[Tino_7]

quote Good intentions:

The surgeon that you saw is today’s run-of-the-mill mesh implantation “mechanic”. He has been trained/convinced/persuaded that mesh is a one-size-fits-all cure-all. He is the worst kind of surgeon, not a true physician, just a medical professional who performs procedures. It might be his inherent character or he might be burned out but he does not have your best interests at heart. You should avoid that surgeon, he will probably implant as much mesh as he can fit, to avoid recurrence, and will reject any pain or discomfort problems that you have with his work.

It is good though that you’ve experienced how bad things can be, before you had surgery. Find a true doctor. Good luck.

I have a Grade 2 indirect inguinal hernia.

I saw a surgeon who does mesh but also has done tissue repair (Bassini and McVay). Another surgeon in his practice recently spent two weeks at the Shouldice Hospital learning that technique.

The surgeon I saw is around 69 years old – so he’s done hernia repairs prior to the wide use of mesh repairs. He’s personable and has very good reviews, and practices at one of the top hospitals in the Midwest.

He thinks I should just wait and watch it, and go on with my life. I kind of want to do something about it before it gets worse.

It says a lot, I think, when a surgeon looks at your hernia and takes a very conservative posture. Many will rush you into surgery. So, I have a lot of confidence in him for that, and as I said, he’s quite likable.

Do you know if certain tissue repairs produce a more favorable outcome for indirect inguinal than others? I’ve heard very little of Bassini but much about Shouldice.

Thanks. I’m still gathering information in trying to make a decision. I know from this forum that there are many good doctors out there, some of whom contribute to the forum. It’s still not an easy decision, and especially when one has to travel distances.

[Tino_7]

quote WasInTN:

Post-Op Recovery: What to Expect

I have something to say since I went through IH surgery in PA with Dr. Goodyear and stayed in the hotel for 4 days. BTW I flew from KY to PA and back with family (2 kids and wife). Here we go.

I posted “POST SURGERY THOUGHTS” on this board which Dr. Towfigh put on top of the discussions (thanks to her). Do read it. You will NOT become a superman within 6 months – no, there is superman only in cartoons and movies.

1. I returned to work after 2 weeks and yes I am in desk job – software development. BUT I got up every one hour and walked around. It was a weak and slow walk but no matter GET UP EVERY ONE HOUR and walk around – that’s what Dr. Goodyear told me. The day after surgery onwards, the advice given to me was “Keep walking” and I kept walking till legs ached. So I went to work in 2 weeks BUT my advice is to wait 3 WEEKS. So you feel much better. But up to 6-8 weeks, depending on what Dr. Ramshaw says you should keep walking so the mesh will jell better with your tissue.

2. for 30 minute gentle yoga you will need to wait 6 weeks and depending on how good the tissue heals. Surgical cut and tissue heal differently in each person. It can take up to 8 weeks. My suggestion – 8 weeks till you are able to jog on the roads. If you are able to jog and walk briskly on the roads THEN ONLY attempt the yoga bending and all. Yes I saw you said the word “Gentle.” But for God’s sake remember you are going to have surgery. So give some respect to the surgical cut and be careful. You never know what/how internal tissues react with your “GENTLE” yoga. Listen to your body and give it time to heal. You have nothing to lose. 2 weeks POST SURGERY IS ***NOT*** the time to do exercise and diet even if you are an Olympic Gold Medalist and are in twenties. They can wait. Let the body come to terms with the surgery and heal itself. Yes, it takes time.

3.I have done the post surgery check up by Dr. Goodyear. YES IT IS VERY VERY IMPORTANT. I had surgery Thursday and travelled back to KY on Monday. Dr. Goodyear gave me OK on Monday to go home. Surgeon had better clear you before you travel. It is better to spend $200 on hotel for 5 days than travel next day or later and spend 20 days in ER. What do you think? I heard Ramshaw is a great surgeon. Listen to him. He knows the best time for you to travel. Some can travel earlier, some later and some at some other time. Again each case is different depending on age, past problems blah blah. No two people recover the same way. Each of the X billion people on earth are created randomly. Wish I have the algorithm God uses to create this big random numbers. Ha.

