Dr. Grischkan Experiences

Hernia Discussion Forums Hernia Discussion Dr. Grischkan Experiences

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    • #30717
      Mike M
      Participant

      Hello –

      I am new to the forums having just been recently been diagnosed with a inguinal hernia. I noticed this hernia one day after repeated coughs (some times forceful because I was annoyed) over the past 2 weeks on a minor cold. It was one of those coughs that was just barely enough to be annoying and create a tickle. I isolated at the time for 10 days just in case it was COVID.

      I have been searching the forums quite a bit and after sifting through most of the info I am seriously considering Dr. Grischkan for the repair.

      I have never had a repair previously or even had a surgery aside from my wisdom teeth.

      Has anyone had any recent experience with Dr. Grischkan? I see a lot of pros and cons with the Goretex suture he uses as well as the potential for staples?

      A big deciding factor is at no point do I want the Cremaster muscle or Genitofemoral nerve cut, shaved, reduced, etc. I want it 100% intact. It sounds pretty problematic to start messing around with male parts as I am still a fairly young guy with an active life.

      Dr. Yunis sounded like a great option too. However my conversation with the female nursing assistant who answered the phone was pretty disturbing. Patient respect, privacy, and simple accommodations to retain dignity as it pertains to the opposite sex were not possible at their facilities. I felt a bit gaslighted by the staff for having even proposed the suggestion?? This is a non-negotiable term for me unless it a medical emergency. I stated I have no problem paying for the additional expense for the accommodations as needed regardless of cost. Having worked in a hospital IT at the highest levels I worked with a lot of high level staff, admins, I know it is not an unusual or impossible request. Additionally I have successfully obtained those accommodations for my wife when she had to have a DNC.

      Dr. Grischken has been 100% fantastic with his bedside manner and willingness to address those concerns. The environment where the surgery is performed also sounds very conducive to someone with anxiety regarding medical situations and patient dignity. I plan on setting up an appointment with him to follow up and move forward once I resolve some of the technical questions.

      My biggest concern with the procedure itself is the risk of having male anatomy “cut” and having a foreign object of any kind in my body that doesn’t dissolve after the tissue is healed. I am pretty young active dude so that thing floating around in my body at 80 might look a lot different than it does today.

      Anyone have positive experiences with Dr. Grischkan?

      This Dr. seems like he is one of the best technically and his bedside manner has been impeccable so far.

      • This topic was modified 7 months ago by Mike M.
    • #30720
      Watchful
      Participant

      Are you planning to do just a Shouldice procedure there or Shouldice+GoreTex mesh?

      I think the procedure that minimizes the cutting of tissues and risks to nerves is actually laparoscopic TEP mesh, although it has the disadvantage of requiring general anesthesia. Shouldice involves a lot of manipulation of your tissues as you can appreciate by reading the steps of this surgical procedure. My wife sometimes calls it “doing a Picasso on you”.

      I’m personally not a fan of either procedure, but there isn’t really a great solution. This is why watchful waiting is the way to handle it as long as the hernia doesn’t progress beyond a certain stage. Once that’s not an option any longer, you basically have to pick your poison.

      I would lean toward the original Shouldice (maybe with the modification of not cutting the cremaster and the genital nerve branch). The main reason is that it seems that when mesh causes trouble it’s more serious trouble than when Shouldice causes trouble. However, if mesh complication rates are miniscule in the hands of a top surgeon, then I’m not sure that this is the right thing to focus on.

      I have no experience with the surgeon you mentioned – sorry.

    • #30721
      Chuck
      Participant

      Grishkan is a heartless punk…he treated me terribly when i had questions about mesh and his procedure. He also has a rep for denigrating other physicians. He is also like 74 years old and you can read a few horror stories about his responses to his failed surgeries…guess what its not his fault. If I were you…the slam dunk choice would be to fly to korea to see Dr, Kang….this guy has tons of experience..and new techniques no one else has…i didnt go to him and i paid the price. Yea its far…yea its gonna cost…dont be cheap you need to do this right the first time,,,otherwise like me you end up in pain depressed and looking for answers…hernia surgery is a minefield dont step on one…desarda clinic in florida would be my second choice maybe or germany for dr koch

      • #30725
        Mike M
        Participant

        @chuck – Very sorry to hear about your experiences. I hope you find a solution that works for you long term. It does sound like Dr. Kang is one of the best. I have been fortunate enough to have found success very early in life so money is not a concern when picking any choices. I am just not sure if I want to or can delay it? I am not that knowledgeable yet on how likely my specific hernia can become a “crisis”. This is just the beginning of the journey for me and I want to end it fast and move on. I have tension in the area like very minor dull pain occasionally but no real pain to speak of at the moment.

