Dr. Kang – 1 Year update – Direct Hernia repair

[Mike M]

It has been 1 year since my surgery with Dr. Kang!

Everything is going great.

It is night and day from where I was at before surgery (I almost did not make it to Korea).

No tension issues now, I can run full speed again, plan on lifting this summer, and have already lifted some heavy weight that would directly impact the hernia without issue. No pain when coughing, no bulging, no pop outs. Nothing of the sort.

I did add weight back starting around winter for the simple fact it was winter and I didn’t want to “over do it” within the first year. I gave the repair every opportunity to heal and get strong more so out of paranoia then necessity. I did walk and move a lot however for the first 3 months after the surgery.

Dr. Kang put me back together to where I was at prior to my self-induced injury, perhaps even stronger with the perm sutures. Just to rehash – my hernia developed because of excessive coughing + weight (30% BMI) + maybe a little age? (late 40s) most likely. I am a former “athlete” and lifted heavy in the past but I don’t feel that contributed to creating the hernia.

I feel with open tissue repair you have to be patient and let your body settle down to accept the new fixes.

Everything for me was a progressive improvement as the days passed post surgery.

My hernia was large and I lost weight prior to surgery but I was still on the upper end of the spectrum according to Dr. Towfigh and Dr. Sbayi’s interview regarding a Shouldice style repair.

It was a difficult repair but Dr. Kang was successful and I feel as long as I do not do anything irresponsibly egregious again (i.e. take care of my health) the repair should last “forever”.

Mesh was never an option for me and neither was surgery at a major hospital under any circumstance except an extreme critical care emergency.

My biggest concern with Shouldice was all the slicing and dicing near my “manhood” coupled with the fact there was no Doctor I trusted to complete that specific procedure.

If I did consider mesh I feel there were a lot of potential good options available in the United States with some reputable doctors that I could trust. However the entire surgical procedure of Mesh was not something I could ever come to grips with at my current age.

Mesh vs. Open Tissue for me personally was a combination of three things:

#1. What procedure and environment am I comfortable with enduring as it relates to this type surgery and with what Dr. ?

#2. What procedure leaves the least possible long term negative impact on my body?

#3. Recurrence still very important but in last place for me. I think there is a lot of blame to go around in regards to a recurrence with no mesh open tissue repair and it starts with the patient being responsible for their continued health. The body is restored to a “healthy” state, perhaps a little stronger even with a good procedure method, but if the patient continues with the same bad behavior / lifestyle and it breaks as a result it is not the fault of what surgery was done or not done. I feel in a scenario of egregious negligence (which I think we are all guilty of myself included) Mesh could be a better long term option with potential downsides that do not always appear in the “research” stats.

Conclusion is Dr. Kang stands out for a few key reasons:

#1. His repairs are successful, minimal, and done in a safe (nearly) stress free environment that is very welcoming to foreigners.

#2. Dr. Kang is an extremely caring and thoughtful doctor who spends his free time continuing to improve the field of Hernia repair.

[pinto]

I know you have made important posts here at HT and like me a patient of Dr. Kang’s. Many members know of my reviews about Kang as well as knowing I had a recurrence. About that I wanted to correct your point #3 recurrence: In my case never was it a matter of patient responsibility.

I am a former NCAA Div. II basketball player, who is not far from his former athletic state. I continued to play the game until my hernia struck. I am thin of stature and careful of diet. I was in excellent health before and after surgery.

I was careful of activity post-op and exercised only to keep body tone–no heavy lifting, no squatting, or anything to strain my pelvic area. Dr. Kang mused that maybe the absorbable suturing gave way too early. Whatever, it had nothing to do with me personally for I was quite careful in lifestyle.

As an aside, I wonder if you really can say what caused your hernia. In my case was it basketball, golf, dancing, weight training–or simply sneezing or coughing or bladder issues?? Surgeons differ about these causes. So who is to say which one? How can you really be sure it was coughing or even weight gain? You say it so confidently that it reminds of my own personal quandary as to what triggered my original hernia. Anyway, just for discussion I am posting and the wish to clarify recurrence. Otherwise, bro, take it light.

[William Bryant]

Brilliant update Mike M, many thanks.
And ask Pinto for clarifying about the recurrence.

Talking of cause I wonder if mine was self inflicted as I was doing stomach crunches or sit ups whatever they’re called to lose weight plus blowing up balloons to strengthen lungs as I have lung problem. But for work I lugged heavy office machines and boxes and boxes of paper. I’m annoyed with myself about the exercises but who knows it may have been the years of copier lifting and also I hds several chest infections one year with terrible coughing.

[William Bryant]

I totally empathise with Mike about the cutting near manhood.

A lot of people worry I’d imagine.

In relation to pain can Mike say how long the bad pain lasted?

