Reply To: Researching surgeons – what questions to ask

[drkang]

quote Jnomesh:

In America (and I’m guessing a lot of other countries) we need more options to mesh repair. And to piggy back on a point you made earlier about how mesh looks once it has been inside the body for a while-I bet if you opened up people who have mesh and no symptoms you would see that the mesh is messed up inside but for whatever reason it don’t bothering the person and is probably still doing its job of preventing a hernia recurrence.
also how is the Marcy operation performed/Carried out. Is it very different from a bassini approach?

Hi Jnomesh,
I was on a bit long holiday, so I couldn’t answer your above question quickly.

Almost all tissue repair, including Bassini operation, are reinforcing the Hasselbach triangle. Shouldice or Desarda repair is also included.
These procedures are suitable for direct inguinal hernia which breaks out through the weakened and torn floor of Hasselbach triangle.
These are called ‘the posterior wall repair’.

However, Marcy operation is just closing the internal inguinal ring. So, it is the most suitable tissue repair for the indirect inguinal hernia which is coming through the widened internal inguinal ring.
The internal inguinal ring, together with the spermatic cord, is located within the bundle of cremaster muscle and has nothing to do with the Hasselbach triangle which is underneath and medial to the cremaster muscle.

Therefore, it is unfortunate for most surgeons to perform the posterior wall repair for indirect inguinal hernia instead of closing the internal inguinal ring as Marcy operation does.
I think the high recurrence rate after tissue repair for inguinal hernia, in the past, is probably due to this mistake.

So, my Kangs repair consists of two surgical methods.
The Kangs repair for indirect inguinal hernia is similar to the Marcy operation and that for direct inguinal hernia is similar to Desarda method.
Since the skin incision is made at a specific position for each type of inguinal hernia, it is possible to operate with a smaller skin wound.
The indirect and the direct inguinal hernia are about 2 cm apart from each other.

Thank you!