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Dr. Kang, Gibbeum Hospital, Stephen Kwon, and more REVIEW
The obvious: This is going to be a lengthy review divided into two parts on this thread. I am going to cut to the chase regarding the basics on the diagnosis, repair, and outcome at the start. I will elaborate in further detail on other areas of interest related to the operation in the subsequent sections.
TLDR:
Was the repair successful: A resounding YES.
Would I recommend Dr. Kang and the Gibbeum Hospital: A resounding YES.
Was this one of the smartest decisions I have ever made in my life: A resounding YES
Was Stephen Kwon indispensable in making this experience effortless, easy, and enjoyable for an inexperienced international traveler who only speaks English (maybe a little Spanish badly): A resounding YES
Recommend Stay: 2 weeks in some cases like mine but 1 week minimum.
REPAIR:
First Hernia:
Left side DIRECT inguinal hernia, large (egg size), deep field difficult
No indirect sac was found
Defect of Hesselback triangle was closed in two layers continuously with 2-0 prolene sutures.
Spermatic cord and cremaster muscle were not touched or damaged.
No nerve was cut.External oblique aponeurosis and subcutaneous fat were closed with 2-0 Vicryl (absorbable sutures)
Skin was closed with medical glue
Second hernia:
Umbilical hernia 1cm
Herniated fat was removed
Defect was closed with 3-0 Prolene continuously
Subcutaneous fat was closed with 2-0 Vicryl (absorbable sutures)
Skin was closed with medical glue
*Little bleeding during the operation.
TIMELINE:
Day 1 – Initial consultation with Dr. Kang. Testing at hospital. Ultrasound, blood, urine, X-ray. I did not spend the night.
Day 2 – Arrival at hospital in the morning. Surgery with Dr. Kang and his team. Stayed the night.
Day 3 – Meeting with Dr. Kang and nurses prior to discharge. Left around noon to go back to hotel and recover.
Day 4 to 11 – Recovery. 5th day *after* surgery did extensive amount of walking. 7th day after surgery even more walking plus a lot of steps.
Day 12 – Meeting with Dr. Kang. Final ultrasound and verified “perfect” outcome.
SONOGRAM:
Sonogram / surgery was done prior to the surgery and about 12 days after (usually 14 but I had to leave on a Sunday)
Sonogram clearly showed all the defected areas (direct left side and umbilical) prior to surgery as well as ruling out hernias on the right side, indirect, etc.
Final sonogram at 12 day showed excellent repair and body healing normal with no recurrence.
AFTER SURGERY WHAT TO EXPECT:
These are typical with open repair non-mesh inguinal hernia repair and will vary in degree based on a lot of factors (size and location of hernia, pain tolerance, are you at your “fighting” weight prior to surgery?, age, etc.).
*I am going to focus strictly on the inguinal hernia in this section because the umbilical was nearly non-existent in terms of pain, complications, etc. in all categories and not even worth the effort in mentioning.
SWELLING: There is going to be some swelling. I tried to really get out and walk A LOT including careful maneuvering of staircases at day 7. This even included walking back and forth in my hotel room with breaks during the first few days. Swelling is probably going to happen at the incision site and possibly @ the testicle side where you had the operation. Any excess fluid in your testicle gets reabsorbed (as I understand it and experienced) and goes away. My experience is that I saw noticeable differences about every 2 days and at the two week mark the swelling is nearly gone. Because my hernia was LARGE and difficult, I expected mine to last a little longer than a smaller hernia repair. One of the reasons not to wait imho.
NUMBNESS: I had the typical but temporary minor numbness around the surgical area, inner part of thigh. I started seeing it fade significantly and go back to normal after about a week. Some people report less some a little longer. I have read it could take up to a month a more too. Not a big deal. Imho.
TENSION (aka pulling sensation at site of hernia repair): This is normal and probably the most noticeable post-op recovery “pain” you will feel. Understand this dissipates with time. The first week after about 10 to 15mins of standing or walking I had to sit down to “reset” my body. The pulling sensation would start to happen around that 15min mark and grow in intensity. Sitting down provided immediate relief. 8-10 day mark I could start to stand and walk with minimal tension sensation for long periods of time. I still tried to rest often just to error on the side of caution in my mind but was not necessary. Day 14 I walked all over the airport forgetting to rest at all sometimes.
