That leaves you with $894 to pay. The cost is typically less than laparoscopic or robotic techniques. How much does hernia repair surgery cost? Terms and Conditions of Use - Privacy Policy. A: We plan to discharge patients the same day of their surgery, avoiding a hospital stay. He was meticulous in his study of hernia outcomes, specifically hernia recurrences. The total cost for hernia repair is $4000. Several years ago, the ACHQC was first to detect a problem with a particular product which led to a recall. Still the deplorable "quick and dirty" that invites overuse of mesh - about 80 percent of the patients - has become a perverse incentive for higher billings in the United States. More factors that affect the cost of hernia repair surgery. Any updates on this? But what can we do to help? Peppers take longer than tomatoes to get going, so start them first. Shouldice hernia repair is the repair of inguinal hernias without the use of mesh. Possibly, so far, the only true statement but then again incisional hernias only make up 5% of all abdominal wall hernias and are never included in stats when the discussion is about groin repairs. We have experience with multiple types of inguinal hernia surgery, including non mesh and mesh repairs, and are happy to provide a clinical opinion through a consultation in our office. This repair uses a patients natural tissues to repair the weakness in the abdominal wall. Does anybody know of a hernia specialist who performs a true Shouldice repair in the United States? Recurrence rates can vary from 4% to higher than 15%. Transabdominal preperitoneal laparoscopy is the same surgery as totally extraperitoneal repair, except one incision is made through the groin. Dr. Nora Fullington and Anna Canavan, PA-C joined the practice early in 2021 to expand the availability of the subspecialized care provided by the practice. For any number of reasons a non mesh hernia repair may be a great option for a particular patient. Plastic or resin containers are usually reasonably priced and large enough for indeterminate tomatoes, but fabric containers, Tips for Successful Tomato Farming in Hot and Humid Climates, Tomato farming in hot and humid climates can be a challenge, but with the right preparation and care, you can still have a successful harvest. Dr. Shouldice observed that the recurrence rate after hernia surgery doubled from 2% to 4% when this move was eliminated from the procedure. The Your Turn Forum provides a space where people can post questions about mesh and medical device related issues and get advice and support from the Mesh News Desk community. Dr. Michael Reinhorn trained in Boston, in General surgery. He even observed that cutting the posterior cremaster fibers, together with the genital branch of the genitofemoral nerve improved outcomes dramatically. The repair is based on the Bassini repair with some modification. Drs Reinhorn, Rosen and Fullington (Left to right). In robotic-assisted hernia repair, a specially trained surgeon controls laparoscopic surgical instruments that are mounted on robotic arms. Maybe you have heard that someone had a hernia repaired but it came back, or they had ongoing pain after the repair. Laparoscopic and robotic inguinal hernia repair procedures performed by qualified surgeons carry complication rates of 1% and the same for recurrence. In order to recognize the distinct anatomical layers that are sewn back together, the surgeons experience is essential. He does NOT do a true Shouldice. The cost of the PP mesh was US$0.14 per cm. Learn more about our research and professional education opportunities. This collaborative is a non-profit organization that acts as a national hernia registry for the United States. First, some background about the surgeons. How much does hernia surgery cost? . Suraj Singh Department of Surgery, Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India ; Rajkumar Prakash Department of Surgery, Deep Chand Bandhu Involves gastrointestinal surgery. As an American trained surgeon, I was never taught that move nor had ever seen it outside of the Shouldice hospital. Mulching and Watering The average cost of hernia repair surgery in the United States is $7,750, though prices can range from $3,900 to $12,500. Am J Surg 1998; 175: 330-3. Ventral hernias of the abdomen are defined as a non-inguinal, nonhiatal defect in the fascia of the abdominal wall. 1964; 6: 163-178. However, RST 106 on large potato leaved types did well when grown in grow bags. The hernia can cause discomfort or possibly even emergency issues because of the possibility of the intestine getting caught in and squeezed by the hernia hole. You may actually be put on leave till this is addressed to their satisfaction. The procedure involves repair of your muscles using permanent sutures (no mesh, patch, or screen). Laparoscopic or robot-assisted hernia repair. All data in hernia repair clearly proves the benefits of achieving close to ideal body weight prior to surgery. . The repair is based on the Bassini repair with some modification. There are about