        Weighing my options I am looking at two concerns –

        #1. Is Dr. Kang that much better than Dr. Grischkan that I put it off to make the trip? Dr. Grischkan has a lot of positive reviews with a lot of searchable positive legal work on the side of Plaintiffs who have gone through botched surgeries. His reviews across all health review platforms are overwhelmingly positive with most of the only bad reviews focused on “billing” since he is out of network for a lot of the major insurance companies. I have yet to see a botched surgery horror story on here as I have with some of the other doctors not mentioned in this thread.

        #2. I would need to reach out to Dr. Kang to see if he makes accommodations for male patients who have specific requirements in regards to patient dignity before, during, and post op. As I said before this is critical for me and non-negotiable. I would definitely consider Dr. Yunis with all things being equal. However after speaking with Dr. Yunis staff regarding their practices and processes I would never consider them as an opinion. Dr. Grischkan has so far been very agreeable to accommodate in this regard should I proceed.

        Ultimately I would just like to bounce some questions off of actual patients on here who have had successful surgery with him before I made a final decision.

        @Watchful – I searched on these forums and read some unfavorable opinions on the Desarda procedure. It sounded like it was much more “destructive”? One story from 2 years ago on here quoted Grischkan as a success story for the failed Desarda procedure. I believe the username was Casimir. I am still learning so I will need to dig into this further to see the subtleties between the two.

    • #30722
      Chuck
      Participant

      watchful i had lap tep…it destroyed me…my quack doc Sam Carvajal hacked me to pieces…in a 15 minute surgery….if you do lap tep go to carolina medical center… dont think mesh should ever be placed in the body….however

    • #30723
      Watchful
      Participant

      Chuck – That is maddening – sorry to hear that.

      I’m leaning toward tissue repair. You mentioned Desarda, and that one is interesting. Simpler than Shouldice. Cutting a strip of a healthy muscle (external oblique aponeurosis) and using it over the weak area may sound a bit scary, but it looks like it works well. I haven’t seen any repercussions mentioned for the slicing of that muscle, but that doesn’t mean that there aren’t any. Some nerves occasionally do need to be cut during the Desarda procedure, so it’s not always nerve-sparing (neither is Shouldice).

      There’s some perception that Shouldice is superior to Desarda, but I’m not sure what’s behind that. Maybe just the long history of experience with Shouldice, while Desarda is relatively new. In the papers that I’ve seen, results seem to be similar, just with faster recovery for Desarda. Seems like a good alternative – I haven’t really seen anyone raising a clear objection to it other than the shorter history.

    • #30724
      Good intentions
      Participant

      I’d rather have a heartless punk for one to two hours of my life with good lifelong results, than a considerate surgeon who gave bad results. The goal is the hernia repair results.

      In the same vein to Mike M the original poster. The hernia itself is “damage”. The hernia repair will not undo that damage. Your goal is to get through the surgery to the other side with the best potential future ahead of you. Surgery will be traumatic. You’ll be naked under a thin gown, various people will be cleaning, shaving, poking, probing and cutting down in your nether regions. They have seen hundreds of patients. Plan to suffer through the indiginites of the day of surgery so that the rest of your life will be better.

      As far as hoping that nothing foreign is left in your body – it seems unrealistic for hernia repair. As an older guy who used to be a young active guy, I can say that you will probably suffer more damage over time that will make a few Prolene or SS sutures in your groin area seem like nothing. Focus on getting the good long-term results from the repair. Don’t worry about surgeon attitude or a few sutures, or a testicle that hangs a little bit lower.

      The hernia is a much bigger deal than most surgeons will say. To them it’s just another procedure to perform on another patient. To you, it’s a lifetime of normalcy or a lifetime of struggling with what happened. Focus on the long-term results, pay the price in the short-term.