PAIN: I would describe the pain as what I expected given my hernia size, scope of the repair, and all other factors. Day 1 was the most intense and required assistance from my buddy who came with me to get up and go to the restroom. I used the automatic bed (very helpful) to sit me upright then he could pull me up careful and I could hobble over to the toilet and use the ADA rails from there. Remember I had an UMBLICAL hernia as well and this was probably the only day where I noticed it. I was also trying to be extra careful not to screw anything up.
OTHER CONTRIBUTING FACTORS: What could I have done better to help Dr. Kang, myself, and even possibly avoided the operation?
My direct hernia was self-inflicted.
I was forcing myself to cough over an extremely minor tickle in the back of throat. The cough lasted 4-6 weeks and I was annoyed and frustrated. I forgot I am in my 40s now, forgot I am not indestructible, and coughed each time with the magnitude of seven earthquakes even lifting my leg up on a few occasions for “extra sport”. I knew better and it was pretty *!#$ stupid. If I had stopped coughing so hard the moment I started noticing minor movement near the inguinal canal the damage would have most likely been much smaller.A significant drop in activity during the “COVID years” also did not do me any favors and compounded the issue. This snuck up on me faster than I could have ever expected. I have always been very active, lifted free weights, and involved in sports.
Prior to the operation I did get a tad closer to my “fighting” weight, but I still had a good 20lbs to lose regardless. On a quick side note: the ideal weight on the Shouldice Hospital is a bad metric to use. I am a little over 6’2” and on the high-end scale it would have put me around 217lbs. I was advised by my previously retired and current GP never to drop below 210lbs under any circumstance for my height, muscle build, etc. This is when I expressed interest to my GPs to start working out again after COVID and get back into my “fighting weight”. The low end of Shouldice weight scale would have required me to lose extensive muscle mass and introduce my body to an unhealthy low weight and potentially formidable medical complications.
My conclusion on this section – Doctors like Dr. Kang who possess the intelligence, surgical prowess, and all the other intangibles that make him a world class doctor is the reason why I trusted him and his methods. Dr. Kang is a doctor that can deal with all types of adversities using his method and has even performed the procedure on very elderly patients with excellent results. Dr. Grischkan gets honorable mention because he shared the same analysis as Dr. Kang, my GPs, and myself.
Dr. Kang did the best and most advanced medical procedure possible on me for the damage that was present. This point forward it is up to me to make sure I do what is needed in my best interest to heal, get stronger, and avoid a recurrence or damage elsewhere.
DR KANG:
Dr. Kang is an incredibly intelligent, extremely efficient, and driven doctor that maintains a genuine obsession for finding the perfect solution to hernia repairs. Dr. Kang’s only hobby is hernia repair. If he is not in the hospital seeing patients, he is outside the hospital working on something related to improving the process of hernia repair and the outcome for his patients.
Dr. Kang exudes the right kind of confidence you want in a surgeon that resolved my overactive anxiety.
Dr. Kang and his staff have phenomenal bedside manner which really helped me reduce stress before, during, and after the hernia surgery process.
STEPHEN KWON:
Stephen Kwon was the most important factor in my decision outside of Dr. Kang and the procedure itself. Stephen was instrumental in calming my nerves and streamlining everything at the hospital perfectly. Looking back, I could not have begun to coordinate this surgery without him. I would have been a mess. As an English speaking foreigner, Stephen Kwon was a big part of making this surgery possible for me.
Stephen Kwon rolls out the red carpet for Dr. Kang’s international patients and this guarantees you will have a positive experience from start to finish.
Overall recovery especially during week 1 was so much easier with Stephen’s assistance.
I spent most of my trip with Stephen. Putting the business of surgery aside for a moment he and his wife are exceptional human beings. I can’t express how gracious they were and how much I enjoyed South Korea with him as a guide. Also having him put up with one of my friends that I took with me proves he has the patience of a saint! (LOL).
Stephen is just a really good dude that takes excellent care of you during your stay.
Final thoughts for part 1:
#1. I feel I dodged a bullet avoiding the Shouldice repair. Time will tell but since I did not have an indirect Hernia I could not have imagined repairing the entire inguinal floor “unnecessarily” in the absence of an indirect hernia. Taking part of the cremaster muscle would have bothered me even just partially in the case of the modified Shouldice version from Dr. Grischkan. Dr. Yunis would have been a good option to avoid that scenario although he prefers Desarada for open tissue repair and his facilities are limited in regard to my personal preferences.