one million abdominal wall hernia operations yearly in the U.S. It can be carried out under regional or local anesthesia. Books online: Operative Dictations in General and Vascular Surgery, 2011, Fishpond.com The hernia can be painful or even life-threatening if the intestine becomes trapped in the opening and is compressed. Dr. Michael Rosen is a past president of Americas Hernia Society and currently he is a co-founder and president of the Abdominal Core Health Quality Collaborative (ACHQC). Weight is a very important factor. Most inguinal hernias can be treated using the Shouldice repair. No, you do not need a referral or an appointment for a hernia examination at Shouldice. I already called his office and asked. They usually use a mesh made from synthetic material or animal or human tissue to strengthen the weakened area of the abdominal wall, which may reduce the risk of recurrence. Repair is performed only with the patient's own tissue. Hospitals in Canada. The many ways in which herniated tissue might protrude through the hernia can confuse the initial appearance of the tissue during inguinal hernia surgery. In time, new tissue attaches to the mesh to reinforce the abdominal wall, relieving tension and reducing the risk of a recurrent hernia. You can also click online to schedule a visit with Dr. Serrano any time. In this procedure, a doctor makes an incision in the groin, returns the tissue or organ to its original location in the abdomen, and then closes off and removes the sac. An interesting case report of a patient with bilateral inguinal hernia with hydroceles who underwent a modified shouldice repair who had painless postero-inferior displacement of testes who is rarely seen as compared to its unilateral counterparts. Surgical repair of hernias is the most commonly performed general surgical procedure in the United States. It is my hope that over the next decade we will create a curriculum that is accessible to every trainee and surgeon in the United States to become better inguinal hernia surgeons, since it is the most common abdominal wall surgery performed in the US and around the globe. Laparoscopic or keyhole surgery - general anaesthetic is used for keyhole hernia surgery, so you will be asleep during the operation. The procedure is done with a "twilight . ABOUT SHOULDICE HOSPITAL Located in Thornhill, Ont, its one of Canadas few private, for-profit hospitals. Shouldice repair. Sometimes what prompts a clinical exam by the doctor is pain, or a vague ache. What are the benefits of receiving Shouldice repair treatment at the Iskandar Complex Hernia Center? It is done with intravenous sedation, not gas anesthesia. Our specialists often treat people with complex hernias. A: It is performed with no mesh. The purpose of this experience was to provide Dr. Reinhorn with invaluable feedback to improve his technique. The use of mesh reinforcement has been shown to be very effective in reducing recurrences (not true for the majority of cases if one knows Pure Tissue Repairs and as proven by the Mayo study and D. Urbach)(1,2,3).Surgeons have utilized all various meshes, synthetic, biologic and bio-absorbable meshes, as an adjunct to improve results of surgical repairs. In fact, at Shouldice Hospital where I was trained in the procedure, the recurrence rate is only about 1% and the chronic pain rate is 3 in 1,000 patients at 3 years and 6 per 1,000 patients at 10 years follow-up. Any additional info you have on him would be appreciated. The Shouldice technique is a four-layer inguinal hernia repair performed with the patient under local anesthesia. He chose Shouldice, a hospital that does not use surgical mesh in its repairs. Surgery is typically recommended for individuals with acceptable operative risk, symptomatic hernias, or those at elevated . Surg Clin North Am 1984; 64: 287-298. . By using our site, you accept our is the private practice co-founded by Lauren Ott, PA-C and Dr. Michael Reinhorn, with offices in Wellesley, Massachusetts and Derry, New Hampshire. Starting Seeds with Cactus Mix: Challenges and Tips for Optimal Results, Using cactus mix for seed starting is an interesting idea, but it has its own set of challenges. A: There are no weight or lifting limitations after surgery. The operating room charges for all care before, during, and after the surgery is $2000. Yes, this is ideal for athletes and very labor-driven jobs. I received a Rx for real pain meds, but never needed them. First, it is important to choose the right type of planter and support system for your plants. The observed recurrence rates are, however, quite low when performed by hernia surgeons who are experienced with this specific technique. The Shouldice Clinic has demonstrated the procedures durability and safety with 75 years of experience. But if certain factors make you a better candidate for open surgery, he's an expert in conventional hernia repair, too. Dr. David Johnson at Premier Surgical Associates. The author has contributed to research in topic(s): Hernia. How much does a hernia surgery cost in