      • #30726
        Mike M
        Participant

        @Good intentions – The goal is to have the fix better than the original we were born with or ended up creating right” lol!

        In regards to patient dignity I can promise you 100% that will not be me if that is their policy. My surgery will maintain dignity and modesty (as much as possible) regardless of “how many patients” X staff has seen or I will not be going to that facility. My only request is that when I am being “handled” or “exposed” only the same sex staff are present. Not an outrageous request as men work in the medical field in every capacity. It can be done, has been done, and will be done if they are operating on me. Only exceptions are medical emergencies.

        It sounds like there might not be any avoidance then regarding some foreign material? When I was first thinking “no mesh” I was equating that to everything left behind is dissolvable. I guess that isn’t the case if it want it to last and hold up under intense workouts?

        It sounds like some of the reoccurrences (or lack of ) are almost too good to be true based on your outlook? I was hoping this would be a fast one and done!

    • #30728
      Good intentions
      Participant

      Good luck with your search. I think that you will find that everybody and anybody who had bad results would run naked through their hometown if the bad results could be undone.

      I think that you might also find that surgeons will see a patient with unreasonable expectations and might avoid you. So, your demands might actually end up being a big part of your selection process, limiting your choices.

      Good luck.

      • #30729
        Mike M
        Participant

        @Good Intentions I agree with you on the first part lol! but for me personally I could never trust a Doctor regardless of reviews that doesn’t take into account all aspects of a patients well-being and concerns. If the doctor finds maintaining basic human dignity and simple respect / requests for a planned procedure to be unreasonable I can sleep peacefully knowing I am not the difficult one and move on to the next choice.

        So far I have only found 1 facility that would *not* accommodate. That site would probably accommodate if I had actually spoken to the doctor as I had on the other consultations. I am finding it is the staff not necessarily the Doctor that are unreasonable.

        Hopefully I can come back with a good review on the one I pick for others like me with similar concerns.

        Doctor’s motto Do no harm! 🙂

    • #30732
      Chuck
      Participant

      Good grief…personal modesty should be at the bottom of the list here…GRishksan is a total ass,,,i hear he lines up 10 patients and moves through them assembly line style i could tell from talking to him that his main motivation is ego and money…will he take the time to fix you right…the surgeon that messed me up was exactly like grischkan…bragger and ego maniac…please do your homework and go to kang…if you want to forget this ever happened thas the best approach by far…kang will tailor you repair…grishkan only knows modified shouldice..who knows if that fits wit your tissues

    • #30749
      Mike M
      Participant

      @Chuck Thanks. I am requesting more info from Dr. Kang today. Not a bad idea to get a few different options. Everything I read so far is that he is top notch too. I also read on the Facebook Forums that he sometimes comes to the US? I will update what I find out.

    • #30750
      William Bryant
      Participant

      If you do find out he goes to USA please let us know.

      • #30763
        Mike M
        Participant

        @William Bryant

        He does not operate in the US (no medical license to operate here).

        Travel to South Korea seems easy enough aside from the potential language barriers and the COVID19 annoyances.

        Dr. Kang also makes accommodations as mentioned above for anyone else with similar concerns.

        All the aforementioned Doctors so far sound like solid choices and are top notch in their field for no mesh.

        I think for me it is going to come down to getting some more patient feedback as well as some imaging done to see how long I can wait.

        If I can wait I will seriously considering consider traveling to see Dr. Kang too.

    • #30968
      Mike M
      Participant

      Just a little follow up – I met with Dr. Grischkan and it was a very positive experience. I found Dr. Grischkan to have an excellent bedside manner and he was very knowledgeable. He showed me examples of some difficult cases he worked on (which mine is not) with very positive outcomes. Additionally he had a lot past and very recent of personal experiences expressed in hand written letters / cards attach to the wall as soon as you walk in making you feel a little more at ease.

      He also tailors the procedure depending on the size, scope, and anatomy of the patient. If it is a seriously large hernia his approach is very aggressive with the polybutester suture that has demonstrated to be one of the best inert options available.

      Dr. Grischkan also does not cut any nerves but he does trim the Cremaster muscle 30%-50%.

