Can we mention the Germans?

[Good intentions]

If you scroll down to the German Hernia society on the EHS chapters page and open the + button you’ll see some familiar names. Kockerling, Conze, Lorenz. I think that William might be right to focus on what’s happening in Germany. They don’t seem as tied to mesh as the EHS is. The EHS started the push to mesh and is fully invested in promoting its use, no matter what.

https://europeanherniasociety.eu/chapters/

[Good intentions]

Here is more from Dr. Wiese’s bio.

https://www.chirurgie-hessen.de/Martin+G.+Wiese

“Since my training in the clinics of the Main-Taunus-Kreis Bad Soden under Professor Peter Wendling, I have increasingly dealt with the topic of hernias, i.e. soft tissue fractures, in addition to general surgery. Since then I have helped to develop new procedures and have been a guest center for hernia surgery for years, and since 2016 also for international guests. With us you get an individual concept for the care of your inguinal, navel or incisional hernia, also in cooperation with neighboring clinics. A specialty is chronic groin pain and groin pain in athletes. I regularly give lectures on these topics and have performed several live pre-operations at international congresses.

Since 2016 I can be found in the Focus list of top physicians for hernia surgery without interruption.

Along with PD. dr medical Guido Woeste, I am the conference president of the German Hernia Society 2022 and a member of the extended board of the German Hernia Society.”

[Good intentions]

I got back on to Dr. Wiese’s practice web page to see what types of procedures he performs. It looks like he has the ability to do several and chooses the one that he feels will give the best results. In another current thread there is much discussion about how surgeons tend to be “one-trick ponies”, only performing a single type of hernia repair. This is the training that today’s surgeons get, to use only mesh for hernia repair, codified by the suspect Guidelines that the EHS promotes. Very interesting that Dr. Wiese is there in Europe but chooses his own path.

Here is the text from the web site, to add to Freeman’s report of receiving a Shouldice type repair.

https://www.chirurgie-hessen.de/Leistungen

“Hernia Surgery
Individual concepts for the treatment of inguinal, navel and abdominal wall hernias, including incisional hernias
Training center for years and now international internship center and Milos training center
Conference President of the German Hernia Society 2022 together with PD. dr medical Guido Woeste
Member of the extended board of the German Hernia Society
Inguinal hernia operations with and without synthetic mesh
Abdominal wall hernias with diastasis recti using the MILOS technique
Second opinions and advice for athletes”

[Good intentions]

Thanks for posting your story Freeman. It is great that you had a good result and know some of the details of the method.

I found a link to Dr. Wiese’s profile on the internet. It is in German but anybody can use Google to translate it.

https://www.chirurgie-hessen.de/

Also, the jameda link –

https://www.jameda.de/martin-g-wiese/facharzt-fuer-allgemeinchirurgie-spezieller-unfallchirurg/kelkheim

[Freeman]

Hi folks ,
First this link for combined hernia :

https://www.sciencedirect.com/science/article/pii/S1743919116301418

I explain my situation : I am 66 and this article is very related to my age for higher risks of developping a combined hernia.
The surgeon showed me photos of the operation and said that I had ” a long sac of indirect hernia and a smaller direct hernia” . But he estimate that indirect hernia have a lower chance of recurrence that direct hernia so I was somehow luckier to get a predominant indirect hernia than a predominant direct hernia . He has evaluated the rate of recurrence to 2 % . I asked him if it was more complicated to repair , he said “not for me ” . The operation lasted one hour like a classical shouldice operation .He said that the my tissue was good enough to make a shouldice rapair. I can testify from my own experience that I have had a total confidence in his expertise and ability to cure me. He had performed thousands of hernia surgery for 20 years. I had a complete trust in him when I met him in person the day before the surgery. It was not only based on his vast experience but it was my feeling. Before to fall asleep in the operating room he told me ” I will take all the time needed for your operation , I am never in hurry”, After the surgery when I came back home I sent him some questions sometimes and a photo of my scar 2 weeks after and he replied me in the next 30 minutes each time. Now after 24 days after the surgery I feel great.

[pinto]

William, your post sheds much light on it. Thanks. However, I hope you and @Freeman can be ready for a revelation. It is this from radiopaedia.org: They inform us that pantaloon hernia is not one but mulitple hernias combined:
“A pantaloon hernia, also known as a saddlebag hernia, is defined as any combination of two adjacent hernia sacs of the femoral or inguinal region (direct or indirect inguinal hernias (alternative plural: herniae)) on the same side 2. Thus, examples include: femoral with direct hernias, femoral with indirect hernias, indirect with direct hernias.” https://radiopaedia.org/articles/pantaloon-hernia?lang=us

Given that is an organization of radiologists, we can assume the quote above is authoritative. So, William, both you and Freeman might actually have or had two or more hernias/herniae, as well as explaining the contradictory diagnoses you received.

[William Bryant]

I think it may have been a pantaloon hernia. It’s of interest to me because of the mixed diagnosis I’ve had with my ultrasound saying direct yet every consultant, and I’ve seen 3, saying indirect by touch/cough etc.

The consultants say it doesn’t matter as surgery is same regardless???!!!

[pinto]

@Freeman, congratulations on the success. No surgery is without risk. You are saying you only had one hernia yet the surgeon said it was a combination of indirect and direct IH. From your description it appears you never had an ultrasound (or other imaging) and this “combination” became known only during the course of surgery. Wouldn’t a combination be literally impossible technically speaking? Aren’t they one or the other? Much has been posted at HT, for example, how they merit different surgical methodology. 🙂 This could warrant a thread dedicated to answering this.

[Freeman]

Hi William, I didn’t know . I had only one inguinal hernia at the left side of the groin. The surgeon saids me after the operation that it was a combination of direct and indirect hernia. Only ultrasound could have evaluated the anatomy of the hernia. I don’t know if surgeons perform ultrasound prior to surgery ? In France I was on the verge to get a mesh surgery before to cancel it and they didnt proposed me ultrasound exams.

[William Bryant]

Thanks Freeman for the information and glad to hear it’s gone well. Did you know it was one direct and one indirect before you got to Dr Wiese?

[Freeman]

I had an hernia repair 21 days ago with Dr Wiese in Kelkheim (Germany) as I mentioned before . A small inguinal hernia however it was a combination of direct and indirect hernia. Very happy with the outcome and a lot of gratitude for the surgeon. I feel great.

[Oceanic]

Small Inguinal hernia (3-4cm long), moderarely active, I don’t think one single event caused it but an accumlation of lifting over the years.

• This reply was modified 11 months, 3 weeks ago by  Oceanic.

[Good intentions]

What type of hernia will he be repairing? How active are you? How did you get the hernia? Those are interesting questions, I think.

Good luck.

[William Bryant]

Very best of luck Oceanic. Hope everything goes really well for you and if you can post how it went and type of repair, when you’re up to it.

[Watchful]

Good luck, Oceanic. You made a good choice. Please report how things go.

[Oceanic]

I have surgery scheduled with Dr. Conze, will post how things go so wish me luck

[William Bryant]

Thanks Oceanic. Slight difference. I’m thinking maybe Dr. Lorenz is between those two prices.

[Oceanic]

Biohernia €2200

Dr Conzw €6200

Dr Lorenz Don’t know

[William Bryant]

Costings! Can anyone help with how much the various German centres charge approximately…

Biohernia

Dr Conz

Dr Lorenz

Many thanks

[pinto]

William, you’re much appreciated here, I’m sure.