[UhOh!]

The big (philosophical) problem here is in defining a “successful” surgery. As far as I know, the only metric used officially is recurrence rate, and by that metric, mesh has demonstrated superiority overall. Until that changes, it will continue to be the unquestioned standard.

[UhOh!]

quote Dill:

Oh. I didn’t even know that was a possibility. I wouldn’t have wanted that either. Hope I didn’t sign on that. I’ll ask on the follow-up.

I’m just assuming that any resident would be entirely unfamiliar with the procedure (other than, perhaps, a textbook) because nobody seems to teach it these days, and virtually all of the doctors who do it are doing it by request only, not as their standard of care (meaning the opportunities to observe them doing it are seldom).

[UhOh!]

quote Dill:

[USER=”1218″]Beenthere[/USER] what is a ghost surgery? [USER=”1391″]UhOh![/USER] I was asked to sign if I would mind students in the surgery (I haven’t found out if there were) and I said sure because I actually want younger people to know how to do the surgery without mesh, however it seemed like it would have been fine with them if I said no.

Observing, sure, but not operating. Chances are that this would be the first time they’d even seen a pure tissue repair done, so to me the risk is too high letting them actually cut. I might feel differently about a fellow, who is already a board certified surgeon but continuing t do specialized training.

[UhOh!]

quote mattl:

Would the bulge be easily noticeable. If I cough hard I feel what seems to be a ‘weak’ spot toward my left groin area. I can feel what seems to be dime size ‘object’ that I can push on… so strange, causes no pain when I push on it and so far haven’t noticed any. I assume there’s no clear imaging I can have done to get a clear diagnosis? Should I avoid surgical solutions as long as their is no pain?

I feel almost the exact same thing on the right side (left side I have an obvious hernia). I’d wondered if it was the beginning of another hernia but it’s been unchanged for about a year and no bulge/discomfort. Honestly cannot tell if it’s something “internal” herniating, or if the “object” is just expanding muscle/connective tissue that runs through the area.

[UhOh!]

quote Tino_7:

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.

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.

[UhOh!]

True, I think that it’s more applicable if one wishes to pursue a non-mesh repair, where different docs use fairly different repair methods. Knowing what type one has will let them ask different docs more specific questions about methods used and what to expect.

[UhOh!]

Ultrasonic imaging should be able to differentiate fairly easily (if operated by an experienced technician), no?

[UhOh!]

quote pinto:

Seems you both are barking up the wrong tree. ‘Tension‘ here is neither shrinkage nor tissue rejection. By definition suture repair involves tension because it stretches the IH membrane together to patch the IH gap or hole. Because mesh repair instead ‘covers‘ not stretches the membrane, mesh repair is hailed as tension-free. If suture repair also can do that then its the biggest story ever–and begs to be told.

I think this is why the Desarda repair is considered a “tension-free” repair. As I understand it, it utilizes a flap of muscle to cover a defect without the need to stretch structures to suture them together.

I believe one of Dr. Kang’s two repairs is also tension-free, that for an indirect hernia. For a direct hernia, if you look at the repair type comparison chart on his hospital’s website, it says there is some tension when creating an auxiliary barrier with existing structures. Again, as I understand it, there are two parts to his direct hernia repair: suturing together the torn fascia (no tension) and creating the auxiliary barrier similar to the original Basini repair (some tension).

[UhOh!]

quote Jnomesh:

Cremaster muscle is cut. I believe i heard shouldice hospital say they do it bc they believe of you don’t it can lead to higher rate of recurrence

But isn’t that an anatomical feature exclusive to men? Is there a female equivalent? Otherwise, wouldn’t apply to the OP.

[UhOh!]

Personally I’d ask:

1. Which technique he uses.
2. How many tissue repairs he does each year.
3. Recurrence rate of tissue repairs he does.

There are other questions I might ask that have to do with impact on other anatomical structures, but they are male-specific.

Out of curiosity, can you share the name of the surgeons you found (both in and out-of-network)? I seem to recall you are also in the midwest and would be interested in knowing if other options exist within a short distance of me.

[UhOh!]

Is there perhaps an additional/alternate use for belts/trusses that’s being overlooked? As more and more people become skeptical of mesh, but tissue repair recurrence rates remain (theoretically) high, might it not be appropriate to use such a device during the post-op period? Would it not make sense that such adjunctive support could help the repair fully heal whereas one’s normal life would otherwise put too much stress on it too early?

[UhOh!]

quote drtowfigh:

[USER=”1391″]UhOh![/USER] indirect hernias are more likely to incarcerate contents than direct hernias. And overall the risk is low.

Does that mean that one is more or less likely to have intestine eventually enter what was once a fat-only sac? Thanks

[UhOh!]

quote Good intentions:

Yes, it doesn’t seem to fit what most surgeons tell their patients. Very few seem to recommend waiting. The message the patients receive is that bad things can happen, emergency rooms and death, so you should get it fixed soon.

Perhaps this is an argument for making diagnostic imaging part of standard practice. Those risks exist, but, as I understand it, the likelihood of them coming to fruition varies greatly depending on hernia type and contents… which can certainly influence the decision about surgery… which one can only know with imaging…

It’s why I asked for imaging to be done of mine. US revealed fat-only, which is a big part of what made me comfortable to just wait and let symptoms guide decisions.