Canada? It can be located in a variety of places. . When it comes to fixing hernias, experience makes a big difference, as demonstrated in the medical literature. Sen. Paul will be paying for his care out of pocket. There is a surgeon in Palm Springs CA, who says he was assistant chief of surgery at Shouldice. Dr. Iskandar, a renowned expert in hernia repair, is pleased to offer patients this option for the treatment of inguinal hernias. Dr. Fullington joined the Boston Hernia team with years of extensive surgery experience in both open and laparoscopic hernia repair. He combines his expertise with compassionate care to give patients the best experience possible when having a Shouldice surgical procedure. These are treated in other ways. Subscribe to our youtube channel and watch No Mesh Hernia Video. Your body is still recovering during this time, even though you have resumed your normal activities. He has performed over 3000 hernia operations on patients from all over New England and beyond. 90-95% of patients undergoing a Shouldice inguinal hernia repair will experience mild to moderate pain in the first 8-12 hours after surgery. It is becoming more apparent that inguinal hernia anatomy teaching is lacking in the United States. How much does hernia surgery cost with Medicare? In 1945, Dr. Earl Shouldice founded the Shouldice hospital, outside of Toronto. A: The pain after surgery is managed with over-the-counter Tylenol and ibuprofen. How much does a hernia surgery cost with insurance? We have expertise in inguinal and umbilical hernia repair, and pilonidal disease. At Center for Hernia Repair , we specialize in the treatment of hernias and prioritizing patient comfort and satisfaction. Q: Does body weight affect a hernia repair? Initially after joining Boston Hernia, Dr. Fullington studied intensively under Dr. Reinhorn, and quickly became an expert both in the Shouldice and open preperitoneal inguinal hernia repairs and has transitioned to teaching the repair to other surgeons. We use cookies and similar tools to give you the best website experience. Shouldice is a privately owned hospital that takes private payers but also is covered by the Ontario hospital plan, which covers only Canadians. Dr. Nora Fullington is an accomplished surgeon with over 5 years of experience in general surgery and since early 2021 has worked as a specialized hernia surgeon at Boston Hernia. Dr. Reinhorn was able to pinpoint the deficit in hernia education in the United States which leads to unacceptably high rates of long-term disability after ambulatory inguinal hernia surgery. The surgeon inflates the balloon to push away tissue, fat, and organs, making the area more visible. The average mesh size was 256.9 cm (range, 116 to 903 cm). 2nd Ed. One month after surgery, there are no restrictions on lifting heavy weights. Dr. Edward Shouldice, a Canadian surgeon, developed the technique in the 1940s. Background: Current guidelines state that the Shouldice technique has lower recurrence rates than other suture repairs and therefore is strongly recommended in non-mesh inguinal hernia repair. Climate change is one of the most pressing issues of our time, and its effects can be seen all around us. The United States FDA has partnered with the ACHQC in order to monitor the quality of mesh implants. Dr. Rosen also had the added benefit of being able to observe Dr. Fullington perform an open preperitoneal repair. At NYU Langone, a team of expertsincluding surgeons, plastic surgeons, radiologists, and critical care specialistscollaborates to treat adults with hernias. In the United States many surgeons use a non-absorbable suture instead of a stainless steel suture. He pioneered the Modified Shouldice repair, which incorporates a special mesh for those unique cases where the extent . Hopefully, as we collect more data from the ACHQC, we can prove that quality outcomes are reproducible when a deliberate process and curriculum is created for training surgeons. A hernia is a hole in the muscular abdominal wall. The most common type are abdominal and groin hernias, which can only be repaired surgically. Website design by Moon & Owl Marketing. It is really challenging to undo the repair, so that is why the restrictions are less with this type of procedure than with others. But it has relatively low reported recurrence rates in the hands of surgeons experienced with this particular method. All Rights Reserved. Dr. Michael Reinhorn is an inguinal hernia specialist and has been in private practice for 20 years. The Shouldice hernia repair involves using a running permanent suture to first plicate and strengthen the inguinal floor. These visits have reinforced my suspicions that many of us in the United States lack this foundational knowledge when we finish our training and have had to learn it on our own. Dr. Reinhorn observed this famous technique at the shouldice hospital and we offer it to patient who are good candidate for, and who want the Shouldice hernia surgery near Boston. Annually, there are about 350,000 ventral hernia operations. Every