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Researching surgeons - what questions to ask


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  • Researching surgeons - what questions to ask

    Just wondering what sorts of research I should do if and when I need to find a surgeon for a hernia. Have appt tomorrow with someone in Dr. Procter's department at VCU in Richmond VA and suspecting I have a small direct inguinal hernia that has my health anxiety through the roof. The idea of watching and waiting panics me as does surgery and the seemingly high rate of complications/pain. I just lost a lot of weight last year and have been enjoying running at least 4 days per week for the last year+, and then I seem to be paid off with a potential hernia. Seems finding a great surgeon is critical and I want to do my homework and be prepared.

    I don't want things to progress any further (largely asymptomatic right now) but don't want to get surgery on something that isn't currently a huge problem if it means I risk more life-long pain or complications. But I also feel like this is a ticking time bomb and feel uncomfortable even moving now simply from worry about what I might do to that area by exerting myself. Wish I hadn't even discovered the tiny bulge. My PCP did the cough test and said no hernia. But my understanding is that's only good for indirect hernias and this looks and feels like direct. Just a big dilemma for me.

    So that being said, what's the best way to learn a surgeon's skill? Ask for references/stats directly from him? What kind of stats (number of operations and type, success rate, etc.)? Ask my PCP? Are there websites for such things?

    Thanks in advance.

  • #2
    Start with PCP, however sometimes I have found if you call and just ask for a surgeon they will give you someone close by to you, but you will want more than just convenience. So make sure you ask for who they recommend themselves and who has your PCP's other patients have had good results with.
    I assume you don't know anyone who had this surgery, because obviously if you find anyone who had it, ask how it went and get a surgeon's name if they had good results. I got a name (turned out to be the same doctor) both ways.

    I thought this website looked useful:
    you can find surgeons based on condition, and based on insurance info the site can tell you if the surgeon is very experienced in treating it.

    In general for hernia you ideally want a doctor that has been doing this for many years and should have thousands of repairs under his belt.


    • #3
      Thanks! Very helpful. I know three people now who have had this surgery, two locally. I will ask them how it went and who they used. Though it seems everyone had some complication or another or some minor lingering issues. But they seem satisfied ultimately.

      By the way, does mesh need to eventually (over years or decades) be replaced, or is it intended to be permanent? Thanks again.


      • #4
        the majority of mesh implants will be permanent, and hopefully will never need to be removed.
        I didn't mention mesh vs. non-mesh in my first reply because it is a much bigger issue as you can see from other posts. You will find the overwhelming majority of surgeons will use mesh these days, and it will be polypropylene or polyester which is a permanent implant.


        • #5
          wonderful that's great to know thanks


          • #6
            Originally posted by ajm222 View Post
            The idea of watching and waiting panics me

            Seems finding a great surgeon is critical and I want to do my homework and be prepared.

            I don't want things to progress any further (largely asymptomatic right now) but don't want to get surgery on something that isn't currently a huge problem if it means I risk more life-long pain or complications. But I also feel like this is a ticking time bomb
            I felt similar to you when I found that I had a hernia. But mine was symptomatic and painful and was inhibiting my doing the things I liked to do. If I can be frank - a person would be a fool to get an asymptomatic hernia repaired, by any method, if it's not getting worse and they are doing all of the things that they like to do.

            It's not a "bomb". If it gets worse it will be fairly slowly. You'll know that it;s getting worse. More stuff will push out and you'll have a sizable bump and various other discomforts.

            This is an interesting time for hernia repair. There's been a very big push to get the new mesh products and techniques out to the masses (25% of the population is massive, marketwise). Everyone involved has been overlooking problems, and/or hoping that all of the change is only for the better. But, as you've seen, many of the professionals, from the device suppliers to the insurance companies, and many surgeons, are ignoring the signs that there are major problems. The cost, to the patient, physically, of a problematic hernia repair is huge, but the probability of it happening is smaller. They, the people I mentioned above, are paying for lower recurrence rates with the lives of the few that have problems.

            Basically the odds of a successful repair (no recurrence) are better but the cost of complications is huge. It will completely change your entire life. That's what you should be afraid of.

            If I had just discovered a hernia and it was minor and asymptomatic I'd wait and see how things shake out. I don't think that things can continue as they are, the law firms are lined up out there. When I was researching for mine, in 2014, just three years ago, I barely saw any law firms advertising for hernia mesh lawsuits. All I saw was transvaginal mesh law suits. Now the first search page for "hernia mesh" is almost all about hernia complication law suits. That's in just three years. I'd wait.
            Last edited by Good intentions; 09-28-2017, 06:34 PM.


            • #7
              Thanks! That’s great info. Most friends who’ve had the surgery always say ‘sooner rather than later’ but perhaps they simply weren’t aware of the possibility of ‘watch and wait’ or had very symptomatic hernias. I imagine if I DO get surgery I should find someone that seems aware of all the things you’ve mentioned and have considered them. Must be some knowledgeable and experienced surgeons aware of these problems and care enough about their patients to discuss them. But I’ll be sure to bring this up. And perhaps try and steer clear of any cutting-edge, latest-and-greatest mesh products and ask for something tried and true if possible. Will find out tomorrow hopefully what’s going on and start considering what to do.


