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Another Successful Surgery With Dr. Kang
Hi everyone. This is my first post and it’s going to be a long one. The HT forum has been invaluable to me and I wanted to pay it forward by describing my recent surgery in Seoul with Dr. Kang. A big thanks to Jack, ColinM, Roger555, MikeM, WilliamT and Alan (sorry if I forgot anyone) for sharing their prior experiences with Dr. Kang which greatly aided my decision. I’m currently six days post-surgery and flying home today.
After months of extensive research and consulting with a number of U.S. surgeons, I felt confident that surgery with Dr. Kang was the right fit for me and my single-side indirect inguinal hernia. I didn’t have the typical bulge so my hernia was perhaps smaller, but apparent on ultrasound, and pretty bothersome. I later learned that smaller hernias can sometimes actually produce worse discomfort.
Before traveling to Seoul I consulted with three different U.S. surgeons who all recommended laparoscopic and/or robotic surgery with a variety of different types of mesh (absorbable, biologic, polypropylene etc.). One surgeon indicated that he could alternatively perform a tissue repair but he couldn’t articulate the specific technique and it would require a 5-6 inch incision under general anesthesia. No thanks! I had a smaller indirect hernia and wasn’t interested in a 10×15 cm. piece of plastic left in my body in order to prevent a new direct hernia in the future. To be honest, I was less concerned about reoccurrence than chronic pain and other complications.
Having completely eliminated mesh as an option I began the search for the most minimally invasive repair that was effective and appropriate for my specific hernia. I explored both the Shouldice and Desarda procedures but also determined that neither made sense for me. All the extra cutting and 2-4 layers of plastic or metal suturing in the Shouldice seemed like overkill for an indirect hernia. The Desarda technique appeared slightly more interesting but I didn’t want to disrupt more healthy tissue than necessary. With Dr. Brown’s retirement and no remaining U.S. surgeons offering a minimal repair, I decided to pull the trigger and begin planning for travel to Seoul.
Everything that has already been said about Stephen Kwon is spot on. He’s a wonderful man who was instrumental to me having a smooth and pleasant experience from start to finish. As others have already mentioned, Stephen rolls out the red carpet for foreign patients. He is your Shephard throughout the entire process.
I arrived in Seoul on a Saturday night and stayed at the JW Marriott Hotel which was phenomenal. It’s about a 20 min. taxi ride to the hospital with traffic or 2 mile walk. I highly recommend this hotel, especially if you’re a frequent Marriott traveler like I am. They serve a massive breakfast and dinner each night in the executive lounge so I never had to deal with meals. On Sunday I played tourist around the city while I was still able to walk fast pre-surgery. Seoul is a fascinating city! I had been to many of the other major cities in Asia and always wanted to come here but hadn’t been able to until now.
On Monday afternoon I met Stephen at the hospital for my consultation with Dr. Kang and pre-procedure testing. Dr. Kang is exactly as advertised, an extremely friendly and sharp surgeon that believes very strongly in what he’s doing. I was comforted by the confidence he exudes. After 20,000+ hernia repairs I’m sure he’s seen it all. While Stephen is available to help translate if necessary, Dr. Kang can speak and understand English. One of the nurses on my floor and also all three surgical nurses spoke good English. After the ultrasound Dr. Kang indicated that I likely had a large lipoma, which is a term I had never heard of before. None of my prior ultrasound reports or any of the other surgeons I met with noticed or mentioned it. After the consultation I then gave blood and urine, had a COVID test, EKG and a chest x-ray all performed in less than 10 minutes! Gibbeum Hospital is busy but very modern and runs like clockwork.
Monday evening I had to educate myself about lipomas which are essentially herniated pieces of fat that travel through the inguinal canal and get stuck to the spermatic cord. They’re apparently very common, cause discomfort, and can be missed in some laparoscopic techniques, especially TAPP. I read a number of studies about laparoscopic patients with ongoing pain believed to be related to a reoccurrence, however was ultimately a remaining lipoma that needed to be removed. No matter what type of hernia procedure you’re having I would strongly recommend confirming with your surgeon that the spermatic cord will be completely visualized and any lipoma resected.
I arrived at the hospital at 9:00 AM on Tuesday for surgery and was quickly brought up to my four-patient room. I was not spending the night. I got changed into a very comfortable pajama-like shirt and pants. No terrible string ties or your backside hanging out like the hospital gowns you get back home! An IV was started, antibiotics administered, and before I knew it, it was go time. Dr. Kang performed 12 hernia repairs on Tuesday! I think I was number 4 or 5. There are adjacent operating rooms so the patient on deck is getting prepped while Dr. Kang is finishing up the prior surgery. For anesthesia they now use propofol which is fantastic as you’re completely out and back to life so quickly. I was unconscious in 2 seconds and woke up in the OR 20 minutes later when it was all done. I was shown the lipoma he removed which was very large. I also had a smaller fat filled hernia sac that was treated. For my situation Dr. Kang recommended absorbable PDS sutures which I was very pleased to hear as I’ll have no foreign materials remaining in my body in about 4-6 months.