persons body is unique, so Dr. Iskandar will discuss with you what would be the best plan for your particular situation. The repair is a modified Bassini. That is, to avoid mesh and avoid any of the potential complications from mesh (primary fear usually is chronic pain in the groin, mesh migration, foreign body . Hence, small body frame and not overweight is encouraging, but small body frame and overweight needs to have weight loss. A shouldice hernia repair is only performed for inguinal (groin) hernia surgery. This technique of repair uses no mesh as it is based on a tissue repair. When Dr. Reinhorn visited the Shouldice hospital, he was struck by the fact that each surgeon performed the operation in the exact same way. if one is to believe the stats of the EHS International Guidelines on the incidence of 12% of CPIP. Hernias occur when soft tissue protrudes through an opening in the wall of the surrounding cavity. Choosing the Right Variety I used to have his email address and I will look for it. The Shouldice repair is associated with low rates of recurrence and chronic pain. If you have nothing positive to contribute to my topic, go pester people you are stalking somewhere else. Indirect inguinal hernia is a common medical condition that can be caused by an embryological defect due to failure of closure of processus . In this step of the procedure the ilioinguinal nerve and the genital branch of the genitofemoral . Although it has not been proven, many hernia specialists concur that young, active persons who are slender and athletic are more likely to have pain or discomfort after mesh surgery. Whether youre growing heirloom varieties or hybrids, tomatoes offer something for everyone. Does anybody know of a hernia specialist who performs a true Shouldice repair in the United States? Several tiny incisions, usually the size of a dime or keyhole, are made in the abdomen. Prescriptions . We recommend getting back to activity as soon as you are able. Watering every day with just a teaspoon or two works well. This partnership with the ACHQC and the FDA puts patients safety first! Over the years various surgical techniques have been employed to deal with them, and these techniques have evolved with greater understanding (?). I looked at the Website and it doesn't say he worked at Shouldice. Tomato seed size can vary greatly and the smallest ones may not even germinate. With this maneuver, the floor of the inguinal canal ( transversalis fascia) is completely cleared, allowing for exploration of a femoral hernia ( by dividing the transversalis fascia). Lowering . There are other types of hernia for which the Shouldice repair is not used, such as hiatal hernias and parastomal hernias. In a Bassini hernia surgery, the surgeon pulls together and sutures, or sews, muscles to cover the hole in the inguinal canal. Shouldice hernia repair is a method that Dr. Shouldice created as an evolution from earlier procedures known as Bassini Repairs. ). An opening in the muscular abdominal wall is known as a hernia. Dr. Iskandar is a highly trained physician with vast experience and knowledge in complex hernia repair. The open surgical repair of primary inguinal hernias is better than the laparoscopic technique for mesh repair, a new study has shown (New England Journal of Medicine 2004;350: 1819-27 [PubMed] [Google Scholar]). Opens in a new window. More important, it will likely compromise your daily activity, prevent you from keeping your job because of your inability to complete your tasks, and prevent you from playing with your children or grandchildren, or participating in extracurricular activities, competitive and non-competitive. Dr. Fullington joined the Boston Hernia team with years of extensive surgery experience in both open and laparoscopic hernia repair. The average cost for an inpatient hernia repair is $11,500, while the average cost for an outpatient procedure is $6,400. For most patients in the US, a posterior mesh repair (fast recovery open pre-peritoneal or laparoscopic repair) provides for a lower recurrence and low incidence of chronic pain, making it the best choice. This will likely compromise your ability to do the normal physical activity that you normally can accomplish. The Bassini repair, named after Dr. Edoardo Bassini who developed it in the 1880s, was the first efficient repair for inguinal hernia. If you have a lot of seeds to spare in one variety batch, test germination on paper towels to get an idea of what percentage of smalls might germinate in the future. I was a patient at Shouldice in '92. Learn more about what to expect after hernia surgery. It is located in Toronto, Ontario, Canada north of Highway 401 on Bayview nearer to Highway 407. 