This is eye-opening. Spoke with Dr Grischkan who said I can get on the road (someone else driving) an hour after surgery, which is only 25 minutes. I have a 9-hr drive from Cleveland. He said I’d be doing great in 2 days and that some of his patients (weight lifters) are back in the gym pumping iron in 3-4 days.

I had an IH repair (mesh, open surgery) years ago and it took a few weeks to bounce back, with first 4-5 days being pretty painful getting out of bed.

You didn’t travel for 5 days after surgery?

I don’t relish the thought of getting in a car an hour after surgery and driving back 9 hrs with ice packs. And since my wife cannot get off work (nor can she drive 9 hrs for health reasons), I’ll need a friend to drive me, but he can’t take off more than 2 days of work.

[Tino_7]

quote UhOh!:

My conclusion (still as much a question as anything) was based more on what I saw on his website than anything discussed here.

Lol, I was impressed enough by your ability to draw that conclusion/formulate that kind of question. Shows quite a bit of knowledge, I think.

[Tino_7]

quote DrBrown:

Each hernia repair needs to be tailored to the patient’s anatomy. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a very good choice, especially if the floor of the inguinal canal is just weak and not fully torn. But there may more tension on the repair than the other techniques. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch to cover the inguinal floor. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. The Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is very strong. But it does rely on an intact inguinal ligament and good tissue in the inguinal floor. Thus, there will be times when the Shouldice may not be possible.

Regards.
Bill Brown MD

Very helpful, Dr. Brown!

I’m meeting with a surgeon who does open and robotic mesh, but was trained in tissue repair as well (Bassini).

I have an indirect inguinal – my second one. My prior was repaired at RUSH University in Chicago (Millikan Modified repair, after Dr. Keith Millikan) two decades ago with mesh + plug. It’s held up well with no issues whatsoever.

I’d prefer an open repair under twilight sedation because of BPH and voiding difficulty. My concern: post op urinary retention and Foley catheter if general anesthesia is used (since I am at risk).

Dr. Grischkan offers a modified, two-layer Shouldice under twilight sedation.

If not for BPH I’d opt for the less invasive laproscopic so I could bounce back faster.

It truly comes to a trade off of potential risks-benefits, doesn’t it?

I’m early 60s, BMI = 25, reasonably good shape but certainly no longer have hard abdominals, thus expecting a longer recovery than my first open repair.

Overwhelmed trying to plan two surgeries close together – praying and asking God for guidance/wisdom.

Thank you.

[Tino_7]

quote UhOh!:

Perhaps you can comment, based on your interaction, but reading Grischkan’s website, it sounds as though he’s using mesh for a fundamentally different purpose than the majority of surgeons.

From what I understand, it’s usually used as a “patch” which, when combined with tissue ingrowth, serves the function of a bandage or splint. It sounds, from what I’ve read, that Dr. Grischkan is trying to get the Gore-Tex (which I thought was a bit stretchy) to mimic the form and function of the damaged fascia itself. It would be reasonable to expect different results, no?

I could be mistaken, but my response to Ddot14 was based on my recollection of a very brief conversation with Dr. Grischkan – too brief to elaborate further. I hope I haven’t introduced any confusion to this topic. You certainly appear to know far more than do I, as I couldn’t even draw the conclusion you did.

[Tino_7]

quote joep:

Hi Ddot14, according to HerniaSurge, as per the evidence published so far, Shouldice technique is the best non-mesh repair. They concluded that Desarda repair, at this point, simply do not have required data regarding its outcome, and shied away from recommending it.

https://link.springer.com/article/10.1007/s10029-017-1668-x

I asked Dr Grischkan about the Desarda method and his response was that it has not been around long enough to demonstrate long-term success. He did not appear impressed with it. I do know someone who did great after seeing Dr Tomas in Ft Meyers – he was up and walking that same afternoon with hardly any discomfort.