Back in my room I rested flat for about an hour and then had a great Korean lunch. The local anesthetic began wearing off sooner than I expected but it wasn’t severe pain. An auto-dose pain med pump is attached to the IV and I pressed it one time before remembering how much I dislike opiates. I just relaxed in my room with Stephen for a couple of additional hours before Dr. Kang came upstairs for his afternoon rounds. Everything looked good and I went back to my hotel via taxi around 4:30 PM. Before discharge I received two additional antibiotic pills, a stool softener (3x day for 5 days) and “pain pills” which I then learned were just ibuprofen.
COST – All in I paid $2,000 for the procedure and an extra $400 for the lipoma removal. I used airline miles for my flight and hotel points for my lodging so this was my only cost which was less than my insurance deductible at home.
RECOVERY – I took a combination of Tylenol and ibuprofen the first few days but nothing stronger. I also religiously took the stool softener three times a day which worked perfectly. TRUST ME you cannot take a chance on becoming constipated after hernia surgery.
Days 1 and 2 post-surgery I was mostly in bed and took small walks within the hotel. I had no pain while lying down but was moderately uncomfortable standing or changing positions which was to be expected. It took me about 10 minutes to figure out how to get my pants and shoes on the first time, LOL!
Day 3 I started feeling incrementally better and went for a walk outside.
Days 4 and 5, I did more walking around town. Laying down and sitting were fine. Even walking wasn’t terrible. It was mostly standing still or standing after sitting/laying down that was briefly uncomfortable. It’s more of a pulling, tugging feeling which again is to be expected with muscle incision and suturing. I also have some numbness below the incision which I understand will take a little time to resolve.
Day 6 (Today) – I just went in to see Dr. Kang for a follow-up appointment and ultrasound and everything looked good. My incision looks great, it’s 3.5 cm as advertised, very little redness or swelling, and will ultimately be hidden. Dr. Kang said I could even get out and golf or go for a run in another week or so. By the way, after my post-surgical consult, he indicated that he had 11 hernia reapirs on his calendar today! I’ll be heading off to the airport shortly.
Here are a couple of other suggestions. Coughing, sneezing or even clearing your throat feels pretty brutal after surgery. I discovered that if I sat into a full squat I could much more comfortably do these things. Also, I’d recommend bringing both briefs and boxers. I was normally wearing briefs before surgery (sometimes with a hernia belt) but I was much more comfortable in boxers afterward. I’m guessing that people will have differing opinions on this one so better to be prepared with both.
You can definitely do this on your own. I have three small kids at home so my wife wasn’t able to travel with me. Stephen mentioned that 2 out of 3 foreign patients travel alone.
Many people (including my own family) thought I was crazy for traveling all the way to Korea for hernia surgery but I am so thankful that I did. Interestingly enough, one recent publication ranked South Korea as having the number one healthcare system in the world. Stephen has finished translating Dr. Kang’s book into English which I read cover to cover while recuperating. In his book Dr. Kang notes that many people come to South Korea from all over the world for different medical procedures, but often from countries with less developed healthcare (often Russia, China, Middle East, Mongolia etc.). However, for hernia repair, most of the foreign patients are from the U.S., Canada, UK, Europe and Australia, countries with arguably first-world healthcare. I have some strong views about why this procedure doesn’t exist in the U.S. but perhaps that’s better saved for another thread.
I look forward to continuing to recover over the coming weeks and would be happy to answer any questions. Wishing everyone good health and healing on your own journeys.
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17 Replies
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Hello Max, there aren’t many patients who have posted on here about their Dr Kang repair saying they had or have chronic pain. One had pain after operation but it resolved quite soon as far as I know.
The main problem according to people who have managed to read Korean reviews seems to be more about recurrence rather than chronic pain.
However as is always pointed out it is a risk with whichever inguinal hernia surgery is opted for.
I’m seriously considering Dr Kang as it is often stated it is not so invasive. And I’m impressed with all the testimonials his repairs have on here from patients who travelled.
The one recurrence was also put right but I think initially three was some difficulty with communication though. But it was rectified in the end.
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cpk303, I read your post with great interest. First of all, I hope you are recovering well post surgery. I was recently diagnosed with direct left inguinal hernia, there is a small reducible bump in my left groin, but no pain. I am also considering traveling to Korea to have Dr. Kang perform my surgery. According to Dr. Towfigh and various posts, patients with open surgery and no mesh still can experience chronic pain. Just wondering if any others who have had Dr. Kang’s open no mesh surgery are experiencing any chronic pain post surgery.
