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Should I go out of state?


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  • Should I go out of state?

    First off, I'd like to say thanks to everyone on this forum, I've found surprisingly few resources considering how common hernias are. I'm a 46 yr old male, diagnosed with indirect inguinal hernia on my left side. My hernia is small to medium, doesn't hurt and rarely bulges out. After what I've read, I've decided I want to go with a no mesh repair. The 'in network' surgeon my insurance sent me to wants to do the standard mesh procedure(open not lapro), but is willing to do a no mesh procedure if that's what I ask for. She stated she does go with no mesh in some cases with women(to avoid issues with pregnancy), so she is at least somewhat familiar with no mesh, albeit not in men. I would basically have to sign a document saying I have been made aware that mesh is the standard of care, and going non mesh is accepting a higher risk of recurrence. So my question is, should I go with my doctor, who is willing to do no mesh but doesn't do it often, or go out of state to one of the doctors frequently mentioned on this board, who will do a better job but will cost me at least 5g+? (My insurance will not pay anything if I go out of network). I know it's difficult to say without knowing more specifics, but is the chance of recurrence that much greater with an average surgeon doing a standard repair vs. someone like the Shouldice hospital? If it's a big difference then I will spend the money, but if we're talking like 2% greater chance then I would opt to go with what I've got.

  • #2
    My personal advice would to be travel to one of the few surgeons/ places and get it done right.
    of you listen to the surgeons who specialize in non mesh repairs they will quote very low recurrence rates that are at least equivalent to mesh or even lower. This is because they of their skill level and confidence having done so many. It is my belief that when a surgeon who mostly to always uses mesh but is willing to do a mesh repair quote higher recurrence levels they are just covering themselves and are essentially in a round about way they arenít confident in their ability to do this type of repair. I believe the higher rate they are telling you is illustrating their confidence level.
    Also the a guys anatomy is different then a womenís so the fact this surgeon has only primarily done women is also a little bit of a red flag. Since you hernia is small the repair should be relatively easy with very good results.
    But here is the thing just in case when the surgeon gets in there and there is something not expected then you want someone who can adapt the repair to your specific needs and this requires someone who has done many non mesh repairs.
    I have heard it before where a surgeon will say they will do a non mesh repair only to change there mind once in there bc the hernia was to big and they will slap mesh in and tell the patient when they awake. This is another reason to go with someone experienced. For example, When I had my initial hernia surgery it was beloved I had only a indirect hernia but it actually turned out I had both a indirect and a indirect so the scans arenít always 100% accurate so you want a non mesh surgeon to have the skill and redundancy to handle anything with confidence.
    i know the thought of traveling can be worrisome but for someone like myself who ended up traveling out of state to have my mesh removed, trust me traveling and paying out of pocket is worth it to get something done right.
    id also double check your out of network benefits if you have them and see if they will reimburse anything-speak to a supervisor.
    if you have been reading a lot of posts on this forum you will know the number of surgeons/places to get a non mesh repair are very few: there is dr. William brown in CA, shouldice hospital, dr. Tomas Iím florida and dew other secondary ones.
    Id probably lost those three surgeons in that order as there are testimonials on this forum of success with dr. Brown. What I like most about brown is that he tailors his repair based on what he finds once inside. He has great bedside manor and offers a personal touch that you just didnít see in todayís society-follow up calls and hands out his cell phone number and actually picks up and answers while you call or calls you back shortly.
    Shouldice and Desarda (dr. Tomas) are to specific types of repairs that also seem to offer very good results. Whoever you choose still do as much research as you can. For example, I have heard great things about the shouldice hospital but I have also come across one surgeons name there that people have had complaints about and not good results.
    Best wishes


    • #3
      Thank you for your thoughtful reply. My family, my doctor, and the insurance company all want me to just go with the flow and get the mesh, but I'm definitely leaning towards going with Dr. Brown. As an Arizona resident, and he offers the best combination of good reviews, proximity, and affordability. Still, it's very frustrating to pay for insurance all these years, and now, when I really need it, it's worthless to me. I'll contact them about reimbursement but I doubt they will work with me.


      • #4
        Hi, well as a female, I'd be going with her. I am in the same boat and if I had any disposable income I would be going to Dr. Brown but I am further than you and the out of pocket plus bringing along another and hotel bills just aren't doable. I am going to go with someone in network that will do no mesh but doesn't specialize in it.


        • #5
          For some perspective:

          The Shouldice hospital reports a 1% or lower recurrence rate. They highly select their patients and no one has been able to reproduce their results.

          The average expected recurrence from a non mesh mesh performed in the US is 10-15%. Most experts have a rate in the 3-10% range.

          Compare that to the average national recurrence rate with open mesh as being in the 5% range and under 1% with experts.


          • #6
            For sure, everything I've looked at indicates that of all the issues mesh repair might have, hernia recurrence is not one of them. My take from everything I've read is that mesh usually works out fine, but when it doesn't, it can be devastating for the patient. My feeling is that if I go with someone like Dr.Brown, maybe I could lower the likelihood of recurrence to the 5% range. All that being said, I could have the mesh done in my home town for free, versus a very difficult trip to San Jose, the logistics of which I still haven't figured out.


            • #7
              Spot on! Recurrence is often used as the primary outcome measure in these statistical studies of hernias. When what they should be using is as primary outcome measure is pain and other long term complications. Of course, reinforced concrete is much stronger than just concrete alone! But should you ever have complications from bad reinforcement and decide you want to get those rebars out of your concrete... well... good luck getting that out without damaging the concrete.

              Don't look only at the recurrence rates. That's the trick! You have to look closely at other factors and take them into account.

              I could also have done my hernia surgery for free in my home town like most people that live here. But the surgeon I met could not even tell me what kind of mesh would be installed in my body or what material it was made of. So much for "discussing" the "options" with my surgeon.

              I have a relative who had a hernia repair with mesh, open surgery, and he told me he never had any issues with it. He did his several years ago and he is in his 60s. But why play dice? You need to know what the risks are if things go wrong. This is something that upsets many people who had mesh repair that are now against mesh repairs. They were never told of the disabling complications that can arise from mesh implants.

              I went out of country for my surgery. And what really made my decision easy is when I read about cases where one surgeon would put the mesh in and refuse to take it out. There was one woman from my own town who got mesh implant for urinary incontinence, and she had to seek help out of country to get that thing out. The first surgeon refused simply because the procedure was too risky? Dear God! So I knew right then what I had to do.


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