Pure tissue/no mesh inguinal hernia repair: anybody can advice where/who in the UK/Europe?
Posted , 6 users are following.
Hi all,
I'm new to the forum, although I've been lurking around for months. I'm in the UK.
I was diagnosed with a right inguinal hernia last December - no bulge visible, but the little thing can be felt slightly poking out from the superficial inguinal ring when performing the Valsava manoeuvre. Painwise it's not bad at all, sometimes does give me mild discomfort, and sometimes mild testicular pain, but really nothing that would require urgent care.
Initally GP found no hernia, carried out a few tests to explain intermittent testicular pain, then a private visit to a hernia surgeon confirmed the hernia. Went back to GP for a referral, but since private surgeon was outside of my local health board, had to wait months to see my local hospital NHS surgeon, who confirmed the presence of an hernia, very small.
Surgeon ordered an US scan (going for it today!) to size the defect, but mentioned that although it's true hernias do get bigger with time and makes sense carrying out a repair, the risk of inserting a mesh that could cause more problems is real and needs to be taken into account.
Interestingly the surgeon I saw privately said "yes we have to repair it" and never mentioned how, but based on my own research on him I'm positive he'd use mesh.
My NHS surgeon would probably do a tension-free open mesh repair, and the nice thing is that she spent quite some time explaining to me all the risks associated with the mesh and the fact that I might well be going from the mild discomfort I have now to constant chronic pain.
Hence I have been starting researching options on pure tissue repairs, and found there are only a few surgeons that offer this.
So far I've been able to find Peter Jones and Sue Jones based in Maidstone, Kent, and Ulrike Muschaweck, Munich based but she also comes to the UK. Also I have read about Andreas Koch (somewhere near Berlin).
The Jones have now retired, so I'm left with Muschaweck and Koch.
I was wondering whether anybody has got any experience with them, or if there are other options for a pure tissue repair in the UK.
Many thanks in advance,
David
0 likes, 7 replies
tom76387 DavidUK
Posted
Yes. Muschaweck patient here and it's no surprise many pro athletes from the states still goto her. Had bilateral 4 years ago and am still having issues that seemed to come on about 4 months after the repair. She thinks it's scar tissue pressing on nerves so deciding if I should allow her to go back in or go with someone else. Possible Mike Fox also at the Wellington.
DavidUK tom76387
Posted
Hi Tom,
Thanks for replying.
You're still having issues after 4 years? Really sorry to hear that.
I guess you must be unhappy to have gone down the pure tissue repair route then...
Did you go with Muschaweck to avoid mesh in the first place?
The sonographer that did my US last friday said he can't really see a hernia in my groin. He said he doesn't think anybody will want to operate on me. Will have to see what my surgeon says in the next follow up.
Interestingly 8 months ago the visit with the surgeon and subsequent US confirmed a small hernia that needs repair.
I can see why they are reluctant to open me up to repair something small, but as we all know these things just get bigger and bigger, and don't fancy the idea of ending up with a serious bulge that will need extensive repair.
Moreover, I am still unsure about tissure repair vs mesh.
Does Mike Fox also carry out non-mesh repairs, or did you select him especially for releasing scar tissue causing neuropathic pain?
tom76387 DavidUK
Posted
My issue is likely scar tissue related causing inflammatory responses and irritating nerves. She will remove any scar tissue she finds and free or remove nerves as needed. I have seen Mike Fox as although he would not repair a hernia he is expert at removing scar tissue that effects nerves. A downside would be that he is less familiar with groin anatomy than Muschaweck is but he comes across as confident. I have seen him on the NHS as well as privately and he has offered me surgery via that route also. I think ultimately I will have surgery with both as I have agreement from them both to operate together so as to get the best of both worlds but I am yet to take that plunge!
DavidUK tom76387
Posted
Oh well, if you can manage having both carring out the op, that's fantastic!
Re permanent sutures, are you sure they can be removed?
When I first found about non mesh repairs I too tought they used resorbable sutures to avoid leaving any foreign material inside the groin, but then learned they actually use prolene, which stays there and supposedly helps in maintaining the repaired muscles together.
Did Muschaweck say she'd remove those sutures? Maybe after years the muscled have sufficently healed and they can be taken out. I hope that's the case.
