Chronic Pain…kang repair…calling all kang patients

[pinto]

@amelia4, ameliakhan is not a an HT participant but rather a carpetbagger. Avoid her.

[Jack2021]

Thanks Pinto and G.

I agree Pinto, that KR could turn out to be revolutionary. In my humble opinion, that would be regardless of whether it’s a case of having changed the suturing technique/positioning, or multiple modifications.

If it’s a minimally invasive technique with low recurrence and chronic pain rates over the long term and takes less than half the time of other hernia repair surgeries, then it would surely be the biggest leap forward in hernia repair surgery in many years.

Along with that, if it turned out to be easier to teach than the Shouldice repair and perhaps the Desarda repair too, which the speed that Dr Kang does his KR surgeries may indicate, then it could be of huge benefit across the world, apart from to the mesh industry of course.

There appears to be some interest already from Dr
Lorenz and perhaps others in his circle. However, we all need @drkang to explain and publish all the details of his repair, as Professor Desarda did and the sooner the better so it can be peer reviewed and validated.

Here’s hoping this happens soon. 🤞

[pinto]

@Jack2021, again much appreciation for the Kang link. Evidently the link came after my operations. Mention was made to me Stephen was working on a English guide for patients. Let me point out something from the link: “Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences…. That is why this new sort of procedure has not been developed until now.” This statement if valid surely would make KR, Marcy Supercharged, an approach underreported, unappreciated by both Lorenz and Towfigh in their comments made at HT. In their defense, KR is under the radar researchwise, so it would be hard to evaluate it. In short, KR is not Marcy in disguise. Again if the KR as claimed turns valid, then in my humble opinion it would be revolutionary.

[G]

Jack thanks for providing more light and less smoke to this forum. I agree with you that keeping it simple is often the optimal way. Occam’s razor. The medical device industry is strong and well established. When you go to a doctor it is routine to have mesh prescribed as the cure for your hernia. The honorable Dr. Kang is one of the few pure tissue surgeons left. I also hope the honorable Dr. Kang or some other master of the pure tissue technique make their services available in the future. There is significant push back against pure tissue repairs ranging from folks akin to internet shills on down to the more common useful idiot. People get what they tolerate. With all the pain, repeat surgeries, chronic pain management, etc. maybe people will opt for the less invasive option. Money talks.

[pinto]

@Herniated, I respectively refer you to none other than Doc Brown on Marcy: “in a young athlete with an indirect inguinal hernia, the Marcy hernia repair with ringplasty yields excellent results with minimal dissection and minimal postoperative pain.” https://herniatalk.com/forums/topic/shouldice-vs-desarda/

If true that Brown served pro male athletes in healing their hernias, then it’s quite possible that you have shortchanged Marcy.

• This reply was modified 10 months, 1 week ago by  pinto.

Shouldice vs. Desarda

[pinto]

@Jack2021, I stand corrected, thank you also for your considerate post. Let me point out though as I made clear in my own related post: My statement about Kang Repair was solely and entirely based on Dr. Kang’s postings here at HT. He clearly stated that he didn’t agree that KR necessarily is or based on Marcy. Further when we draw analogy to another source as A to B, we must realize that just like a mouse and human sharing 98% similarity of DNA, we still may end up with two very different entities, as your post suggests. Anyway bravo to your post.

[Herniated]

In women the round ligament (from the uterus) passes thru the inner inguinal ring. Apparently the round ligament can be cut without significant consequences. Doing so enables the Marcy repair to rigorously seal the inner inguinal ring in women.

In men, the spermatic cord and associated structures pass thru the inner inguinal ring. Cutting those structures would similarly enable a rigorous seal, but most men would object to the consequences. Thus repairs to the inner inguinal ring in men must find other solutions. The standard Marcy repair in adult men had a very high recurrence rate.

[Jack2021]

Hi Pinto,

I’ve read through the Kang Repair information on the Gibbeum Hospital website (http://gibbeum.com/whykr/Why-and-What-Kang-Repair.php) and in the ’Direct Closure’ section, it does actually state that ‘Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences.’

