51. HerniaTalk LIVE Q&A: Hernia Repair Techniques with and without Mesh

[@urdivine]

Shirin, [love that name] Subject: large indirect Inguinal Hernia If you have not, why haven't you learned the Shouldice Hernia Repair and incorporated it into your practice? The reason I ask this is because after my first consultation with my primary care physician, they referred me to a surgeon and I'm wondering if it's unreasonable to request that they would consider learning the technique to broaden and improve their practice, here in Beaumont, Texas Or, is this a procedure that virtually no one does in the U.S.? I'm in my early 70's and have never had a need to see a doctor, visit a hospital and take any prescription drugs, so this whole thing is a new experience for me. Your videos are helping to educate me. Thank you, Dennis

[@herniadoc]

Yes, I do offer the Shouldice technique, as well as other tissue-based hernia repairs, which I incorporate in my practice. I also teach my surgery residents this technique. In Texas, it is worth asking around to see who offers tissue-based options. Thanks for subscribing to my channel!

[@veronixawardwell8802]

I have a metal allergy and an umbilical hernia surgery coming up. What do you suggest? I have so many allergies and am not sure if I can tolerate mesh either.Would you suggest cat gut or something else?

[@herniadoc]

That’s a discussion to have with your surgeon. And perhaps an allergist. Car gut is never an option for hernia repair

[@ananusa7161]

very informative talk, thank you! One of the comments as well as your website mentions you using Da Vinci with no mesh repair for small inguinal hernias in normal to low weight patients, will that be similar to 4 layer sewing in Shouldice but using robots or 2 layer sewing? Have there been enough patients going through that robotic no-mesh procedure to show it has equivalent or better results than Shouldice in terms of recurrence rate and chronic pain rate? As that sounds like a really promising option for eligible patients.

[@herniadoc]

Thank you. I’ve discussed the rIPT (robotic iliopubic tract) repair in detail online and in publishing’s. It is not equivalent to the Shouldice. It is equivalent to the Nyhus-Condon repair. It does not provide better results to any open tissue based repair. It is a good option for some patients of low risk with low risk hernias

[@Jackjack1978.]

Do you talk about the Desarda hernia repair procedure on this video or can you direct me to somewhere where you do talk about it? I have an umbilical hernia and thinking I would like to go this route rather than the Shouldice procedure.

[@herniadoc]

Do a search for Desarda on my page and it will show you which shows we discuss it.

[@alisonirwin109]

Dr this talk is so enlightening is there a way I can contact your clinic for help.

[@herniadoc]

All contact information is in the description of the video

[@mx.j262]

Whats the difference between shouldice and desarda technique

[@sharontribble5560]

I saw a clip of a video of a surgeon in California doing a laparoscopic Tissue repair, no mesh. Is laparoscopic tissue repair being done now, and is it safe and a solid repair as the the Shouldice's tissue repair?

[@herniadoc]

For inguinal hernia, we published robotic tissue repair, aka robotic iliopubic tract repair (r-IPT). It is useful only for small hernias in low risk populations (eg, not obese). It is not as solid as Shouldice.

[@sagedakotalmft7763]

Very interesting. Makes so much sense; after all, if when sewing a seam on clothing I might run two rows of stitches to make sure the seam doesn't come apart, why not do that with sutures? My only concern would be that stainless steel has nickel in it. And surgeons really ought to have their patients do allergy testing first before doing any implants or using any products that are going to remain in the body. Thanks for the reminder and i will definitely do this before I get my surgery.

[@herniadoc]

Allergy testing is not reliable

[@deezerdeezer]

I was told by Shouldice that the stainless steel sutures do not contain Nickel

[@cooljazzr]

Is Desarda a stronger repair than Shouldice since Desarda uses the External Oblique Aponeurosis as sort of a mesh replacement to make it stronger?

