Traditional hernia surgery is a way to repair a hernia without using mesh. It has been pushed aside by proponents of mesh hernia surgery and very few surgeons perform it currently. Mesh has reduced the overall incidence of hernia recurrence but at a cost of causing chronic pain in 20% of patients. For this reason many patients are now asking for information about traditional hernia surgery. And members of the American Society are beginning to ask why are we not doing more traditional hernia surgery.
There is great value in many of the traditional ways we have of doing things that have been pushed aside and forgotten in the name of progress. Economic interests, technology appeal, marketing, politics and peer pressure define progress and can blind us to the value of tradition.
Take archery for example. Put a skilled archer with a traditional long bow up against any archer with a high tech compound bow with peep sites, counter balances, shock absorbers and a mechanical trigger. In an artificial setting, the shooting range, the compound bow archer will hit the bulls eye with little effort. Once the bow is properly sited it takes zero skill to shoot it well. Anybody can do it. In traditional archery with a long bow it takes a great deal of skill. Not everybody can do it. The skilled traditional archer can hit a moving target, something that a compound bow archer has no hope of ever doing. A traditional archer can react quickly in the field and hit his target while the compound bow archer is still squinting down a narrow site and looking for his target. In a real life setting there is no comparison. The skilled traditional archer wins every time.
Traditional non mesh hernia surgery in the hands of surgeons skilled in the techniques consistently has good results. The masters of hernia surgery Dr. Edoardo Bassinni and Dr. Chester McVay in their original reports showed recurrence rates of 2% and less. There are many other single surgeon and single institution studies that have verified these results. Proponents of mesh however point to studies which show high recurrence rates for non mesh hernia repairs. The problem with all of these studies is that they examined the results of heterogeneous groups of surgeons which undoubtedly included surgeons not skilled or experienced in non mesh repairs.
The reason this matters is because mesh hernia surgery has been adopted as "The Standard of Care", case closed, discussion over. Any intelligent person should be struck with terror whenever they hear that phrase, be it in politics or medicine. This only serves to quiet dissent and debate is always a good thing
Some very well respected doctors acknowledge the risk of chronic pain in mesh hernia surgery saying it is a professional embarrassment but mesh is the standard of care. Not everyone accepts this. A traditional hernia surgeon who can repair a hernia without mesh and can achieve a low recurrence rate will dispute this standard of care.
The advantages of a traditional non-mesh hernia repair is that the incidence of severe chronic pain is very low. In fact, in the 6,000 traditional non-mesh hernia repairs Dr. Petersen has done he has not seen it. The recurrence rates of mesh hernia surgery and expertly done traditional non-mesh hernia repairs are the comparable.
In college Dr. Petersen shot competitive compound bow. Recently he has picked up traditional long bow and has become a huge fan. Dr. Petersen has been doing traditional non-mesh hernia surgery for 33 years.
P.S. Dr. Apologizes to any compound bow archer he may have offended.
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"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News