Reply To: Researching surgeons – what questions to ask

Hernia Discussion Forums Hernia Discussion Researching surgeons – what questions to ask Reply To: Researching surgeons – what questions to ask


This is very interesting and good to know. The surgeon I initially consulted with does do the Desarda technique, presumably on both direct and indirect hernias. But he says he only does that when patients are very determined not to have mesh because of what they have read on the internet. Perhaps because my hernia(s) are indirect I should likely go ahead and get the mesh. I really don’t want to wait because I am now already more uncomfortable and just cannot distract my mind from the fact that I have this damage to my body that I am worried will quickly get worse and/or cause complications. Most people I have talked to have not had any issues with mesh and consider themselves back to normal and pain free several years after surgery with no recurrence. Some had a longer than expected recovery, and some light twinges and pulls of pain up to a year or two after the surgery. But all seemed to eventually see even that disappear.

I understand that people can have major problems with mesh, and that’s definitely a big concern. But it seems the vast majority are fine. There doesn’t seem to be any way to predict ones reaction. And clearly in the US it is very difficult to find surgeons who do tissue-only repair. And because of the way insurance in the US works, it’s not as easy as just finding someone on the other side of the country and traveling at ones own expense and paying much more money for an out-of-network doctor to do a consultation and then scheduling a procedure.

Dr Kang – do you have any concerns with mesh? Do you do mesh repairs, and if so how often do you see issues and people returning for removal and chronic pain more than a year or two later?


quote drkang:


I understand why some people prefer to wait and see if they have an asymptomatic hernia. This may be due to fear of complication of mesh repair.
But strictly speaking, asymptomatic hernia cannot exist. Because hernia buldging itself is a symptom (actually a sign).
So it’s just the difference between having or not having pain.
However, the presence or absence of pain and progress of the hernia are not proportional. A large hernia may not have pain at all, and pain in the early hernia may also appear. And a painless hernia can also cause severe pain with sudden incarceration or strangulation at any moment. It’s an emergency.

I think you can wait and see a little when it is a small hernia. But eventually it will grow bigger and require more extensive surgery. So, I think it is better to have surgery as early as possible when considering the hernia itself.

The only obstacle is the risk of mesh repair. But there are actually other options, though not easy to find. Shouldice or Desarda repair is the one that does not use a mesh. These repairs are used for both indirect and direct hernia. However, if you look for these surgical procedures on youtube, most of them show only direct inguinal hernia surgery.
Why not indirect?
This is because these operations, which are known as typical tissue repair, are actually suitable for direct inguinal hernia. Not only these but also other tissue repair methods, such as Bassini, McVay, Ferguson, etc., are the same. It means that indirect hernia, which accounts for 70% of the inguinal hernia, does not have the appropriate tissue repair procedure. I think the limit of existing tissue repair, such as high recurrence rate, is due to this fact.

But in fact, there is an appropriate tissue repair procedure for the indirect inguinal hernia. It is just forgotten and ignored. That’s the Marcy operation.

I am a surgeon who strongly advocates tissue repair. And I am trying to make up for the shortcomings of tissue repair and to get better surgical results than mesh repair in all aspects. As part of that, I have devised and implemented different hernia repair procedures for both indirect and direct hernia. Somewhat similar to Marcy operation and Desarda repair, respectively.

I do not know if there is a doctor in the US doing Marcy operation. (Actually, Marcy is an American surgeon who was active in the early 20th century.)
Anyway, if you have an indirect inguinal hernia, I recommend you to seek a doctor who performs Marcy-like operation, and if you have a direct hernia, find a Desarda repair. I think Shouldice is unnecessarily invasive.

In my experience, I do not think that the choice of surgery should be changed according to the size of the hernia. The patient’s body weight and activity also have no significant effect on outcome.
If you can meet a surgeon familiar with the above tissue repair, you will get the best surgical results without fear of mesh.

Thank you!

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