[Jeff]

Hello Dr. Towfigh,

I greatly appreciate your feedback.

Fyi, two highly reputable hernia surgeons indicated that they would ONLY perform a TEP, not a TAPP! Their clinical rationale for the TEP was that it was less invasive than TAPP, especially considering my older age and medical comorbidities. However, one indicated that he would consider performing a Lichtenstein, stating in his “hands” he would carefully dissect the scar tissue in the anterior plane, with a very low risk of injury to the ilioinguinal nerves, recurrence or inguinodyna.

Another highly regarded hernia surgeon offered a TAPP, but indicating that “if” I was a “member of his family”, he would prefer performing an open repair!

At my age, my major concern is the potential side effects and sequalae of general anesthesia, [POCD, POD and urinary retention], as well as having a third recurrence and chronic post surgical pain syndrome, which I did not experience after my original PHS repair many years ago.. Based on the feedback from several hernia surgeons I consulted, there isn’t much difference in rates of recurrence between another open repair versus a TAPP or TEPP, but that levels of inguinodyna are decreased with a posterior repair.

I would appreciate your impression about the statement made by one of these surgeons that because I didn’t experience inguinodynia after my initial PHS repair that I wouldn’t after a second repair?

Thank you for again.