              • #8
                But. If you do decide to go ahead and have it done, I would ask the surgeon if they have actually talked to patients who've had the materials and techniques the surgeon is currently using, after 6 months to a year, and heard the patient say that they were happy with the results. Not results from older methods and materials, because change is being made based on potential benefits not proven benefits. And every surgeon has a different method. So you can't even compare materials and methods. I've only found a few people who will say that they're happy with the results of their hernia repair. I think that there are probably many many people who aren't but have just accepted their new diminished life. Because there's nothing that they feel they can do about it.

                There are pretty sizable communication barriers between patient and doctor these days. If I want to talk to mine, I have to call his answering service. They deliver a message. If he wants to he can call me back. Or he can ask me to come in for an appointment. That means waiting one to two weeks, then paying a copay, then getting 15-20 minutes of time.

                In short, just ask for proof that what the surgeon is going to do to you actually will make you better. It's a very reasonable question.


                • #9
                  By the way, did you have a bad experience? Having trouble finding previous posts. Thanks.


                  • #10
                    Originally posted by ajm222 View Post
                    Thanks! That’s great info. Most friends who’ve had the surgery always say ‘sooner rather than later’ but perhaps they simply weren’t aware of the possibility of ‘watch and wait’ or had very symptomatic hernias.
                    I thought that I had found the perfect person for advice when I had mine. A surgeon who had actually done hernia repairs, and had had a hernia himself, which he had repaired. But after I had the surgery I found that he had his done by the open repair method.

                    If you have friends that will honestly talk about how they are, including all side effects, you'll be lucky. The thing about healthy active men (maybe women too) is that we are all raised to suck it up, throw some dirt on it, be tough. And we don't like to admit that we made a mistake. So I think that many of the problems are being hidden by the patients themselves. And the pros who could extract the information, through an anonymous survey, or discussion, aren't seeking out the truth.

                    If you find someone who had success, and has been okay for over a year, and they do similar activities to you, and have your same body type, consider having the exact same surgeon and procedure.


                    • #11
                      Originally posted by ajm222 View Post
                      By the way, did you have a bad experience? Having trouble finding previous posts. Thanks.
                      I did and I'm seeking solutions. I had bilateral laparoscopic mesh implantation of Bard Soft Mesh, for a direct hernia. It hasn't been anywhere near the impression that's fostered by the industry. It's the worst thing that's happened to me besides the death of family members.


                      • #12
                        Very sorry to hear that. I had one friend who had open for one repair and laparoscopic for another. He said he has no issues now but did mention the open method was actually easier recovery, mainly because the lack of bloat that took a couple of weeks to go away. Another friend has had two surgeries. Said the first wasn’t bad but the second took him a month to leave the house and he had nerve damage in legs, which eventually resolved. He was out of work for two months. He said he’s now recovered. Another friend had three surgeries and he says no problems now but I haven’t really talked to him at length yet for details. And the last said he gets anoccasional twinge or discomfort I guess but feels mostly fine. I don’t know what he had done. But I believe all had mesh repairs.

                        It’s good to be informed but also scary. Went to a law firm website for worst case scenarios and scaremongering and saw stuff about teeth falling out and bowel obstructions and brain damage. But I also know this is one of the most common surgeries there is and has been done with and without mesh for a century. But that doesn’t really matter I suppose if you’re in the bucket of folks who have complications. I know my grandfather had hernia surgery as a middle aged man and never heard anything about complications later in life (he lived to be 91). But I have no idea what method was used for repair. Sigh. So much information out there and so hard on someone like myself who has trouble making decisions. Will see what surgeon(s) say. Thanks again for all your thoughtful responses.


                        • #13
                          I can't emphasize enough how important it is to get the details of what worked and the details of what your surgeon is planning. Make sure that they match. Things are changing very fast right now and things are being tried that have not been proven to work. There is a lot of experimenting going on, with no long-term follow-up.

                          Get on to youtube and search "sages conference hernia" or similar and watch some of the presentations. Many of the talks are about the new things being tried, and if you watch closely you'll see that many of the presenters aren't really confident that their methods work. Their patients go away and they never hear from them again.

                          It's great that you have friends that have had the surgery. But you'll probably have to press them to find out how they really feel. As I said in post #10, we don't want to look weak so we tend to hide our problems. I know I did, and still do. Plus I spent a couple of years trying to believe that I hadn't screwed up by having the surgery done. Convincing myself that things would get better eventually.

                          The "find a surgeon with many surgeries under his belt and you'll be fine" advice that you see is almost a marketing tool, to make people feel comfortable about having it done. My surgeon had about 400 repairs behind him. He was very skilled. But he was still modifying his method. He told me that but I convinced myself that he was fine-tuning to perfection instead of asking him what was wrong with the way he had been doing things. Maybe he had had earlier problems. I still don't know.

                          It's very difficult to challenge an expert about what they are telling you. Some will get angry. But you'll live with your choice for the rest of your life. Much longer than a few months of healing pain. If they can't answer your questions then you know that they don't know for sure that their methods actually work. Make sure that their method is tailored to you, and is not a one-size-fits-all method. It's been posted here and I heard it from my surgeon, that active people with low body fat tend to have more problems with mesh. He told me this after I went back with problems, not before. Even though he knew that I was very physically active, and am obviously low body fat.

                          Good luck.


                          • #14
                            Thanks. This surgeon said it appears I have it on both sides (indirect inguinal) and suggested a laparoscopic robotic surgery with a mesh they’ve been using for well over 10 or 15 years. He had a colleague in this practice that apparently did it recently. He did say he does the open no mesh surgery method that starts with a D (can’t remember name) as well.


                            • #15
                              Hi, Good Intentions: a question: your prosthesis is made of polypropylene?


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