[Tino_7]

quote DrBrown:

[USER=”2966″]Tino_7[/USER]
Dear Tino.
Be sure that the robotic operation does not create too much scar tissue to have prostate surgery later.
An open pure tissue will not interfere with any prostate surgery in the future.
Both operations can make urination difficult. Consider Flomax before surgery.

Regards.
Bill Brown MD

Thank you, Dr. Brown. I appreciate your input!

I’m on Flomax, 0.8 mg/day. But prostate is 130-140 cc, so I need a procedure (considering HoLEP).

If I don’t do the prostate first, it’s good to know an open tissue procedure will not interfere.

I do have confidence in Dr. Grischkan for the open tissue repair.

[Tino_7]

quote Ddot14:

I too would like to hear more detail about Dr. Grischkan’s results. I had looked at him a while back but was concerned that his website is somewhat contradictory about whether or not he uses mesh (gore-tex?) in repairs, and when I called his office the person on the phone also seemed somewhat non-committal about mesh. As I understand it, the mesh patch would be very small if used at all. I don’t know enough about the technicalities of hernia repair to understand if his modified Shouldice repair is good, bad, or unknown so far as recurrence and chronic pain rates. He claims good results for recurrence, but I’ve not seen his method compared to any other repair type, so don’t know what to make of that. He’s done a ton of hernia repairs using his method, so it seems like there should be more information available someplace. I think I remember reading that he was also very expensive for those without insurance he accepts.

Dr. Grischkan will attempt a tissue repair first, but if it is too large for that, he will use a Gore-Tex mesh. I consulted with him and he said my hernia (Grade 2) can be a tissue repair, but cautioned me that if it grew too much he’d have to use mesh. He did say the quality of his mesh was above that used in all other mesh repairs at hospitals.

[Tino_7]

quote UhOh!:

The surest way is to strike that section of the consent form. There’s also a difference between “hold this” and “cut here.” But in reality I think it is imperative to have an honest discussion with the treating physician beforehand, to let them know what you are and are not comfortable with.

You can do that and verbally request to the surgeon that you do not want residents involved in critical points of the surgery. Legally, that should bind them (must be in writing), but once you’re under sedation, what do you really know?

Major teaching hospitals offer the best of care, whether Mayo or Cleveland Clinic or UCLA or Mass General, etc. – but these are teaching hospitals and in surgery, one should expect that the classroom training extends there.

Get it in writing and hand mark the consent form and request a copy of the marked up copy with your signature and date prior to surgery.

[Tino_7]

quote UhOh!:

I did a consult with a surgeon in Chicago who says he can do non-mesh but thinks mesh has a better outcome and hasn’t done a non-mesh in about three years (as of last fall). Ultimately I haven’t done anything; mine is still reducible, contains only fat and rarely if ever bothers me. So I’ve left it alone.

Thank you and thanks for the PM.

I’m going to consult with the Chicago surgeon soon.

Also, I consulted with Dr. David Grischkan, Cleveland, last month. He can do open suture repair. On the plus side, he’s done over 20,000 operations and this is all he does, and he has no residents to assist. He is the only surgeon in the room to work on you. On the down side, he’s 9 hours away by car.

The choices in the upper Midwest are few. I don’t know of any surgeon at major medical centers such as UM Ann Arbor, Cleveland Clinic, RUSH University Med Center in Chicago who do non mesh repairs.

A doctor in central Indiana (Greencastle and Indianapolis), Paul Szotek, does different types of repair including open non mesh and robotic mesh.

I don’t know enough to choose between the two. I know someone who had robotic laprascopic with mesh in Chicago and is doing great. I know someone who had the same in Raleigh, N.C., who five years later still has issues. I guess with robotic, you bounce back faster. With open, you don’t have to worry about mesh migration or immune response-rejection.

Dr Grischkan reports a failure rate of < 1% and says his method is superior.

On a side note…..

I want to start a new thread here, but cannot find anyplace on the forum to begin a new topic. How do I do that?

Thanks!