Might have to get in touch with her. I have one more question regarding cost of the treatment with her, but I'm not sure this is allowed on the forum, I'll message you if that's OK.
sahilana DavidUK
Posted
I am at early stages of diagnosis of inguinal hernia, the bulge has occured in scrotum and is painful. Its restricted me from doing daily activities. The GP is sending me to hospital where they will only advice on mesh repair. My father had the same last year.
i would really like to go for pure tissue route. The best in the world for that is Shouldice centre in ontario Canada but travelling there in my condition is not easy. I have also learnt from research Dr ulrike Muschaweck from germany is good and visits UK. I understand NHS is not likely to pay for this and may have to be private.Could anyone please suggest how much it could cost to have non mesh surgery ?
mark68066 DavidUK
Edited
There is no doubt that the plastic/mesh hernia repairs have relieved thousands of people of their inguinal hernias.
But i think the medical community really needs to zoom out and look at the bigger picture. Until now the main alternative to the plastic hernia repair has been the Shouldice repair. It is the 'go to repair for the middle class in North America and Canada'. The problem with the Shouldice repair is that it is complex and involves 4 layers of tissue. This results in a steep learning curve which most hospitals cannot afford and do not have time for.
I will stand corrected but i understand the Jones in Kent use a 2 layer version of shouldice. But it can be argued that the final 2 layers do not affect the final outcome..
The plastic repair is relatively simple. Therefore it can be used widespread across the globe.
If you have £3k then you have choices 99% of the global population dont have.
Though the plastic repair, lichtenstein repair, doesnt sit right with me. Yes, it has served well since Irving Lichtenstein 'invented it'. But times have moved on. In the 21st centuary do we really want a sheet on plastic placing into the human body? It just doesnt sound right when you say it out loud. There is nothing magical about this sheet of plastic. 'Big Pharma' charge a fortune for the product that comes from a barrel of oil. But it is no different, and has no different result, to cutting to size a piece of mosquito netting. In poorer african countries mosquito netting is routinely used to repair hernias.
Like in any business sales are important. Biological implement companies want sales, sales, sales.
Desarda is effective but doesnt involve a product as such. Which presents a conundrum to biological implant companies. Usually a product is invented to better the existing. Now we have a technique which trumps the product.
Desarda will eventually be trumped by stem cell/lab grown internal oblique.
We talk about plastic in our oceans as though it is sacrilege. But we place this thing in the human body.
Today, we have the Desarda repair. It is a very simple inguinal hernia repair. I cant understand why after millions of hernia surgeries that someone didn't think of it and push its use before Dr Desarda.
Using a sheet of external oblique to strenghten the internal oblique. Absolutely brilliant.
It has been around for long enough now that we have sufficient long term data. Post operative pain is equal to or less likely than the plastic repair. Recurrance rates are equal or lower.
it is bot as widespread as the plastic repair because the plastic is a product and therefore has money behind it.
I simply love the simplicity of this technique. Shouldice is brilliant. But the world doesnt have the resources to use it on everyone.
Whilst nobody wants reoperating on, if there is a problem and you need reoprating on, then the Desarda repair presents a 'clean' environment. Opposed to the plastic repair which could be like opening up a bomb site. Scar tissue forms around the holes in the sheet of plastic which needs to be torn out (going in from the other side isn't an option if your outcome requires the removal of the plastic)
In the UK, Dr Martin Kurzer now performs Desarda. Though i understand his main technique is still the plastic repair. He has performed thousands of plastic hernia repairs. The relief he has brought through his expertise is immeasurable when compared to the alternative (a 'general surgeon' cutting into your groin). I know surgeons who wikipedia surgical techniques on the morning of surgery.
The fact that Martin Kurzer performs Desarda really does give this technique a wonderful seal of approval.
You can firm videos of the Desarda repair on Robert Tomas website (Florida).
Note: When i talk about the power of a product, another example is in bunion repair. Biological implement companies sell a screw to the NHS for £150 per foot. The alternative is the Bianchi repair. In the UK it is currently only performed on Harley street by Dr Bianchi himself. It is a 10 minute prodedure under local anesthetic. It does not involve a tangible 'product'. You then walk home (with a foot boot). Literally. It makes the screw repair look absolutely neolithic. BUT the screw the NHS uses is a product and involves money. Money is the root of all evil.
l01685 mark68066
Posted
Hi 'mark68066'
Your analysis is spot on and will help other readers and inguinal hernia sufferers. Thanks.