[UhOh!]

quote drtowfigh:

As the hole gets bigger, yes.

Curious, any meaningful difference in likelihood of this occurring in direct vs. indirect?

[UhOh!]

quote dog:

Dear UHOH My experience …Loner you wait ..more problems usually happening… i was doing fast..Dr Brown wouldn’t need to repair my direct hernia ..that happened because of that…he would just fix indirect with even smaller incision… Not shure why you after not contacting him..or my words are not enough :} ?

Were I contemplating a repair in the near future, he’d be my first call! However, given that mine only contains fat, rarely if ever causes discomfort, and any surgery can result in complications (that are no fault of the surgeon), the cost/benefit on surgery just isn’t adding up for me at this time.

My hope, of course, is that as interest in mesh-free surgery grows, more surgeons see the benefits in learning tissue repair methods from surgeons like Drs. Brown and Kang, who have truly mastered the craft.

[UhOh!]

quote patient:

@UhOh! 1. Are you no longer squatting because it hurts to do so, or because you are concerned with worsening the hernia?
I am not longer squatting because the pain and also concerned about getting it worst.

2. Do (did) you wear a belt for squatting? I have a (completely nonscientific) theory that use of a lifting belt actually increases the risk of developing a hernia…
I have never used a belt.

Thanks for sharing. What’s interesting, and I guess this just shows how different people are affected differently, is that squatting is the one barbell exercise that doesn’t bother me (occasionally it’ll ache the next day, but feels like any other muscle ache). Deadlifting no bueno (puts pressure directly on it and doesn’t hurt, but feels like it’s pushing on it) and even overhead pressing was bothering me.

Now, my hernia has gotten a bit larger over the past three years, but I do somewhat credit heavy lifting with strengthening the surrounding musculature and keeping it from feeling worse.

[UhOh!]

quote patient:

Hi guys,

Due to doing a heavy squats last year in June I have been diagnosed with a direct inguinal hernia on my left side, I don’t have a bulge and it does not hurt all the time, I am still able to run and exercise the upper body, not abds nor squats anymore. The pain come and goes any time during the day while I am sitting or any odd movement (bend over), I am very athletic 37 male – 5.9f – 175p

I have seen 2 doctors until now, both of them want to put a mesh using laparoscopic method with a robot.

I start having pain on my right groin side, so this could be bilateral inguinal hernia, I will have a new ultrasound for that. My questions are:

1. Should I have a mesh or no-mesh repair

2. If I have a mesh repair
a Should I wait until it hurts more?
b What mesh is recommended?
c I have read there are less recurrence with mesh repairs but you can have chronic pain?
d Is it true for thin, athletic and young patients the chronic pain is more frequently?
e Once you have a mesh repair, and then you start having issues, doctors don’t want to get involve and don’t want to take the risk to remove the mesh and there are only a few drs who do it. Is this true?

3. If I have no-mesh repair, do I should wait more until it hurts more?
a Wait until it hurts more to have the surgery?
b What are the risk of having a no-mesh repair?
c I understand an absorbable sutures are used in no-mesh repairs, what happen after the absorbable sutures are dissolved?
d Will I be able to lift my kids?
e I have read testimonies just for coughing or sneezing you can have a re-occurrence, is this true?
f what happen when you get old and your muscles get weaker, a re-occurrence is going to happen for sure?

Thank you!

I’m curious about two things (as a fellow lifter, who also has a hernia):

1. Are you no longer squatting because it hurts to do so, or because you are concerned with worsening the hernia?

2. Do (did) you wear a belt for squatting? I have a (completely nonscientific) theory that use of a lifting belt actually increases the risk of developing a hernia…

[UhOh!]

quote DrBrown:

Dear Pinto.
Athletes with sports hernias want their injuries repaired so that they can return to sports.
I advise pure tissue repairs for all these athletes, because 10 to 15% of patients with mesh have pain and that would limit the athletes ability to compete.
All the surgeons who fix lots of sports hernias are doing pure tissue repairs.
Regards
Bill Brown MD

This brings up two interesting questions:

1. Does that include multiple generations of surgeons, and does learning to repair a sports hernia equip such surgeons with the knowledge to repair the “common” inguinal hernia?

2. More of a curiosity: How do competing interests factor in when, say, weighing timely return to play against longevity of career? Would an athlete whose team, say, has a real shot at the Super Bowl sometimes opt for mesh if it meant a shorter recovery and quicker return to play simply for the sake of the short-term (since I’m sure some would rather a Super Bowl ring and the risk of chronic pain one the alternative)?

[UhOh!]

I think the idea that “mesh is best” hardly constitutes an adversarial relationship between surgeon and patient. More likely it stems from:

1. Confirmation bias. We all do it. We all do it “the best way we know” and therefore however we do it is best. Not exclusive to any one group.

2. We all respond to incentives, based on what metrics we are judged by. If that is recurrence here, then preventing that becomes the primary objective.

[UhOh!]

Thanks, Dr. Brown. If I decide to pursue surgery that’s exactly what I’ll do. However at this point I’m still waiting in hopes that the next few years will see more innovation in tissue repair, greater adoption of those innovations, and perhaps reevaluation of how to use completely absorbable meshes in ways that don’t lead to unacceptably high recurrence.