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pigskin vs Shouldice - alloderm

January 29 2017 at 4:05 PM
Alan 
from IP address 50.133.240.107

10 yrs ago I had a mesh plug that was trapping the inguinal nerve removed, a neurectomy and alloderm repair. To avoid the pain and discomfort I have had since, I have been keeping busy as best I can but as I enter my 70th year, I find it difficult to keep myself distracted from the pain and believe it is getting worse.

I have major concerns about the alloderm. I was evaluated by a surgeon who does many repairs with people in my situation, stating alloderm could likely be the culprit of much of the pain and discomfort but of course couldn't give me any real assurances. I'm thinking - "I've had the alloderm for 10 yrs. Even though I'm in fairly good health I am 70, getting too old to have a serious operation without increased risk. In fact, surgeons won't operate on me unless it's in a hospital setting. Beside, I don't trust the alloderm to last and am assuming it already has, to some degree, failed. If I'm going to do this the time is now." Does this make sense? Anyone have experience with situations similar to mine so I know what to expect.

I'm deciding between pigskin and shouldice repair and hoping for the best. I was told in my case the Shouldice repair has a 10% recurrence rate. I'm not sure pigskin repairs have been around long and am weary of another dermis mesh (but then if it works better sure..). Thanks

Any thoughts or help in making this decision is greatly appreciated.
Alan

 
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AuthorReply
Jeff

71.223.235.252

Re: pigskin vs Shouldice - alloderm

January 31 2017, 6:55 AM 

Both alloderm and pigskin have what most hernia surgeons would call less than satisfactory results for hernia repair. Patients who choose a Shouldice repair can have complications post surgery as well. There are far more lesser skilled surgeons using mesh in their repairs than doing Shouldice repairs. There are plenty of skilled hernia surgeons using mesh having done thousands of hernia repairs that do not have any patients with complications. Unless you travel to the Shouldice Hospital they state on their website its pretty much at your own risk by having a Shouldice repair. They believe surgeons outside of their system do not have the proper training or experience to perform the Shouldice repair at their skill level.

 
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Anonymous

72.28.168.27

Re: pigskin vs Shouldice - alloderm

January 31 2017, 11:01 PM 

If I were in your situation I would make contact with Dr. Goodyear at North Penn Hernia Institute. His 30+ year career has been almost exclusively the repair of hernias (thousands and thousands) and helping those that have had complications due to surgeries performed elsewhere. I've had two excellent surgical experiences with him. In my opinion he is one of the best in the world and has seen every kind of hernia from simple to complex. Certainly worth a telephone consultation and if you are in the northeast you might want to consider travel for exam and discussion. Lansdale PA is a small, pleasant town and the NPHI staff is very nice and accommodating.

 
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Alan

50.133.240.107

Re: pigskin vs Shouldice - alloderm

February 3 2017, 10:40 PM 


My computer died on me so wasn't able to respond sooner. Thanks for the suggestion. What about someone like Dr. Ramshaw to do the shouldice?
Alan

 
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Bradley

67.6.172.165

Re: pigskin vs Shouldice - alloderm

April 7 2017, 6:51 PM 

We warned people about Alloderm. Stay away from it. Now you must get everything removed and have lightweight mesh put in.

 
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JD

66.166.89.178

Re: pigskin vs Shouldice - alloderm

May 26 2017, 8:00 PM 

Who was your surgeon? Didn't you post along time ago?
Was your somewhere in Illionois or Ohio?

 
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Anonymous

70.58.1.121

Re: pigskin vs Shouldice - alloderm

June 29 2017, 11:27 PM 

I believe I remember your post several years back. I cannot remember your doctor but several people warned you about Alloderm. You were in a lot of discomfort and I believe the surgeon who did your surgery has retired. I don't see why you would want to go with pigskin after the Alloderm incident. On the other hand, I don't see why you would go with Shouldice. If I were you, just get a normal lightweight mesh repair.

 
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James A. Goodyear, MD, FACS

96.93.46.141

POST HERNIORRHAPHY PAIN SYDROME

June 30 2017, 11:55 AM 

To begin, there are many causes for Post-Herniorrhaphy Pain. As such it is difficult, if not impossible to identify the exact or probable cause without a complete and comprehensive examination and evaluation. Furthermore, in circumstances like this, it is even more difficult to 'choose' the exact surgical details for repeat surgery without some degree of flexibility. Operative findings may to a greater or lesser degree dictate some or all of the method of treatment.

Additionally, 'Alloderm' itself is not the cause of your pain. Pain, especially when it is chronic and severe in nature, is caused by entrapment or damage to nerves. This may involve one, two or all three of the nerves. More often than not, this is related to entrapment of these nerves in scar tissue, suture or even permanent mesh. The more surgical dissection, often, the more scar tissue and the higher the potential of pain. Mesh is NOT always the culprit, even though it is often implicated as the cause. Surgical skill, expertise and experience, and the ability to identify and protect these nerves during hernia repair is of paramount importance.

Effective treatment in our opinion for selected patients who are candidates for repeat remedial surgery must include a triple Neurectomy (severing all 3 nerves), as cutting only 1 or 2 nerves is too often ineffective.

With regard to your question regarding the mechanism or subsequent repair, my feeling is this. The most important thing in choosing a course for surgical management of Post-Herniorrhaphy Pain is identifying an experienced and knowledgeable surgeon familiar with the details of this intricate procedure. It is not for the occasional hernia surgeon, but should be a specialist. Given that level of expertise, the repair of any persistent or residual hernia should be a his/her discretion based on operative findings. Micromanaging your surgeon too much can leed to poor outcomes.

 
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