      The entire procedure as explained to me checked off all my boxes except for the Cremaster portion. I would rather have someone work around it and risk a little higher reoccurrence then trim it.

      Ultimately I think I will try Dr. Kang. There are an overwhelming amount of positive testimonials, he is extremely well respected, and his credentials are impeccable from what I have found.

      Most likely I will opt to stay in the hospital for an extra day if needed to make sure the sutures are 100% solid before I go back to the hotel.

      I think the pure tissue repair method is an interesting study on whether or not the human body can handle a more “natural” tissue repair in that area without requiring synthetic assistance. I guess time will tell.

      I did consider the more “traditional” mesh repair method using a specialist from the Cleveland Clinic but I would rather avoid general and an hour long surgery if possible.

      • #30969
        Watchful
        Participant

        Thanks for the update. Did you ask him if he would be willing to leave your cremaster intact even though he normally trims it? Did he mention why it’s so important to trim it?

        Are you sure that Dr. Kang doesn’t cut any nerves or the cremaster?

        You can do open mesh (Lichtenstein) without general anesthesia. However, my understanding is that this method has a higher risk of nerve damage when compared to lap and robotic, and some surgeons cut one (typically the ilioinguinal) or more nerves pre-emptively.

    • #30970
      William Bryant
      Participant

      Thanks for the well written report. Have you considered Dr Yunis, I cannot remember!

      I’ve got both Dr Kang and Dr Yunis on possible list

    • #30974
      Mike M
      Participant

      @Watchful – Regarding cremaster shaving – Dr. Grischkan did not give me the option. Dr. Grischkan stated that it would be incredibly difficult to get a tight repair in that area without doing something. “tight repair” as in one he would be comfortable with in long term. I could probably force the issue but I would hate being the first one for him to test it on if that is what he does and has experience in doing without complications.

      Dr. Grischkan repairs the entire Inguinal floor regardless of indirect or direct where as Dr. Kang has a tailored approach. Dr. Kang will add more support depending on the circumstances and repair everything if it is needed. Repairing everything regardless of circumstance is definitely more involved but I guess it gives you the added reassurance that you won’t get an indirect hernia later down the road if you had a direct hernia? at least that was the impression I had when it was explained to me.

      Dr. Kang does *not* cut any nerves and leaves everything intact.

      Regarding Dr. Kang and cremaster this is how it was explained to me by his team whereas the cremaster is the warehouse.

      Dr. Kang – “To repair the facilities in the warehouse, you can think of it as if you had to open the warehouse door and enter it, split open the master muscle fiber, operate on the structure inside, and close the warehouse door again.”

      Dr. Kang – “I do not remove or damage whatever inside body structure. Only in the type/case of ‘indirect’ hernia, along the fiber plane of cremaster muscle, after I split and I need to deal with the sac in there, I might incur a little bit of damage inevitably but it is almost ignorable. ”

      In my opinion that is a lot better than taking or taking up to 50% of the cremaster.


      @William
      Byrant – I did speak with Dr. Yunis’ assistant / gatekeeper in an attempt to setup a consult. However it did not get past the initial stages as I was taken back by the lack of empathy and professionalism by that individual when I made a simple inquiry and request regarding their procedure and accommodations. Dr. Kang, Dr. Grischkan, and all the other doctors I consulted have been incredibly compassionate and understanding throughout the entire process.

      Dr. Yunis has an overwhelming amount of positive reviews and is a vascular specialist. That can’t hurt? I also understand he works around the cremaster muscle completely which is great.

      Some negatives reading the forums here regarding Dr. Yunis. #1. Someone stated a patient ended up having to have a bag with one of his procedures after nicking a bowel? I suppose when you do thousands of repairs there are bound to be some complications on some of the patients. You just hope that % is incredibly small. #2. His primary preference and specialty? method of repair is not tissue, it is mesh.

      Ultimately it is really up to Doctors themselves in regards to how things are going to be setup and handled so my advice is if Yunis is a consideration for you make sure you speak to him directly before you form a final opinion.

    • #30975
      William Bryant
      Participant

      Thanks Mike, are you any closer to deciding who, where, when you’ll have operation?

      I seem to go round in circles. From Germany, Canada, India, USA, Korea.