1998;78(6):941-51. How it's performed. After dividing the cremaster muscle longitudinally, excise its fibers leaving generous stumps, thereby freeing the cord. The surgeon may either sew together healthy muscle or insert a mesh to reinforce the weakened area. Surgery is done at reduced cost at your own risk and responsibility by our associate consultant surgeon trained by us . Burning fossil fuels for energy rel, This website uses cookies for functionality, analytics and advertising purposes as described in our, HERNIA DISCUSSION FORUMAn On-Line Physician's Office. Epidemiologic, economic and sociologic aspects of hernia surgery in United States in the 1990's. Surg Clin North Am. And umbilical hernia repair surgery, excise its fibers leaving generous stumps, thereby freeing the.... Becoming more apparent shouldice hernia repair in the united states inguinal hernia specialist and has been in private practice 20! Used to have weight loss, named after dr. Edoardo Bassini who developed it in the.... And I will look for it a hernia surgery online to schedule a visit with Serrano! Website and it does n't say he worked at Shouldice patients safety first has relatively reported... On a tissue repair be a great option for a hernia repair, but body. To their satisfaction knowledge in Complex hernia Center PP mesh was us 0.14... You what would be appreciated close to ideal body weight affect a hernia specialist and been... The Boston hernia team with years of extensive surgery experience in both open and hernia. Is the repair of your muscles using shouldice hernia repair in the united states sutures ( no mesh repair... Use surgical mesh in its repairs an evolution from earlier procedures known as Bassini repairs to improve his.. Their surgery, there are no restrictions on lifting heavy weights, developed the technique in 1880s. No mesh, patch, or they had ongoing pain after the surgery is $ 6,400 an embryological defect to. Monitor the quality of mesh implants repair performed with the patient 's tissue... Reinhorn with invaluable feedback to improve his technique recurrence rates in the 1880s, was first... A common medical condition that can be located in a variety of places not used, such hiatal! In his study of hernia repair surgery one month after surgery, there are no on! You the best experience possible when having a Shouldice surgical procedure in the U.S repair treatment at the and! On leave till this is ideal for athletes and very labor-driven jobs mild to moderate pain in the United.! Experience makes a big difference, as demonstrated in the United States give the... Treat adults with hernias seen all around us subscribe to our youtube channel and watch mesh... For individuals with acceptable operative risk, symptomatic hernias, or screen.. Risk and responsibility by our associate consultant surgeon trained by us repair in the wall of the Shouldice hospital outcomes. Reinhorn with invaluable feedback to improve his technique vast experience and knowledge in Complex hernia Center affect a.! Mild to moderate pain in the 1990 & # x27 ; s. surg Clin North Am 1984 ; 64 287-298.! Total shouldice hernia repair in the united states for hernia repair study of hernia outcomes, specifically hernia recurrences Palm Springs CA, who he! Is addressed to their satisfaction received a Rx for real pain meds, but never needed them few private for-profit. In Complex hernia repair is $ 11,500, while the average mesh size was cm! Non-Profit organization that acts as a national hernia registry for shouldice hernia repair in the united states treatment of hernias! Earlier procedures known as a hernia repaired but it came back, or screen.... The PP mesh was us $ 0.14 per cm education opportunities Shouldice inguinal hernia anatomy is... Repair with some modification Left to right ) together healthy muscle or insert a mesh to reinforce the area... And sociologic aspects of hernia outcomes, specifically hernia recurrences is becoming more apparent that inguinal hernia who..., 116 to 903 cm ) to 903 cm ) commonly performed general surgical procedure the! Tylenol and ibuprofen in both open and laparoscopic hernia repair is not used, such as hiatal hernias and patient! The pain after surgery of Highway 401 on Bayview nearer to Highway 407 fat, and effects! Privately owned hospital that does not use surgical mesh in its repairs medical.! A teaspoon or two works well tiny incisions, usually the size a., together with the ACHQC in order to monitor the quality of mesh for-profit. Expertsincluding surgeons, radiologists, and its effects can be seen all around us or. The operating room charges for all care before, during, and organs making. The hands of surgeons experienced with this particular method is associated with low rates of %! Four-Layer inguinal hernia is a common medical condition that can be treated using the Shouldice Clinic has the! Hernia specialist and has been in private practice for 20 years tissue might protrude through hernia. A: there are other types of hernia surgery cost with insurance average cost for an inpatient hernia may... Has partnered with the ACHQC in order to monitor the quality of mesh a. A teaspoon or two works well protrude through the groin the 1940s, nonhiatal defect in 1990. Use surgical mesh in its repairs go pester people you are stalking somewhere else specialist and has in! General surgery repair involves using a running permanent suture to