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There was an anesthesiologist when I was there. I’m not sure if he stayed with me throughout the entire operation, or moved from operating room to operating room. I have to say that this was one of the areas where I didn’t feel confident with the way they were doing things.
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The difference in sedation options also has to do with patient safety. At the Shouldice, unless things have changed since I last visited, there is no anesthesiologist. Therefore, deep sedation cannot be safely provided. It’s a cost saving decision.
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I was shocked when they started using deep sedation in colonoscopies. For mine, I went to a place that agreed to do it with light sedation (midazolam). It’s not so much the difference between propofol and midazolam – they are both bad for your brain, although some people react worse to one vs the other. The problem is deep sedation (where propofol is typically used) vs light sedation (normally with midazolam).
Surgery under light sedation (as they do it at Shouldice) has its issues. I did wake up during surgery, and felt pain during the stitching. They increased the sedation a bit when they noticed that. They try to keep you sedated just enough, but not beyond that. It minimizes the brain insult and the airway risks.
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Yes, propofol, similar to a colonoscopy. I confirmed it a few different times. It’s still conscious sedation as you’re breathing on your own. I personally prefer propofol vs. the typical versed/fentanyl combo as there’s no hangover and I’ve returned to being completely lucid almost instantly. They don’t want you waking up and/or moving so this would be better for the surgeon as well.
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Does he really use propofol rather than midazolam? Propofol (or a propofol/midazolam combo) is typically used in heavy sedation. Not a fan of that personally because of the effects on the brain. One of the (few) things I like about the Shouldice Hospital is that they normally go with light sedation using midazolam. They use propofol only in unusual circumstances. Most other places use heavy sedation with propofol.
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@WilliamBryant, they don’t push the propofol until De. Kang enters the OR, says hello, and is ready.
@DavidM, Phasix.
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Cpk, in your original post you mentioned that you had had absorbable mesh recommended by a surgeon at some point. Do you remember which absorbable mesh?
Also, we probably need to separate Kang repairs done for direct vs indirect in our list of people here who have used Dr Kang, as his technique would be different for each. You havent possible sorted that out in your research while reading the people here?
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All sounds good cpk. Thanks. It’s these reports that help others decide.
What happens if Dr Kang finds a complication whilst another patient is prepped and ready?
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Just a quick update. I’m now nine days post-surgery and feeling pretty good with noticeable improvement each day. I’m back home and at work leading a relatively normal day, minus any real exercise yet. I still have pretty numb areas below the incision and inner thigh with mild burning and itching at surface level. I had a large lipoma excised from the spermatic cord so possibly had a little more trauma and nerve disruption. I’ve got some minor swelling in the scrotum which interestingly arrived 5-6 days post-surgery so I switched back to briefs. Gravity isn’t my friend right now down there, LOL! The surgical glue just fell off and you can barely even see the scar already. All-in-all I’m pleased with my recovery trajectory.
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cpk303 Congratulations! I’m glad you went with a pure tissue no mesh repair. I had a pure tissue no mesh repair done by Dr. Brown shortly before he retired. I’m completely satisfied with it and haven’t had any problems. It was good that you got the surgery done before Dr. Kang retired as so few (if any) pure tissue specialists are left. It was refreshing to hear about your pure tissue surgery rather than the latest and greatest new and improved mesh product coming soon to a surgery center near you. All the best and have a speedy recovery.
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Wheelchair support at Incheon airport was excellent, straight through to the plane entrance then walked to the seat. my recovery was much slower than yours, I would have starved on my own! It’s interesting how the pain is so variable for different people, mine was two direct and an indirect so probably much more trauma to the area.
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Yes, Alan is correct. Only the Korean version has been published, titled “Goodbye Hernia”. Dr. Kang gives gives all of his patients a signed copy of the book. The english version is not yet in final form for publication.
If anyone is interested in reading more about lipomas, here are a few links:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422475/
https://ls.amegroups.com/article/view/5980/html
https://www.frontiersin.org/articles/10.3389/fsurg.2020.00039/full#B42
I’ll post another update on my recovery in the next few days. I’ve got some burning and itching in the numb areas so hopefully that’s a sign the nerves are coming back to life.
One other suggestion. While I checked my suitcase in Seoul, I forgot that my additional backpack probably weighed 20+ pounds. It was very difficult to walk while wearing at Incheon airport and the distances to the departure gates can be far. I would recommend having very little and very light hand luggage for your return journey.
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The books not available yet, he provided a digital copy for patients only, I believe he does plan to publish it though.
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Many thanks cpk. If possible could you keep us updated in weeks to come as a number of people, myself included, have Dr Kang as possible choice of surgeon.
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Sounds like you had a really excellent experience. Do you remember the name of Dr Kang’s book and whether it can be purchased on Amazon or elsewhere online?
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