#2. Shouldice would have still been my second choice after Dr. Kang. I cannot imagine a scenario where I would consider mesh. Maybe if the Dr. Kang repair was not possible and I was over the age of 65? I most likely would never consider Desarada.
#3. I do believe surgeon skill and their surgical experience play the biggest role in success of hernia repair regardless of what type of open tissue non-mesh repair or any type of mesh repair.
#4. I would do the Dr. Kang procedure again if I had a repair on the right side or an indirect hernia.#5. Dr. Kang repair and the overall experience was the best possible scenario for me. Dr. Kang’s explanations on other repair procedures and his repair procedures are well thought out, researched, and substantiated with results. I look forward to the Dr. Kang procedure gaining more traction as his long-term results are proven correct.
#6. Dr. Kang looked over at me a few moments before starting surgery and said do you want permanent sutures (prolene) or are you still set on absorbable? At that point I was on the table I pretty much said whatever you think is best lol (which was prolene). I was dead set against permanent sutures before the procedure but my trust in Dr. Kang (and pinto unknowingly swaying me by his choice) changed my mind. I feel a lot better sticking with Dr. Kang’s choice of using prolene and no regrets.
Disclaimer: I am not a doctor (although I think I could play on effectively on TV).
Do not take anything I say as medical advice. Consult an expert like Dr. Kang, Dr. Towfigh, Cleveland Clinic, Dr. Yunis, etc. etc.
Do your own research (including considering my personal non-doctor opinion and experience from this thread!).
Make an informed decision for yourself based on all the facts researched and your own personal medical circumstance.
***PART 1 END***
PART 2:
WILL COVER THE FOLLOWING IN MORE DETAIL –Gibbeum Hospital. Fantastic facility and I can’t speak more highly of the staff. They were amazing with superhuman efficiency.
South Korea. It was awesome. Beautiful country, safe despite the size, and I felt welcomed the entire time. I can’t speak highly enough about that part of this experience.
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29 Replies
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I write to correct some of the false statements made in this thread regarding the practices of the Shouldice Hospital.
1. You can’t select your surgeon. This is false. You are welcome to request a specific surgeon, and they will do their best to accommodate. This is discussed in the HerniaTalk interview of the Shouldice Chief of Surgery Dr. Spencer Netto.
2. They use staples to close the wound, and only remove them after 2-3 days.. In fact, their current practice is to remove every other staple the morning after surgery, and the remainder the next day. They then apply a special wound tape dressing. The resulting scar is minimal.
3. They force Ontario residents to pay for a “hotel” room, not covered by OHIP. This is what Shouldice calls a semi-private room. However, OHIP will cover a room in the ward. The complication is that the ward is currently closed as a COVID precaution. If you can’t afford the semi-private expense you can discuss with them and they will work with you to find a solution.
4. The wait time for Shouldice is 6 months. In fact, you could get your assessment tomorrow if you are flexible and don’t require an appointment. If you want an appointment for your assessment, the current wait time listed on their web site is 5 months. However, they also offer walk-in assessments. Their web site currently lists 234 walk-in slots available for the coming week.
5. They require you to stay like a week in their “hotel”. This is false. Their web site states: “You should plan to stay at Shouldice the afternoon and evening before, and for three (3) nights after surgery.” In fact, if you have no complications they encourage discharge after the staples are removed (two nights post surgery). Total of 3 days. -
@pinto You are arguing with a ghosts that arent there. I was just paraphrasing info from your previous replies on the forums to assist a member who asked. If some of your info got lost in the transcribe feel free to correct.
Cheers!
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Chuck, you were once in such miserable pain that you were on the verge of suicide. Not once did I question your pain. That is what Mike M did to me by at least implication. Immediately after my surgery I asked for crutches because I could not walk unassisted. A week later when I returned the crutches, Stephen and Kang said it was the first time for the use of crutches. I was never in pain until getting out of bed or walking. The vibrations in my taxi rides seemed to rip right through my guts. I will not let anyone—-esp. a wishful thinker about his own condition—-to imply my pain was nothing and my recurrence was a function of patient irresponsibility.