That is possibly the main source for Dr Towfigh referring to it as a modified Marcy repair, though from what he said in their Hernia Talk Live discussion on YouTube, Dr Lorenz seems to have further insight into the modifications.

With regard to a Marcy repair apparently having a higher risk of recurrence for men than for women, Dr Towfigh has previously mentioned the differences in anatomy in this area being a factor and perhaps the sentences I’ve pasted below from Dr Kang’s ‘Direct Closure’ section that follow on from what I pasted above, qualify, or at least allude to the higher risk for men.

@drtowfigh or @drkang, would need to give the expert medical perspective on this for clarity.

‘In fact, most of the internal inguinal ring is occupied by the spermatic cord which contains the testicular vessels, lymphatics and sensitive nerves. So it is very difficult to close the internal inguinal ring securely without damaging the aforementioned sensitive structures.’

I hope that the Kang repair will soon become more widespread, because if it really is as effective as the feedback on HT and explanations on the Gibbeum website, surely @drkang must urgently publish all the details of his Kang repair and share it globally as a priority, as Dr Desarda did with his repair, to encourage a reduction in the use of mesh and all its associated risks and to offer more choice to those wanting a non-mesh repair.

With @drkang’s repair apparently taking less than half the time vs other tissue repair methods, perhaps that may equate to a shorter teaching duration for other surgeons also.

If Dr Lorenz is correct in his statement about the Kang repair differing to Marcy purely in the way that the suturing is done, I like the idea of that.
I can imagine how Dr Kang would have taken significant time to work out how this would make an effective repair for adults vs the original Marcy method and to finesse his technique.

Despite it perhaps sounding a simple modification to the average layman, if it has groundbreaking results then it’s a huge discovery, regardless.

Keeping things simple and straightforward is often the best way to go in life, hence the KISS acronym commonly used by skilled tradespeople in the UK – keep it simple stupid!

Hopefully for all watchful waiters and future hernia affected people, @drkang will be forthcoming with sharing his technique in the very near future, perhaps starting with an interview on Hernia Talk Live with @drtowfigh. Come on, please get it organised!

[pinto]

@Mike M, I agree. Would you care to share your ideas about that now that you are well out from your recent surgery? How have you progressed. Your outlook. Any tidbits now having experienced it all?

[pinto]

@G, thank you for your post. As far as I know, HT is more an information-exchange rather than a social media per se. To that extent I’m not looking for friends; rather information. Information that will advance my own understanding of things. You claimed—I believed—that Kang’s surgery is basically the same as Brown’s. You said that. Your own words. Well obviously that is quite a claim and I indicated it hoping you could back it up. Well apparently you can’t.

Some people could make unfortunate medical decisions based on your words. The two surgeries could be dramatically different. And by the way you are quite wrong in claiming that I offer “protection and allegiance to Dr. Kang.” Yes I favor him in the same way that others recommend their own surgeons. But it stops there. I am perfectly willing to entertain opposing views. I seek a dialectic so that our conversations can refine my understanding. If it would mean Kang Repair would be less than thought, then so be it. If you just want a koffee klatch then you might be at the wrong website. Lots of people here seek reliable information; less so a friend. Many other social media have that as primary.

[G]

Pinto, I think sensei is right about your unique personality characteristic. I do understand your protection and allegiance to Dr. Kang however. I think that is a productive and positive response especially when so many things can go wrong with hernia surgery. Like you I got a good outcome from Dr. Brown (although I didn’t have a recurrence like you did and everything held up from day one). Having experienced bad healthcare results from other procedures in my life and then the exemplary success I experienced with Dr. Brown I understand your emotionality. Your protective nature towards Dr. Kang is very well warranted and a break from all the gloom and doom rhetoric. Unlike you I don’t like to engage in walls of text with random forum members. I’m less into the minutia and more big picture orientated. Less into the “white papers” and more into positive personal results. So here I must step off the Karpman Drama Triangle with you and bid you farewell. Find another source of positive or negative attention. Just cast another lure and I’m sure you’ll get another bite in no time. Good luck.

[Mike M]

Dr. Kang is the best in regards to pure tissue repairs.