      Dr Kang sounds very good.

    • #30976
      Mike M
      Participant

      I plan on going to Dr. Kang the 1st or 2nd week of April.

      If for some reason my condition changes unexpectedly and dramatically then I will go to Dr. Grischkan. There is zero chance I would choose the Shouldice Hospital in Canada over Dr. Grisckhan.

      Desarda repair had too many concerns from experienced members including some nightmare stories for me to consider it as an option.

      Dr. Conze in Munich sounded good but it is my understanding that the muschaweck repair is very specific and for small hernias exclusively. Not sure what I have at the moment. Also a lot of concerns about the cremaster in their procedures. However it is my understanding that the Munich Hospital is very careful regarding nerves and images nerves route specifically? to avoid long term issues.

      Dr. Yunis works around the cremaster muscle and is a vascular surgeon which is a plus in my book. ThunderRose had success in having him agree to perform the procedure with some of her requirements. However Dr. Yunis does not complete as many open tissue repairs as the other experts and I recently read a story of a patient requiring a bag after one of his operations.

      Here is my checklist by rank of importance.

      #1. Surgeon experience and skill specifically in the procedure performed.

      #2. Type of surgery – No-Mesh (or minimal if absolutely required), open tissue repair under local or twilight sedition. I also used the checklist by ThunderRose as a basic guide along with some understanding of the procedure.

      #3. Longevity – I will sacrifice a slightly higher chance for reoccurrence if it means avoiding a large piece of mesh. I disagree that this is an Airplane to Cars analogy in terms of risk vs. reward. I do agree that there is a higher chance for reoccurrence especially in large hernias with older patients without some mesh type structure to assist. I will roll the dice on this one and hope for the best.

      #4. Bedside manner, ability to meet basic, reasonable, and *respectful* accommodations for a patients needs, ability for staff and the Doctor to communicate in a healthy and respectful manner to patients. Tied for #1 for me for non-emergency situations.

      #5. Specialized Outpatient facility for Hernia Repairs – Not huge but has perks.

      Choices:

      Open non-mesh – #1. Dr. Kang and #2. Dr. Grischkan (mainly because of the cremaster concern)

      All other options – #1. Cleveland Clinic expert (there are a few really good ones up there) or Dr. Towfigh possibly. Had I known I had a hernia when I was in Bev Hills for the Superbowl I would have extended my stay to see Dr. Towfigh for another opinion.

    • #30986
      Watchful
      Participant

      Thanks for the details, Mike M. I still don’t really know what Dr. Kang does, and it’s hard to understand the English in the quotes you posted from him. It sounds like he does do something to the cremaster, but leaves it mostly intact – it’s hard to understand the description. Also, it sounds like his approach is tailored to the patient, so you aren’t really necessarily getting some standard well-known procedure. Anyway, the results that he quotes speak for themselves, and are wonderful (assuming accuracy).

      Not sure how to reconcile what Dr. Grischkan is saying about the cremaster (repair won’t be tight-enough without shaving it) and the fact that a number of other surgeons (including Dr. Yunis) seem to be able to get good results without doing this.

      Recurrence isn’t something to be taken lightly, but if you’re still in the single-digit percentage points, then taking the chance is reasonable. Who knows, though… We’re just guessing since this hasn’t been studied much, and the little that’s out there is contradictory (which is not unusual in the medical field, unfortunately).

    • #30987
      Good intentions
      Participant

      These lists of important factors to consider are a good example of how people should approach such an important event in their life.

      I think that anybody trying to use somebody else’s list should be careful though. Thunder Rose is a woman, with requirements/needs/wants specific to that factor. And Mike M. had a specific demand that no women be involved in preparing him for surgery or being present during surgery.

      Sorry Mike M. but you left that important disqualifier out of your list. Dr. Yunis might meet all of your requirements otherwise. I assume that might be why Shouldice is out also.

      Good luck to all.

    • #30988
      Mike M
      Participant

      @Watchful – My take on Dr. Kang cremaster response is two things.

      #1. Direct Hernia the cremaster is not directly involved in his repair and will not be modified.