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Pinto…lol give old Mike M a break. I am sure he meant no harm. Appreciate the great input of you both. Kang is still my top choice. I find it a little troubling that mike m still feels the hernia over a year after the surgery….but maybe that is just typical for all no mesh repairs….if i had known how hard a hernia is to fix…i would never have gotten one…boy in the bubble
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@Mike M makes a ridiculous statement about my recurrence and my report about my taxi rides:
“The bumpy taxi ride did not cause the issue with Pinto. The hernia he had was called a “sliding” hernia that is rare and was not detected with the initial sonogram. A sliding inguinal hernia is defined as a hernia where part of the hernial sac wall is formed by an organ, e.g., the colon or bladder.”Wow, I didn’t know that Mike M is an automotive engineer and has done credible research into effects of bumpy auto rides on surgery recoveries. If anyone has bibliographical references of his apparent extensive research into the matter, please share them!
Further, apparently he has extensive medical training as well to be able to so authoritatively speak on “rare” hernias in the human body. But that’s not all. His research is so extensive to include the determination of hernia recurrence, such that he can pontificate as follows: “I think there is a lot of blame to go around in regards to a recurrence … and it starts with the patient being responsible for their continued health.”
One of the pitfalls that patients, actually any person, can fall into is wishful thinking. One can wish or imagine so much about cause and remedy of aliments that if not careful one mistakes their wishes as reality. He is not in any position to speak on the severity of the taxi rides I felt because—- he wasn’t there nor was in my physical condition of being unable to walk unassisted from the hospital.
Not even Dr. Kang could know what the cause was; and surely not you, Mr. Mike M. But more than both of you, I know my own body and the sensation of pain. The pain felt in those taxi rides had to be directly related to my surgery because my second surgery handled the same taxi rides quite handedly. Oh but of course, Mr. Mike M, because you experienced surgery in your way that means ipso facto all others must as well. Well, Mr. Mike M, I haven’t changed my idea that those bumpy taxi rides contributed to my recurrence, in the same way that nearly any surgeon cautions his patients post-surgery to brace, hold their pelvic area for protection when coughing, etc. They say that for good reason.
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Dan – My understanding is that the Shouldice Hospital doesn’t operate on these small “occult” hernias because they don’t believe surgery is warranted for those. I don’t know if this is valid or not, but that’s their view, which I’m guessing is based on their experience.
The big concern for many of us considering that place is primarily that you don’t get to select your surgeon. Out of the dozen or so surgeons there, there are 2 or 3 who have a significant number of bad reviews. Also, they do have trainees who operate under supervision. The other issues you mentioned are a factor as well, but not as significant.
The Dr. Kang approach is indeed very appealing for indirect hernias. A tissue repair that works extremely well according to his numbers, while requiring a much less extensive surgery than the Shouldice procedure.
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I actually live right across shouldice hospital and despite this i will go and get treatment from Dr Kang.
The issue with shouldice is that they’ve committed to the “if it ain’t broken don’t fix it” attitude. Shouldice still refuses to use sonography as a tool for diagnosis. They still do the traditional physical examination method only. When you bring them your ultrasound result from your GP, they will ignore it.
Even post surgery, instead of using skin glue or a suture to close the wound, they staple it like it’s still the 1990s. Their technique just hasn’t evolved at all.
They also require you to stay like a week in their hotel which also looks like it’s from the past.This is usually what happens when you lack competition in the space. Shouldice has always been the #1 go to for non-mesh repair. I do hope that as Kang method enters into competition that it will wake them up
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There was no indication to me that Dr. Kang was retiring anytime soon.
It is my understanding that the other doctors (including his son) are very successful in completing Kang repairs as they perform them every single day in mass.
I would assume Dr. Kang’s information regarding recurrence, chronic pain, etc. are for his hospital as a whole and not just for him performing the procedure personally.
His new book clearly shows the other surgeons who perform the repair along side Dr. Kang.
These would be great questions for Dr. Kang or Stephen Kwon.
All Hernia repair surgeries including surgeons that use mesh require extraordinary skills that are uncommon imho. This topic of discussion is one the thing all of the best Hernia surgeons and hospitals seem to agree on regardless of the type of repair.
There was a discussion previously on the Shouldice hospitals in CA negative vs. positive reviews that were channeled towards specific doctors and not the hospital or procedure itself. The biggest issue a lot of potential candidates had with that hospital was the inability to pick the doctor.
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Is Dr Kang the only doctor who can do the kang repair well? I read on his web site that he does almost all of the repairs. What if he is no longer doing them which will happen when he retires? Will that be the end of the kang repair? Does it require extraordinary skills that only dr Kang or very few have?
