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Dr. Grischkan Experiences
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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.
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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.
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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.
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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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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. -
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. -
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.
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@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.
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@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! đŸ™‚
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@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!
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@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.
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