      #2. Indirect Hernia he will also work with extreme care however it will need to “manipulated” to an extent as to fix the issues with the indirect hernia with his procedure. The expectation is there could be some damage but it will be “superficial” and not affect the outcome. I don’t know if you could ask for anything more with any type of open tissue non-mesh repair.

      In regards to Dr. Kang using a “non standard and not well known procedure”. This is an excellent point. However it is my understanding after posing this question that Dr. Kang uses modified versions of existing well-known procedures. The modifications are his version of improvements.

      Indirect – The repair method (at least the ideology) is similar to a Marcy? https://www.sportshernia.com/marcy-technique-nonmesh-hernia-repair/

      Direct – It is similar to Bassini / Shouldice repair.

      You always have to take into consideration for the law of unintended consequences anytime a standard procedure is “modified” to improve it especially to the extent that it resembles a new procedure rather than the original.

      I took questions from people that researched the topic extensively, feedback from other doctors, my own questions and ultimately accepted the responses. I will probably keep asking questions up until the knife starts slicing. lol

      Everything I have research so far from Dr. Kang is very conservative in his methodologies, approach, and his appreciation for keeping nerves, muscles, etc. “intact”.

      So conservative to the point where I ask myself is it a lot more likely for a recurrence to happen 10-20 years down the road using this method vs. anything else in my 40 something but active age group. I am not sweating a 1% point however which seems to be where the data leads.

      Dr. Grischkan and Dr. Kang have been extremely successful in working on a wide range of body types, athletes, body builders, martial artists, people with pre-existing conditions, extreme cases etc. so my case should be a walk in the park. Crossing fingers.

      @Good Intentions – 100% Agree. Dr. Grischkan’s “modified” Shouldice is enough of a comprise I could live with with if I had to in a pinch with all of the other checkboxes marked.

      I do not have enough data with Dr. Yunis to tell you if he would be able to meet my criteria because I never got a chance to speak to the doctor directly. Based on other patient positives experiences it does seem like he would be able to meet all criteria with the one asterisk you mentioned. Dr. Grischkan proposed a very simple and easy work around which was totally acceptable as did Dr. Kang. I am concluding for now that my experience with Dr. Yunis was more related to a specific staff member / assistant which I found to be appallingly devoid of compassion and totally unprofessional as it relates to male patients. The request was posed in a very polite and benign manner and the response was power trippy, incredibly “weird”, and not something I am comfortable with in quoting verbatim. Not to be dramatic but I mentioned it to my wife just to make sure there wasn’t something I missed or another way I could take it and she was taken back by it. I suspect (although unknown) Dr. Yunis would have been able to make simple and agreeable accommodations if I had spoken with him directly.

    • #30989
      Watchful
      Participant

      Thanks, Mike M. I don’t know how much he modifies Marcy, but if it’s very close to Marcy, and it works so well, then why does anyone do the much more complicated Shouldice on indirect inguinal hernias? Why is Marcy so rarely done in adults?

      I consulted with Dr. Brown before he retired. He used to do a bunch of tissue repair techniques, including Marcy. For my indirect inguinal hernia, he was going to do a combination of Shouldice and Desarda. The Desarda was for further reinforcement and for reduced tension. He did not mention Marcy as an option even though it was in his repertoire. Why would he even think of such a complex procedure if the repair could be done successfully with the much simpler Marcy? He knew how to do Marcy. This whole area is quite baffling…

    • #30990
      William Bryant
      Participant

      Is Marcy the high stitching? That is usually done in children? If so there was a post on the forum that was a link to one surgeon who advocates for it’s use in adults due to less pain I think it was and no mesh.

      Someone may remember it. It was the surgeon saying he was going against convention.

    • #30991
      William Bryant
      Participant

      Good luck Mike M, hope it goes well. If you think of it and don’t mind. Could you keep us updated afterwards do you think? When you think of it.

      It’s really helpful to those of us who ate finding it difficult to decide where to go etc.

    • #30992
      William Bryant
      Participant

      Hurray!!! For once Ive found what I remembered seeing!!!

      And of course it was originally posted by Good Intentions!!!

      Hernia repair “blasphemy”… High ligation mesh free repair in adults!!! Dr Ponsky I think…

    • #30993
      William Bryant
      Participant

      If Dr Kang repair is a variation on this it sounds good to me.

