completely, although one can live without it. Things can and do go wrong in it, and I can see why it would lead to chronic pain also. The results and the tightness of the fascia afterwards are all in the hands of the surgeon. In fact I was sufficiently scared of a Shouldice too. It can make Laparoscopic insertion of mesh look attractive again. It’s just a different angle of looking at things.

Also, I started watching the SAGES seminars on youtube, and Dr. Towfigh and many colleagues make presentations concerning chronic pain and complications in hernia repair, so they are aware of it and some very smart and talented surgeons are always working on improving things. If it was as easy as “just do Shouldice”, they would do it. It may be complicated but not beyond their abilities.

I ended up seeing a couple of Docs, and ended up scheduling mesh surgery in three weeks from now, but I’m not done seeing Docs yet. I still have open questions and often consider cancelling the surgery. I’m still trying to understand from all angles.

[mst3k]

Does age play a role? Would a younger patient be better suited for suture due to stronger tissues, or just the opposite since they will have to rely on the stitches for many decades?
How about how long one has had the hernia? Having a hernia for several years, even if it is only medium sized, does this weaken the tissue and raise risk of recurrence vs. someone who recently discovered the hernia and repaired it quickly?