Thunder Rose

The article you linked to cites 4 recurrences vs. 1 recurrence: that isn’t a lot of data. Have you found any similar studies? I’m swayed by the research showing that the recurrence rates for the Shouldice repair are correlated with a surgeon’s experience with the repair, so I’m inclined to trust Yunis if he says he can do a strong repair without…[Read more]

Regarding exercise: I had a large direct inguinal hernia for more than 5 years of watchful waiting. Most exercise was indeed fine: running, x-country skiing, swimming, downhill skiing, dancing, road biking and stationary biking, figure skating, and hiking.

Mine finally worsened last summer and I do think it was in part due to a change in…[Read more]

I was reading the preview chapters of “The SAGES Manual of Groin Pain” (Towfigh is one of the editors) and I saw “snapping iliopsoas tendon” listed as one of the causes of groin pain in the chapter “Groin Pain: An Overview of the Broad Differential Diagnosis”. Did you end up getting a diagnosis?

Please don’t give up. I think you’ve read about the SH patient — the wife on the runner’s blog — who went to Meyers after Brown and had a lot of improvement. Grischkan does Desarda reversals so that’s another potential option. I went to Yunis and he did amazing work with me — he’s also a vascular surgeon and I believe his work is world class…[Read more]

One caveat is if you think you’re reacting to the suture material on the posterior wall (in this case silk which is much more inflammatory than Prolene). If that’s the case than you probably do want that removed, and most likely they’d need to place a mesh. In your shoes I’d want a Nyhus repair with polypropylene mesh. But given my experience and…[Read more]

Hi Peter,
I hope you’re getting more answers from Drs. Zoland and Meyers.

I think your questions about the closing of the External Oblique Aponeurosis get into complexity of the anatomy of the inguinal canal. My understanding is that the modern Shouldice or Bassini uses the external oblique aponeurosis just anterior to the inguinal ligament,…[Read more]

Dr. Reinhorn is a big fan of the Nyhus repair. Since your mesh is large for an open repair that’s probably what you have. With the Nyhus repair the mesh is in the posterior space normally accessed in a laparoscopic or robotic repair. It seems likely your PCP hasn’t encountered this type of repair before and may be misinterpreting what she felt.

My understanding is none of the nerves were cut and I have no reason to think otherwise.

One surgeon who told me he would transect the genital branch nerve told me it would take 6-24 months to grow back and I would have numbness. I have nothing like this. Another surgeon told me he would transect both the genital branch and the ilioinguinal…[Read more]

Anesthesia: I don’t know the specific meds. At the surgical center I first signed a paper where the two main options were General Anesthesia or Monitored Anesthesia Care (MAC, i.e. IVCS) and I only signed permission for MAC. Then I spoke to the anesthesiologist and finally to the anesthesia nurse. If you want to know the specific meds you could…[Read more]

TBH my husband did all the cooking, cleaning, and managing kids for a week. Walking, hiking, even getting in and out of a car repeatedly for hours while going birding at a state park was fine but I didn’t want the kids bumping me (I have very active 7-year-old twin boys). I was doing computer work (designing catalog layouts) (while on vacation)…[Read more]

Hi Eu, Answering your questions one by one:

1. How big was your incision?

— Yunis told me ahead of time it would be larger, but it’s only 6 cm (just under 2.5 inches). I am extremely fine-boned so my best guess is he adjusted the incision to my frame.

2. How long have you experienced post-op pain and what meds did you use for it?

— I did…[Read more]

I found the six-sided box model to be very helpful for gaining a rough understanding of the inguinal canal:

https://en.wikipedia.org/wiki/Inguinal_canal#Walls

I also found watching YouTube videos of Shouldice Repairs to be very helpful for visualizing the surgery:

a more recent 2-layer Shouldice: https://www.youtube.com/watch?v=DWW-ohDn8zs

an…[Read more]

I don’t have direct experience with this, but my understanding is that with a laparoscopic recurrence you’ll have an open repair the second time (avoids scar tissue). (My uncle had a laparoscopic mesh inguinal repair which rapidly failed followed by open mesh repair that has held). However, if you’re having the mesh removed then the…[Read more]

I almost went to Dr. Brown when I thought my inguinal hernia was indirect, as he’s one of the only surgeons in the U.S. advertising a Marcy repair for indirect inguinal hernias. It’s ironic that this attracts those of us seeking a minimally invasive repair. Dr. Brown did impressively correctly predict that my hernia was direct based on a…[Read more]

I hear you Osler, but the surgeons cutting the round ligament are also the surgeons who aren’t cutting the cremasteric muscle and are avoiding cutting the nerves — i.e. these are the conservative, minimalist versions of the Shouldice repair and they’re still cutting the round ligament. It is not clear to me whether anyone even offers a Shouldice…[Read more]

Dr. Towfigh: you wrote that in the Shouldice repair “Classically, the cremasteric muscle and genital nerve branch are resected” and Dr. Spencer Netto confirms in this interview that is the standard of practice at Shouldice Hospital. But in this interview you indicate your Shouldice repair differs from the classical repair in that you do not resect…[Read more]

Hey how did this go? I am struggling to find a US option but would probably go with Kang or Shouldice if travel were possible.