[pinto]

@G, congratulations, sounds like you won the lottery. I’m happy for you. I’m unsure we can equate the two surgeries but the outcomes might be quite the same. If you were so technically savvy as to say so definitively the surgeries are the same, then you would be able to write a decent paper outlining how they do indeed dovetail. Many of us surely would be happy to pay the journal fee to read it. 🙂

[G]

I had a successful hernia repair by Dr. William Brown (now retired). It is basically what Dr. Kang is still doing now (until he eventually retires). In the interest of brevity and because I don’t like repeating myself I’ll cut and paste my comment from a previous post:

For what it’s worth I had a no mesh, nor a Shouldice (described by some as a “sushi roll wrapped up with a guitar string”) repair done by Dr. Brown (basically what Dr. Kang does) several years ago. Pure tissue (no mesh) repairs can differ greatly. I’ve had no pain to speak of and didn’t need to take any pain medication. I’ve had no problems and work out (extensively) six days a week while working over 40 hours a week at a traditional job. I’ll be 70 years old in the not to distant future. Like I’ve said before, there are solutions to problems. Everything isn’t all gloom and doom. That is not to discount or negate that there is a lot of self serving and potentially questionable products and services marketed to the consumer however. “It’s nothing personal, it’s only business”. Cress selling, upselling, all kinds of marketing. Caveat emptor.

[pinto]

Correction of my previous post: KM should be KR (Kang Repair).

[pinto]

For thoughtful conversation: Chuck reports, “Dr Towfigh calls his [Kang] repair a marcy like repair…which she only uses on petite women and children…”

Consider what Doc Brown says about Marcy: “in a young athlete with an indirect inguinal hernia, the Marcy hernia repair with ringplasty yields excellent results with minimal dissection and minimal postoperative pain.” https://herniatalk.com/forums/topic/shouldice-vs-desarda/

A reasonable presumption is that by “young athlete” Brown has in mind male adults. OK, so we have a Towfigh vs. Brown runoff. 🙂
If true that Brown has serviced many pro athletes successfully we must give the nod to Brown. And if agreeable—then Kang Repair ain’t too shabby (though he doesn’t agree with the Macy characterization).

Granting my naivete but how can you so easily categorize KM as a Marcy when Kang might have the smallest IH incision size in the world? Who knows what will happen to me but I have to sing KM praises because my post-op has been so painless (besides other reasons). I think it is quite possible that the Marcy labeling is too premature by other surgeons not fully understanding the KM. (BTW, incision size here has no concern about cosmetics but rather pain. My understanding is the larger the incision, the more pain. I presume also to produce it must entail other surgical techniques rather advanced!)

Shouldice vs. Desarda

[pinto]

@Watchful, medically naive, I knew nothing about imaging etc. My CT scan was not for the purpose of the hernia but something else. I received no report. By luck I could use it for my hernia apparently. I thought it was pretty cool that the later two hernia surgeons I visited looked at their computer monitor–and I believe–applied a measure to their screen. Anyway they both made a calculation coming up with the same measurement in response to my question, how big is my hernia? It was kind of a test of their ability. 😀 (The first doctor quite familiar with CT scans could not identify a hernia, saying he would need a CT for that purpose.)

@William Bryant, you’re lucky to be on the slim side as I found out and maybe you too that being obese is a disadvantage for surgery.

[William Bryant]

Have you been mind reading, Pinto? As soon as I read the but about Dr Towfigh saying only suitable for skin women, I wondered why not slim men? I’m a sort of slim man. So Im hoping it’s ok.

* Not as slim as I used to be

[pinto]

Thanks Watchful. Although a good explanation and maybe quite correct, I must think that the approach to the spermatic cord is not the defining feature that separates hernia approaches from one another. All must deal with the spermatic cord. Moreover, how Dr. T applies Marcy may or may not be textbook Marcy. BTW was Marcy originally developed solely as an approach for children? I’ve always thought it was not age or gender-specific. If true, then the question remains open—-Why not men at least slim men?

[Watchful]

Pinto,

Did your CT report a defect size? 14cm is the hernia sac size.

I believe at least part of the response to your question is that the female anatomy is different. Men have a spermatic cord going through the internal ring, and women don’t. Achieving a good Marcy-type repair of the internal ring on women is not equivalent to doing so on men.