[Tino_7]

quote kls007:

If I’m not mistaken I believe Dr. Paul Szotek in Indianapolis, Indiana practices in “non mesh” repairs. Alot closer to home than Tuscon.

Yep, from central IL to Indianapolis is probably 4 hours, 5 tops. Much closer. Dr. Grischkan in Cleveland is about double that driving time.

Both are experienced in a variety of repairs.

[Tino_7]

quote UhOh!:

I did a consult with a surgeon in Chicago who says he can do non-mesh but thinks mesh has a better outcome and hasn’t done a non-mesh in about three years (as of last fall). Ultimately I haven’t done anything; mine is still reducible, contains only fat and rarely if ever bothers me. So I’ve left it alone.

Ok, thanks. Can you PM me the name of the Chicago surgeon? Glad your hernia isn’t any worse.

[Tino_7]

quote UhOh!:

I’m finally coming around to getting a real evaluation, by a specialist surgeon, to determine whether or not to consider surgical repair. I live in Chicago, and want to stay local. Specifically, I am looking for surgeons who:

Specialize in open, tissue repair techniques
Do them under local anesthesia
Are willing to confirm specific diagnosis (hernia or not; direct or indirect) with imaging
Will not fight me on the fact that I will not consent to residents participating in the surgery (if a teaching institution)

Would appreciate any thoughts/recs. Thanks in advance.

I realize it’s been 3 years but what did you decide on?

I’m near Chicago too but could find no surgeon who does non mesh repairs. Kind of frustrating considering Chicago is home to several outstanding hospitals and medical schools.

I can get to Chicago much easier than Cleveland or Knoxville or Indianapolis.

Since Drs. Szotek and Grischkan are closest, I will look into them.

Dr. Reinhorn in Boston would be a great choice if I were nearby.

I have other issues that make air travel difficult, and so I have to select a surgeon that is a reasonable (< 8 hr) drive.

Very interested to know which surgeon you selected and how your surgery went.

thanks.

[Tino_7]

quote Jnomesh:

The over analysis is warranted in this important decision.
one thing that may help in your decision between mesh vs no mesh relative to your case is I believe I read somewhere (maybe one of Dr. Towfigh responses) is that if someone may need prostate surgery soon or down the line then it isn’t a good idea to have mesh implanted as it may interfere with the prostate surgery. Just something to check out.
Also I always believe it is important if possible to speak to other people who have had surgery with a specific surgeon. There are people on this forum who have had a very positive response with dr. Brown for non mean repairs. You can scour this forum for testimonials with dr. Brown and then message these people to ask questions and get feedback.
Best wishes

Thank you. I appreciate your help. This forum is a good place to be.

With my prostate and symptoms, traveling is very difficult. I can’t even go to a baseball game, let alone sit on a plane and contend for one of the bathrooms – especially on bad days when I need to try to empty my bladder every 20 minutes. Other days I go 4 hours without needing to rush to a men’s room.

So, flying to California to see Dr. Brown or Dr. Towfigh is not possible (perhaps after prostate surgery).

The nearest non mesh docs to me that I can drive to (a long drive, nonetheless) are Szotek (Indiana) and Grischkan (Cleveland OH).

I don’t hear much about Dr Grischkan on this forum but his website says he has done 20,000 hernia operations in his career. And he studied at the Shouldice Hospital, if I’m not mistaken.

Another doc, Michael Reinhorn, in Boston sounds fantastic. But out of town patients have to fly in for a consult, fly back for surgery and then fly back again for one month follow up. I can’t afford to fly to Boston three times (plus lodging and rental cars). But Dr Reinhorn sure sounds fabulous.

[Tino_7]

quote Good intentions:

Mesh typically tightens up the surrounding tissue and will create a tugging sensation,along with a sensation of something inside you that doesn’t belong there. “Tension-free” used to have real meaning, to surgeons, but today it’s a marketing term, used to sell mesh. Mesh does create tension during the healing process that’s why they put in such large pieces, to account for shrinkage and movement. The tension that is being referred to, in “tension-free”, really has nothing to do with a tugging sensation. No offense. It refers to sutures pulling on tissue to close the hernia.

