If you need hernia repair, you’re lucky. World-class surgeons are hard to find anywhere, much less in SE VA, but we’ve got 1, and that’s what he does.
Dr. Youssef performed an inguinal hernia repair for my husband. I could not be happier with the result even if we had traveled to Cedars Sinai. (Prior disappointing dips in the SE VA labor pool made us consider this a very real possibility.)
Hubby and I researched the procedure, deciding we 1) wanted laparoscopy rather than open surgery, and 2) preferred TAPP over TEP. (A stronger repair. Think of patching a balloon or tire on the inside vs. outside.) We researched providers and consulted three of the most promising hernia specialists, which I arbitrarily defined as repairing hernias more often than 90% of their peers.
First was Dr. Y, my fave based on his background, which was by far the most impressive we saw. We got the right answers to 1) and 2). As soon as I mentioned mesh, he volunteered to show us a sample. It conformed… to recommendations I had read. Dr. Y explained he would be using the standard adhesive plus three points of suture attachment. (Arguably overkill. I LOVE overkill.)
After the procedure, Dr. Y reported that he chose an especially large patch due to the size of the hernia (i.e., protrusion). NB: Insufficient mesh overlap is the #1 cause of preventable failure. (15 cm. IIRC. Even more overkill. Now I felt a crush coming on.) And hubby recovered much more quickly than I could have reasonably expected.
Dr. Y rates 5 in all the categories listed here. But frankly, so did the others we consulted. All were polite and took their time answering our questions. Where they differed was the accuracy of, and competence evinced by, those answers. Here’s how the other consults went.
Dr. 2 struck me as reasonably competent, but he promised only to attempt laparoscopy – the difficulty might force him to resort to open repair. He said he preferred to use a robot, but his practice had only one. He’d use if it was available at the start of the procedure. (?!?) He too showed us a sample of mesh when I asked. It looked fine for TEP (poly but no slick side), which was his method rather than TAPP.
At 99th volume percentile, Dr. 3 performed this surgery most often. But our appt was, well, bizarre. He told us that no one would be able to perform this surgery laparoscopically. It would have to be open because the defect (not hernia, I clarified) was “ginormous,” indicating about a 6” spread with his fingers. (It was actually a little larger than a quarter, as the other 2 predicted.) He declined to show us a sample of mesh because it was “expensive,” and said that the hospital, not the Dr chose the mesh that would be used anyway. (??!!??) (Thank goodness I decided to start with the best. Had hubby heard this first, he would have freaked out.) So for us at least, Dr. Y was the only show in town.
Final thoughts.
If you are put off by Dr. Y’s use of a robot, so was I. I was wrong. Yes, many surgeons lacked the skill and dexterity to master laparoscopy, entering the market en masse when the robot came on the scene. But the robot provides superior imaging and other benefits beyond compensating for clumsiness. My bias had blinded me to a fact now obvious: Such a “crutch” can also make a brilliant surgeon, like Dr. Youssef, even better.
If you’re put off by DePaul Hospital, make sure you have current information. DPH has improved its error-prevention procedures, with good results. Today, their record of hospital-acquired infections—perhaps the most important stat for outpatients—is exemplary. But do pay attention to Dr Y’s instructions. Had I not insisted, the nurses would have discharged hubby before he urinated. (I got the idea he had spent about twice the normally allotted time in recovery, but this is no excuse. Perhaps DPH needs more slack in its schedule, or to create a hallway halfway house, so to speak.)
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