[@herniadoc]

No

[@matt_staton]

If taking Tylenol significantly lessens a patient's mesh pain, does this suggest that the pain is more likely caused by a recurrence rather than a nerve issue?

[@herniadoc]

Could be a clue

[@thekevineffect]

Hey! I had a open periumbillical hernia repaired last year likely originally caused by my gallbladder surgery when I was 14 and I went with no mesh and now it’s back with a bump above my belly button and I’m researching into getting shouldice method with no mesh would this make it not come back as I feel like since it’s already failed I don’t feel confident in the tissue being strong enough and having another surgery. What’s recovery time with shouldice? I waited 6 weeks to begin lifting weight again on my first surgery and a big concern of mine is being out that long again as I workout almost everyday. Thank you in advance!🙏

[@herniadoc]

Shouldice repair is not for umbilical hernias. In most patients who failed a tissue repair, mesh is necessary to prevent another hernia and a larger.

[@thekevineffect]

@@herniadoc thank you for your quick reply! What if it is a ventral/epigastric hernia? That’s what I was marked as on my pre-op surgery, but after the surgery he wrote in medical records periumbilical. The bump is about an inch above my actually belly button visually.

[@herniadoc]

Shouldice repair is only for Inguinal hernias

[@thekevineffect]

9:35 you guys talk about ventral and abdominal wall hernias with the same approach is what I’m referring to!

[@felixperalta9135]

For thin people who are not interested in mesh is the shouldice method the best option and can you live an active life if all goes well?

[@herniadoc]

Only for inguinal hernias

[@sharontribble5560]

Does the Shouldice Hospital do many tissue inguinal hernia repairs in women, and what are their outcomes for chronic pain? It seems that it is mostly men who go to this hospital. Also, how long is the incision for inguinal hernia repairs in women.

[@herniadoc]

The do treat women if there is an obvious bulging hernia. Otherwise they don’t treat women.

[@deezerdeezer]

Could I have testicle pain on both sides from a one-sided Inquinal hernia?

[@herniadoc]

No

[@philipmacracj5715]

Is pure tissue preferable for an middle aged male in relative fit shape and who intends to maintain an active lifestyle which will include strenuous activities

[@herniadoc]

Age and activity are only 2 factors in deciding who is best suited for tissue repairs. It is certainly an option. The type and size of hernia and type of activities you plan to do are also important. Also, it is important to understand the risks of pure tissue as compared to mesh-based repair, open vs laparoscopic repairs, etc., as part of your discussion with your surgeon.

[@philipmacracj5715]

From your website, it indicates that you use da Vinci for non mesh inguinal repair. Can you briefly describe how often that is a viable option, for who, and with what type of expectations for activity level post-op?

[@herniadoc]

@@philipmacracj5715 I limit it to small inguinal hernias in normal to low weight patients.

[@philipmacracj5715]

What would be a general treatment approach for a post Shouldice repair, reoccurrence lipoma? Repair seems solid however periodic pressure with no indication of tenderness or bulge is evident daily

[@stumpynubs5387]

What is considered small vs large?@@herniadoc

[@Marc-pt7yr]

I think mine hernia mesh run down all the way from my thie to get rear out

[@donnamartin9825]

I have a large ventral hernia that was repaired once, so a reoccurrence, I am overweight is their anyway to have a tissue repair instead of a mesh repair

[@herniadoc]

Definitely not.

[@donnamartin9825]

Why not?@@herniadoc

[@herniadoc]

Please review multiple prior HerniaTalk LIVE sessions discussing hernia recurrences. Sounds like you have multiple risk factors for recurrence (large hernia, overweight, already recurred once). All of those require mesh otherwise the risk of recurrence is even higher than you are currently experiencing.

[@cooljazzr]

My Dr. is using Desarda method for my inguinal hernia and said he has to cut the ilioinguinal nerve about 50% of the time, since it gets in the way. Is there a way to avoid cutting it?

[@herniadoc]

Sometimes yes. And it’s also surgeon dependent.

