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What’s the knock against Shouldice

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  • What’s the knock against Shouldice

    What are the disadvantages of the Shouldice repair...it seems like in a lot of studies the Shouldice repair is implicated with chronic pain as well... so I don’t know if Shouldice in Toronto is different in there outcome of chronic pain but it seems like the studies make laparoscopic the least chronic pain... thoughts?

  • #2
    Since I had umbilical hernia repair with mesh, done laparoscopically, it seems like I’ve done countless research on countless studies and experiences due to me freaking out. I finally came to the conclusion, and this is just based on all I’ve read and seen, there is no perfect hernia repair as Dr. Towfigh states sometimes on this thread. No hernia repair is the same for everyone. I don’t really believe in the mesh vs no-mesh repair argument anymore because it really all just depends on the patient and their needs. There is a time and place for mesh and there is a time and place for a pure tissue repair. It seems like most mesh related complications occur because of surgical technique. Materials, the size of the mesh, size of the pores, the placement of the mesh, etc... are all important factors to take into consideration when implanting mesh, therefore, it is very important to find a surgeon who has expertise experience in hernia repairs that way they can tailor a repair that is right for you based on your factors as a patient.

    Same goes for the Souldice repair. I have seen many complaints of chronic pain associated with the Shouldice repair and other pure tissue repairs. In a few studies, the complication rate actually appears to the be same compared to mesh repairs. The reason for this I feel like, as I stated above, not every repair seems to tailor to every patient. Personally, I do believe that laparoscopic and robotic methods have a significant advantage over a traditional open repair. Obviously the mean reason is not having such a huge scar on your body. Also is the best option when it comes to less formation of adhesions in the abdominal cavity and a much much better recovery experience.

    At the end of the day, it really is hard to find a perfect repair, wether it’s mesh or no-mesh. Every repair has its complications. The best thing we can do as patients is to find the best possible hernia surgeon who will tailor a repair to match the patient.

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    • #3
      I Giles’s the question is the chronic pain associated with tissue repair vs mesh life long and debilitating

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      • #4
        Originally posted by localCivilian View Post
        It seems like most mesh related complications occur because of surgical technique.
        The evidence does not really support that. It's the meme that supports the use of mesh but there is no proven correlation. It's a hope, the hope that allows people to keep using mesh, the hope that with practice mesh will work. But the vast majority of the data available shows that the mesh itself is the problem. The best, most experienced surgeons have patients with mesh problems. The fallacy that surgical technique can "guarantee" a good mesh repair is something that the device makers love to hear.

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        • #5
          Good intentions I know what you mean. I’m just saying that I have not found that many studies that shows a significant difference between a mesh repair and a pure tissue repair as far as chronic pain. Although I will say that the complications are much more serious with a mesh repair, so I guess that is just a mesh problem in general like you say. But those serious complications that I have seen occur with mesh, it really is surgical technique and perhaps problems with the device. It seems like a lot of complications occur months and years down the road. If it doesn’t occur immediately after surgery, I wouldn’t think it’s the mesh. Correct me if I’m wrong. Most complication studies that I have read up on do happen because of mesh migration, shrinkage, folding and I have seen a lot of chronic lain problems especially with the fixation method that was used. Those metal spiral racks are like the devil it seems and should be banned, btw. But with complications like infection, I agree that you just can’t prevent those. Some complications, you just can’t prevent. I don’t think ALL of the problem is mesh, but the problem is surgical technique and if not then it seems to be a mesh manufacture problem. I will agree that it seems like mesh companies are just shoving these mesh products down the throats of almost all surgeons in the United States, when it shouldn’t be that way. I think if the FDA and mesh companies themselves took mesh a lot more serious, you would see better results. As far as surgical technique, if you think about at least 90% of people who develop a hernia, they usually just get referred to a general surgeon who does not perform most of these at all, rather than someone who does hundreds of hernias per year. Most of those general surgeons don’t even come close to putting in the time and thought into tailoring the right repair for their patients such as placement, fixation, six of mesh and even wether or not to use mesh in the first place. They just seem to do what they’ve been doing for the last few years and what they think is the fastest repair. I think that’s always important to take into consideration. I would just like to see mesh results when I like said, the FDA and mesh companies start taking complications serious. I do believe that improvement can be made if there is more research on how to improve mesh itself rather than just come up with good marketing ideas.

          If more surgeons would practice a good pure tissue repair more often, I would love that, trust me.

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          • #6
            Originally posted by scaredtodeath View Post
            I Giles’s the question is the chronic pain associated with tissue repair vs mesh life long and debilitating
            I never ever heard anything in relation to chronic pain after tissue repair. ..if it done by someone who specialising in it .DrBrown can you please tell us about that ?

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            • #7
              So both of you would agree that tissue repairs say at the Shouldice center result in similar chronic pain levels as say the mesh...I just can’t find data as it relates to the Shouldice clinic one way or the other... though they do mention a low recurrence rate I just wish it was more forthcoming in regards to the chronic pain

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              • #8
                The shouldice hospital reports chronic pain at their hospital is less then 1%. Mesh pain rates is now being recognized to be 10-20% range with some reports saying as hi as 30%.
                Also understand that the world pain has a huge umbrella range to it.
                Pure tissue repairs use your own muscle and tissues to repair the defect. Mesh is a large sheet of plastic that can cause a whole slew of pain problems then pure tissue repairs-mesh can fold and ball up and take your muscles, tissue and nerves with them, mesh can attaché to your bladder, your spermatic cord and nerves.
                mesh can become infected, mesh can migrated and come in contact with other organs, mesh can erode into the intestines and cause fistilas especially with lapascooic relairs. Mesh can cause auto immune issues, digestive issues and more.
                so I think it is about time the medical community stop clumping “pain “ into one neat category when it comes to mesh pain Vs pure tissue pain.
                pain sucks but their is a huge difference in my opinion between “natural” pain from your own. Body and unnatural pain caused from a lice of plastic being implanted into a sensitive area of the human body.
                For a good amount of people it appears mesh “works” but when it goes wrong look out.
                You will have a piece of plastic that is meant to be permanent and very difficult to remove. You will almost certainly be gaslighted by the majority of the medical field in which they will find nothing wrong with you.
                Only until you on your own find the few surgeons who are often in different states than you will you have a chance. And ofcourse you will probably have to pay out of pocket to have the permanent device removed with no guarantee of success of your pain issues.
                So short answer is no: the published data shows pain from mesh to be significantly higher then the shouldice hospital.

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                • #9
                  I agree with Jnomesh. Anyway, whatever the repair, I read somewhere that pain before surgery is a major risk for pain after surgery. So, if scared has pain now, that much more risky than being pain-free.

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                  • #10
                    If 1 percent chronic pain was true... wouldn’t docs left and right be offering it or am I being foolish.... just seems to good to be true compared to what I see in the literature

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                    • #11
                      No other center has been able to recreate the statistics claimed by the Shouldice Center.
                      #ItsNotJustAHernia
                      www.BeverlyHillsHerniaCenter.com

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                      • #12
                        Dr towfigh in your experience with people who have chronic pain, do you find that those with tissue repairs are more manageable then the mesh cohort

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                        • #13
                          Not necessarily.
                          #ItsNotJustAHernia
                          www.BeverlyHillsHerniaCenter.com

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