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After reading here for days – is it fair to say there is zero consensus
on the best way to repair a hernia? The best I can gather is to find a good surgeon who can tailor repairs. Then let them decide what is best for you. There does not seem to be any consensus on whether mesh repair is good or bad. The forum is quite negative in that respect. It seems that all repairs have issues and there doesn’t seem to be a clear cut winner. Maybe Kang repair? Though Kang seems to say that he will only fix what is obviously wrong. He will not search the entire groin for hidden hernias in the way that the shouldice clinic does. He seems to be saying if its not obvious don’t worry about it. Short surgery small surgical field. Come back another time if something else pops up. Whereas the shouldice approach opens the entire inguinal floor to check for other hernias. so one big surgery with shouldice. Or possible several small surgeries with kang. Not much info here on the Desarda repair but it seems to be frowned upon. So now its just time to make a decision with limited facts.
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10 Replies
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Thank you Dr Kang for sharing your expertise and knowledge! We are privileged.
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My pain statistics include both Kang repair and Gibbeum repair results. There was no significant difference in pain statistics between the two surgeries. However, in case of sliding hernia repair, the pain risk seemed to increase slightly.
In gibbeum repair, the lateral fascia of rectus muscle is sutured to the inguinal ligament including the iliopubic tract back and forth twice.
It is true that I performed a hernia surgery on KodyH yesterday.
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I am not this Chuck character. I am happy to enclose my ID as as well. I really want to hear kodys updates. Maybe the forum moderator can intervene to stop this silliness?
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The Chuckster is becoming a master puppeteer running multiple sock puppets at the same time these days, and these sock puppets even talk to each other sometimes (like “MarkK” and “Kody”).
Chuck – How about calling yourself JimH (after Jim Henson, the famous puppeteer), and sticking to that persona from now on? You can ask the same questions – just stick to one identity.
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MarkK is repeating Chuck’s words, in Chuck’s style.
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A 4 on the Swedish scale wasn’t really debilitating. I haven’t rechecked, but I believe it was an interference with normal activity at least once in the last week. I don’t believe the Swedish results I saw had percentages for pain less than the 4 level.
I don’t know which repair has the best pain scores. Might depend on whether indirect or direct. Desarda looks like it involves less tension for direct version, though I could be wrong.
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David M what did the swedish registry study say about all chronic pain? If severe debilitating chronic pain was 15% than the “any” pain metric must have been close to 50 percent. Do you have a postion on the repair that offers the lowest risk of pain? Dr. Tomas says its the Desarda repair.
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Dr Kang has explained his pain repair using the scale that was used in the Swedish study. His pain percentage for level 4 pain was only 1.7% as compared to around 15% for 4 and above in the Swedish registry study. His results were low by comparison.
A better question for Dr Kang is whether the participants surveyed were only for the Kang indirect repair, or did it also include participants who had the Gibbeum repair?
I would also like to ask Dr Kang another question regarding how he tightens the transversalis fascia in his Gibbeum repair? Shouldice does double breasting. I think the original Bassini does something different.
Thank you for being so accessible.
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This reply was modified 7 months ago by David M.
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This reply was modified 7 months ago by
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Dr. Kang thanks for responding. There is a post here suggesting that over 16 percent of your patients experience some level of chronic pain. That seems like a lot to me. Mesh repairs approach these levels. On your website you state that chronic pain is never really seen by you. But 16 percent chronic pain after a year is quite a lot of pain. Maybe I am not understanding the statistics. Thanks for taking time to participate here
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Hi all,
Just for clarification.
During the process of Kang repair (for indirect hernia) or Gibbeum repair (for direct hernia), we always check if there is another type of hernia, and if found, surgery is performed on that part as well.We also always take steps to prevent other types of hernia from occurring in the future.
Many people think that Kang repair is a variation Marcy repair, but I do not agree with this opinion at all.
Just as Shouldice is a different surgery from Bassini or McVay, Kang repair and Marcy are completely different surgeries.
The only sharing aspect in both surgeries is that they do not fix the intact Hesselbach triangle.And yes. It is true that there are some returning patients with pain several months or a few years after undergoing our procedure.
However, most of these people’s concern is not about the pain itself but whether it is a symptom of recurrence.
In other words, it is very rare for patients to come back because the pain itself is difficult.I know most people on this forum will disagree with me.
However, through over 16,000 consecutive our pure tissue repairs, most patients achieved good results. Some of them were over 100 years old, and some were very weak due to chronic heart disease, lung disease, kidney disease, liver disease, etc.
There were also many patients who came with hernias that recurred once or multiple times (after open mesh, lapa mesh, or various tissue repairs), and some with a huge hernia larger than a child’s head size.
Through this experience, I am convinced that mesh has no place in inguinal hernia surgery.
Of course, as many people point out, we acknowledge that the follow-up period for our surgery is not long enough.
However, the results so far are enough to give me that confidence, and I am not concerned about the durability of our surgery.
Thank you!
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