    • #30994
      William Bryant
      Participant

      One further no question Mike M….
      How long after surgery do you intend to stay in Korea?

      This is something I think about a lot.

    • #30995
      drkang
      Participant

      Hi all,

      I am not sure if I could personally answer the various doubts about Kang repair. Because I am afraid that my intentions may be perverted. However, I think it will be helpful to broaden our understanding by giving answers to the various doubts raised.

      Marcy repair was developed around 1870. So it is difficult to say the exact surgical method nowadays.
      Kang repair for indirect inguinal hernia is the same as Marcy, only narrowing the deep inguinal ring, but the specific surgery method is completely different.
      Marcy was developed as a surgical technique for adult hernias. Therefore, the claim that Marcy is only applicable to child hernias is not correct. In most child hernias, high ligation of the hernia sac is sufficient, so repair of the deep inguinal ring is not required.

      Therefore, to say that Marcy is a surgery that can only be used for child hernia is an expression of disrespect for this surgical technique, I think.

      Surgeons don’t just do surgery. After surgery, follow-up and management should be done. Therefore, it is difficult to continue the operation if the results are clearly bad. Because many patients will continue to complain. However, I have done over 12,000 surgeries in a similar way so far, and I don’t feel any pressure to continue with this method.
      The answer to why Marcy is rarely done if its result is good may be similar to the answer to the question of why mesh repair continues despite mesh complications. Anyway, Kang repair for indirect hernia differs from Marcy.

      Most of the tissue repairs as well as the Shouldice focus on repairing the Hesselbach triangle. Therefore, it is difficult to say that these are the proper surgical methods for indirect inguinal hernia. Because most indirect inguinal hernias have a healthy Hesselbach triangle.

    • #30996
      William Bryant
      Participant

      Thank you Dr Kang.
      Would it be possible to let us know what you do with cremaster and also the gentifemoral, illoinguinal nerves etc, please. If you have time.

      And for overseas visitors how long would you suggest they should stay after operation?

      • #30999
        drkang
        Participant

        Hi William,

        The genitofemoral nerve, the ilioinguinal nerve, and the iliohypogastric nerve are preserved uncut. In direct, the cremaster muscle is not injured at all, and in indirect, after split open along the muscle fiber plane, the sac is processed and the deep inguinal ring is repaired, so there is minor injury but no intentional damage.
        Foreign patients usually stay in Korea for about a week after surgery.

    • #30997
      Watchful
      Participant

      Thanks, Dr. Kang – this makes it clearer.

      It looks like Dr. Ponsky simplifies even further and just performs high ligation even in adults (same as in children) without repairing the deep inguinal ring. He says recurrence has been only 4% so far. He does this laparoscopically in both adults and children.

      If even just that works so well, then if you add repairing the inguinal ring, results should be really good.

      I’m still wondering why tissue repair surgeons who know how to do Marcy choose not to do that in most cases of adult indirect inguinal hernias, and prefer Shouldice, Desarda, etc. There must be a reason… Maybe just misguided accepted wisdom?

      By the way, what are your thoughts on the Desarda repair?

      Thanks again for helping us understand your approach, Dr. Kang.

      • This reply was modified 6 months, 3 weeks ago by Watchful.
      • #31000
        drkang
        Participant

        Hi Watchful,

        Many people think that doctors understand and are familiar with all surgical techniques, but unfortunately, this is not the case. The surgical methods taught in most teaching hospitals are not diverse, and it is common to teach a particular surgical method. Also, the greatest goal of most surgeons is to properly implement the surgical techniques they have learned. There aren’t many doctors who are thinking, researching and trying whether there is a better surgical method. Therefore, most doctors are performing the surgery they have learned, not trying many surgical methods and choosing the best among them.
        Desarda’s method is almost identical to that of Lichtenstein’s surgery. The difference is that they use the patient’s external aponeurosis flap instead of mesh.
        I think that a mesh or aponeurosis that is simply covered over a hernia opening, the muscle defect, without suture closure, can be lifted and eventually increases the risk of recurrence.

      • #31001
        drkang
        Participant

        Also, the aponeurosis flap is not as tough as the mesh, and sometimes it may die due to insufficient blood circulation. So it may have a higher risk of recurrence.

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