Don’t get caught up in the “back to action in days” meme either. It’s actually an absurd and disingenuous way to sell a procedure to a patient and is really meant to sell the procedure to the insurance and healthcare providers. It means less monetary expense for them in the short-term, with fewer short-term complications. But it works well on the patients also. It sounds attractive and implies that there are no long-term consequences. Get ’em in, get ’em out, let the patient deal with it in the long run.

Your decision will affect the rest of your life, not just the week or two afterward. Focus on the long-term results. Good luck.

Thank you.

No offense taken, as I’m in the learning process.

I don’t know what to do, frankly. I just read about Dr. Michael Reinhorn in the Boston area. He also sounds outstanding. He does a minimally invasive mesh technique.

I’m in the Midwest and can drive to Mayo or Cleveland Clinic to see a top notch general surgeon, but I want to see a hernia specialist.

Dr. Grischkan’s website talks about quick recovery and he does repairs on athletes like world class body builders and lifters.

Dr. Tomas offers the “tension free” Desarda method and again promotes quick recovery.

It’s a very hard decision and I’m also weighing surgical options for prostate enlargement, so I have two health issues at the same time that are impacting my quality of life, and I have to do something for both sooner than later.

The over analysis is somewhat paralyzing, to be honest.

[Tino_7]

What kind of surgery did Dr. Brown perform? I assume it was non-mesh, but what technique did he use since he’s capable of using several?

I reached out to Shouldice Hospital but could not afford it after discussing fees + travel costs.

My research has led me to Dr. Robert Tomas (Desarda), Dr. Towfigh (just an amazingly impressive resume), and Dr. David Grischkan (modified Shouldice…..but I’m not sure how that differs from the procedure done in Toronto).

I would prefer non mesh and open procedure (not laprascopic), but I’m concerned that non mesh means “tension” and I would not want the constant feel of tugging that a tension repair might produce.

I can stay home and have mesh repair done by very good general surgeons at two hospitals in my area vs. driving to Cleveland to see Dr. Grischkan. Flying to LA or to Ft. Meyers is not only expensive but with my enlarged prostate (and sometimes need of a mens room every 20 minutes), flying is difficult for me, and I have not traveled for that reason.

I know someone who had the Desarda by Dr Tomas and he was out to lunch a couple of hours later and out shopping with his daughter that afternoon.

Dr. Grischkan has operated on bodybuilders who were back in the gym doing powerlifting a week later.

Can non mesh repairs really offer a recovery in days vs. weeks?

[Tino_7]

quote drtowfigh:

Interesting answers, right?

The data shows risk of watchful waiting to be 0.18%/yr and most of us (should) include that as part of our consent to the patient. Or, it’s safe to wait.

We also know that that the risk of complications, including chronic pain is lowest with laparoscopic repair with mesh done by an expert surgeon. That includes comparators of open with mesh and without mesh.

We also know that surgeon skill is directly related to outcome, including recurrence and chronic pain.

Really appreciate your input on this forum, Dr. Towfigh. You’re unquestionably a leading expert in this area.

The risk of post-op urinary complications (need for Foley catheter) is higher for lap repair because the patient undergoes general anesthesia vs. twilight. What do you suggest for men with very large prostates (150 grams or more) with a history of difficult urination (needing alpha blockers + Finasteride)?

Open mesh and open non-mesh under twilight + local reduce risk of needing a catheter, right? (Forgive a layman trying to understand medical journals.)

I’ve been doing watchful waiting, but my hernia is bothering me more, and so I want to consult with a doctor who does Shouldice or DeSarda (sp?). I know of someone who saw Dr. Tomas and had great results.

I am much closer to Dr. David Grischkan than I am to you or Dr. Tomas, and travel costs are an issue for me.

I need prostate surgery too and just don’t know if I can put off hernia long enough to get prostate surgery and recover from that. But your statistic above is informative in my decision making.

If I lived near LA, I’d have already scheduled a consult with you by now.

thank you.