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Thanks Mike, again. I agree with Mike T, your posts are a great help to us all, so many thanks again for taking time to do them.
One more thing concerning me… Dr Kang and retirement… I’ve never thought about that before as when I’ve seen photos of him he looks so young. Is he thinking if retirement? Hope not in the foreseeable future as I’m hoping to go near end of year?
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I meant being dead set against being asleep btw. Edit mode disappeared too quickly.
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@WB The OR Table you are strapped down. Sedation can be lights out and/or twilight. I woke up the last 15 mins of the Umbilical repair though and managed to watch part of the repair through the reflection of the OR light which was pretty awesome. I was super chill in twilight mode and gave the doc the thumbs up when he asked me if I was ok.
Initially I was dead set on being asleep at all throughout the entire procedure up until the doc rolled in with his team. I’m glad I took a little nap during the first part / inguinal portion tbh. I was feeling the anxiety at showtime more than I would have anticipated.
@MarkT Did you have your cremaster cut and/or reduced through another repair and had no issues? I just did not want to chance it just in case.
My hernia was not the worst but it was complicated because of the size and depth. A lot more involved than the typical case. Recovery is on track with everything I researched from other similar cases and what multiple doctors (Shouldice and Dr. Kang) have previously told me it would be prior and post surgery. Dr. Grischkan would have used some polybuster on me for his shouldice procedure given the size. I am glad Dr. Kang was able to successfully avoid that tbh but I completely understand why it would be used for Shouldice. Dr. Kang repair is not as tensionless as mesh or Desarda but less than Shouldice from what I understand. At the end of the day you have to take a leap of faith to a degree with any of the possible procedures and doctors. Pinto did a tremendous amount of research on Dr. Kang prior to my surgery. He had a tricky one too and his final outcome was a great experience.
I think once Dr. Kang retires what you suggested might be a real possibility. Stephen Kwon is translating Dr. Kang’s new book to English now which is a start.
There might not be one main Shouldice hospital but Dr. Towfigh, Dr. Yunis, and Dr. Grischkan all do Shouldice procedures which was a serious consideration for sure.
I appreciate all the support from everyone and I am doing fantastic now.
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@mikem
I am very glad you had such a positive experience with Dr. Kang and you have done the community a great service with your detailed posts.
I think we might quibble over the cremaster concerns and maybe recovery time, but these discussions are very productive and highlighting another reliable tissue repair option is a wonderful thing.
Aside from the way he differentially treats direct and indirect hernias, which itself is quite interesting, I’m particularly intrigued by his assertions that using mesh is *always* avoided in inguinal repairs regardless of patient characteristics (age, weight, etc.), hernia size and complexity, and even tissue quality…all of which goes even further than what Shouldice would maintain.
I wish we could have some direct discussion and debate between surgeons. Wouldn’t it be fascinating to have a top Shouldice surgeon sit down with Dr. Kang for a congenial chat? Two guys who have done many thousands of tissue repairs, who both strongly believe tissue > mesh, who could offer deep insight into why they do things they way they do, and who could question each other on the merits of their respective approaches?
I know he keeps his own data, but I really hope Dr. Kang takes steps to have his work formally studied and published. If his overall approach and repair methods are indeed this good, that is the path to getting his message out there and eventually having his methods taught. I’m dismayed that there is not more than one Shouldice Hospital out there…and perhaps there should be more than one Gibbeum Hospital too!
Thanks for taking the time to document your experience.
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Mike, what stops you moving with local anaesthetic
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Thank you Mike , I have umbilical and inguinal hernia as well, and in Australia no doctor wants to perform umbilical hernia with just sedation .Really appreciate all you great information.
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@Monika. It is local with sedation and not General. I would never do general for this type of operation except for an emergency.
I am writing up a little bit about my experience with that during surgery.
It was a good no issues at all.
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Hi Mike ,
Did you have just a local anesthetiser for you inguinal and umbilical hernia ? -
great read, looking forward to part 2
good luck on full recovery -
Oh thats right, I remember now it was just initially Pinto and Dr Kang thought the taxi journey may have been the cause, then Pinto had imagery for something else and the sliding hernia was discovered.
Think I’m getting forgetful!
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Thanks Mike,
How did you get from hospital to hotel? I ask as I believe Pinto and Dr Kang think it may have been bumpy taxi that caused issues for Pinto?
It may not be an issue for those stayed at hospital though. But thought I’d better check.
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