[@cooljazzr]

​@@herniadoc Cutting it doesn't affect sexual sensation? I cutting it read it does decrease risk of chronic pain so some cut it routinely.

[@herniadoc]

@@cooljazzr No. It may make areas numb, but it should not affect sexual sensation in men. It may in women.

[@cooljazzr]

@@herniadoc I read that it also provides sensation to the anterior of the scrotum. So would it cause numbness there? That would be bad.

[@herniadoc]

@@cooljazzr that is more typical of the genital nerve.

[@edwardkabange2649]

I have hernia over eight years now and am scared of the surgery. and am married for a year now without a child is it hernia that could be the problem of not having a child?

[@herniadoc]

Usually not. Unless you have a large scrotal hernia

[@edwardkabange2649]

Dr what really happens when one testacle has damaged by hernia it means that you're not able to have children?

[@edwardkabange2649]

Dr what really happens when one testacle has damaged by hernia it means that you're not able to have children?

[@herniadoc]

Assuming you have two normal testicles, then fertility should not be affected if one is damaged

[@user-nj6rk5xs1m]

Anti inflammatory shot helped me with my nerves ....since neurectomy ..area is not just numb but the muscle doesn’t work and Dartos and cremaster muscles aren’t working which I have been told is common and almost guaranteed symptom with open triple neurectomy

[@herniadoc]

Not a guaranteed effect of triple neurectomy but certainly can happen.

[@user-nj6rk5xs1m]

@@herniadoc what are my options for nerve graft to reverse the neurectomies ..nerves were already numb and I can’t get a straight up answer from UCLA doc to why the nerves were cut ...I see no benefit of cutting the nerve in my situation

[@stowfigh]

@@user-nj6rk5xs1m I would have to review your situation to correctly answer anything. Please feel free to contact my office for a consultation.

[@user-nj6rk5xs1m]

@@stowfigh sounds good ...from report looks like nerves were cut for preventative reasons ...”to make sure I wake up pain free “ ..don’t know if you agree with that reasoning but that’s what report says pretty much

[@waliddib5291]

@@herniadoc what are the odds of nerve damage from shouldice repair from some1 like Samer? (Shouldice repair in general?)

[@matt_staton]

What is a direct hernia

[@herniadoc]

Type of Inguinal hernia

[@matt_staton]

What’s the risk / percentage of losing a testicle with mesh removal and repair of inguinal hernia

[@herniadoc]

should be less than 1% on average

[@Marc-pt7yr]

How much is this surgery coming from Canada how long does a person have to wait

[@herniadoc]

Please contact my office or Dr Hibner’s office directly.

[@ashwanistudycircle7738]

I have 21 by 11mm fat containing umbilical hernia with 6.7mm wall defect. If I loose fat can it correct itself.

[@herniadoc]

No hernia can be cured with exercise but it may help reduce the size and the symptoms.

[@ashwanistudycircle7738]

Mam I am from India ,Msc Mathematics can u tell me what will size of hole

[@lbromley2940]

It's been 20 years since I had a hernia repaired, this last May I woke up with pain in my stomach and most concerning, my legs were swollen. The swelling didn't go down and I noticed the lump in my stomach so I went in to the emergency room. Since , I've been to my primary doctor and I'm not getting help! I do have an appointment with a GI doctor but not until November I have many symptoms and pain. the latest, yesterday I have debilitating pain on the side of the swollen surgical site and it feels like a pinched nerve everywhere. Please is there anybody that can help, with information abought what I can do?

[@herniadoc]

Please contact my office directly if you would like to have a consultation

[@lbromley2940]

@@herniadoc Thank you, I will call your office.

[@matt_staton]

I’m scared to see a surgeon who want to do a triple neurectomy by default

[@Marc-pt7yr]

I just realized .my the red source and pain between my rite thie self worth is over I feel like broken man at 62 Ii had mesh out in 7 years back it no sexual