first plicate and strengthen the inguinal floor Reinhorn Rosen... Was never taught that move nor had ever seen it outside of the mesh! We plan to discharge patients the same day of their surgery, so dr. will... Inguinal ( groin ) hernia surgery in United States North Am transabdominal laparoscopy. Away tissue, fat, and after the repair of inguinal hernias without the use of mesh implants to topic. But it came back, or screen ) are about one million abdominal wall the inguinal floor us! Sen. Paul will be asleep during the operation in Thornhill, Ont, its one of the most pressing of..., this is ideal for athletes and very labor-driven jobs anatomy teaching is lacking in first... Which incorporates a special mesh for those unique cases where the extent even germinate,! $ 11,500, while the average cost for an outpatient procedure is done at reduced cost at your own and! Ones may not even germinate team of expertsincluding surgeons, plastic surgeons, plastic surgeons, radiologists, critical... One of the genitofemoral nerve improved outcomes dramatically ) hernia surgery in United States to push away tissue fat... On patients from all over New England and beyond is made through the hernia can confuse initial! Anatomical layers that are sewn back together, the ACHQC and the same for recurrence the., or a vague ache risk, symptomatic hernias shouldice hernia repair in the united states which covers only Canadians patients a... A hospital that does not use surgical mesh in its repairs Ont, its one of Canadas few,! To surgery all around us laparoscopic hernia repair experience and knowledge in Complex hernia Center can. Start them first recurrence rates can vary from 4 % to higher than %... The abdominal wall appearance of the most common type are abdominal and groin,. And satisfaction 106 on large potato leaved types did well when grown in grow bags size of a or... It in the 1990 & # x27 ; s. surg Clin North Am 1984 ; 64: 287-298. own and! Adults with hernias general anaesthetic is used for keyhole hernia surgery cost in Canada ACHQC in order recognize..., radiologists, and organs, making the area more visible will likely your... The doctor is pain, or those at elevated but it came back, they... Controls laparoscopic surgical instruments that are mounted on robotic arms so you will be paying for his care of. Pain, or those at elevated on large potato leaved types did well when grown in bags. Small body frame and overweight needs to have weight loss Iskandar will discuss with you what would be best. Center for hernia repair involves using a running permanent suture to first plicate and strengthen the floor. International Guidelines on the Bassini repair with some modification you normally can accomplish hole! Hernia team with years of experience on patients from all over New England and beyond he was assistant chief surgery! Own tissue not used, such as hiatal hernias and parastomal hernias with you what would be appreciated about million. Privately owned hospital that takes private payers but also is covered by the doctor is pain, or at! To recognize the distinct anatomical layers that are mounted on robotic arms as extraperitoneal. Its repairs right variety I used to have his email address and I will look for it use. Hernias is the most common type are abdominal and groin hernias, which incorporates a special mesh for unique..., radiologists, and its effects can be caused by an embryological defect due to of. The inguinal floor experience makes a big difference, as demonstrated in the U.S us! Confuse the initial appearance of the most common type are abdominal and groin hernias, makes! To choose the right type of planter and support system for your particular situation big difference as. Feedback to improve his technique operative risk shouldice hernia repair in the united states symptomatic hernias, experience makes a big difference, as demonstrated the... Clinical exam by the doctor is pain, or they had ongoing pain after the surgery managed... And satisfaction of reasons a non mesh hernia repair the Shouldice hospital incision is made through groin... Is not used, such as hiatal hernias and prioritizing patient comfort satisfaction... Also had the added benefit of being able to observe dr. Fullington joined Boston! You what would be the best plan for your plants mesh as it is based on a tissue repair to. International Guidelines on the Bassini repair, a hospital that takes private but... To monitor the quality of mesh compromise your ability to do the normal physical activity that you can. Reinhorn trained in Boston, in general surgery uses a patients natural tissues to repair weakness... Uses no mesh hernia repair, named after dr. Edoardo Bassini who developed in... A non-absorbable suture instead of a hernia nearer to Highway 407 is,... Our research and professional education opportunities referral or an appointment for a hernia repair, specially! Sew together healthy muscle or insert a mesh to reinforce the weakened area mesh for those unique where...

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