[ajm222]

Thanks for the update. I am currently two months out from a tissue repair done several years after a robotic mesh removal. Worry every day about recurrence. My doc used absorbable sutures. The area isn’t particularly painful but it’s uncomfortable as I feel a large knot type feeling there, and it feels kind of weak. Sort of like when I had the hernia. Been that way though since the surgery and I suspect it’s all the work done plus scar tissue and may take a long time to feel more natural. Was hoping it would feel great by now but guessing I won’t really know for many more months. Glad you’ve had a good outcome.

[Mike M]

@Pinto The reason I am pointing at the “coughing” is I had never experienced even a hint of a hernia at any point in my life. It was the furthest thing I thought possible. However I was forcing myself to cough in a pretty extreme manner over a long period of time (2 months) because I was annoyed by the simple cold / covid remnants. I never got sick outside of a tickle cough I thought (moronically) I could solve by increasing the intensity of my cough. Like you said it could be a culmination of time, a little age, and other activities but there was no indication prior.

Also you had a “sliding” hernia if I remember correctly? A little tricker to detect and possibly took extra steps to resolve? It is where the floor is made up from tissue from other organs?

@William Bryant I plan to go back to doing similar things you mentioned at 100%. I already am lifting massive spools of utility wire when I help my workers load up. No issues. I am not going to live my life restricting my activates because of the possibility of a recurrence. However I need to lose about 20lbs before I do anything too extreme to soften the load on that area.

“Bad pain” (but what I expected) the first 48 hours. Standing the first few weeks for over 15 mins would tense up the area and I would have to sit down for relief. That all went away with time no issues at all. Nothing was overwhelming or more than I anticipated. Only time I really needed help was the first 24 hours.

@ajm All the things you mentioned are common from what I was told and experienced. It all fades with time. Some people freak out about a sensation of “movement” or a “popping” etc. Just scar tissue, nerves, and your body trying to adapt for the most part. I walked up 10 flights of stairs 5 days after the surgery and thought I was doomed because of a little swelling. lol Follow up Ultrasound showed perfect repair.

[ajm222]

Thanks, Mike. I’m two months out and still feel weird – like a heaviness and lump in the area below the hernia and in the crease between testicle and thigh. And pulling sensations and tightness. Some mild soreness still. I don’t think my experience is typical at this stage and probably not a great sign long term. I’ve been here before. Just constantly saying to myself – well, let’s give it another month. And then another. And another. I will say there’s been some glacial improvement over that time as opposed to worsening.

That said, surgical team suggested it can take months for things to settle down and feel more normal. And I am SUPER sensitive to any and all discomfort, and tend to amplify it when stressed. I had a single stitch placed in the larger trocar hole where my mesh was removed because it had to be dilated more, and that was very uncomfortable to me for months. Finally resolved. So perhaps I personally just need a long time for my body to ignore these sensations. Very minor things can seem terrifying as a result of medical PTSD. Certainly far more was done in my groin for a tissue repair than just a single stitch. Anyway, everyone’s experience is so different.

Will try and stay calm for the next few months and see if I make steady but slow progress. Just don’t know why this continues to be such a problem. But I’ve had some medical issues in the past that also failed to heal (or maybe they healed but I didn’t anllow myself to move on) until I was able to take some medication that allowed me to stop obsessing. Perhaps that’s all I need. Mind-body stuff can be complicated. And I came into this surgery with some preexisting pain and discomfort to some degree that I can’t expect this surgery to necessarily fix.

[Mike M]

@Ajm Also most patients were damn near doing barrel rolls immediately after the surgery from what I witnessed. My buddy helping me on the trip was making fun of me as I was walking out of the hospital from surgery. He was telling me I was giving Americans a bad name. lol meh I knew I was coming into it a little bigger and my hernia was probably larger than most.

[pinto]

@Mike M says, “The reason I am pointing at the ‘coughing’ is I had never experienced even a hint of a hernia at any point in my life. It was the furthest thing I thought possible.”

Exactly my experience–and to boot I was the fittest I could be. I had always heard growing up “be careful picking things up.” I had never heard that it could be from sneezing or coughing. Shocking to me. But what about simply reaching for something in your car with a heavy backpack on? I don’t think any surgeon can pinpoint the cause in our cases. And further they all seem to have their own pet causes. Another dilemma is that surgeons differ about physical exercise. Despite the hundreds of years of history, hernia surgery appears still full of mysteries.

Sliding hernia–yeah, sure there’s no secret about that. But there’s research to show that with proper surgical technique, outcomes match standard ones. “A little tricker to detect”? I don’t know but one surgeon looked at my prior CT scan and could identify it as sliding. I don’t know if he was blowing smoke but he seemed well-informed and experienced about hernias, one of the most impressive ones I met.

[David M]

Mike M, How big was your direct hernia? Tennis ball? Baseball? Golf ball? Somewhere in between?

Does anyone remember who else that Dr Kang treated had a direct hernia?

[Alan]

Me, I had two direct and one indirect.

[Mike M]

Hen sized egg is how it was described to me for the direct hernia.

I also had my belly button hernia repaired which was 1cm, pretty small?

[David M]

Thanks for the response. I may have already asked you that, now that I hear the answer. A hen sized egg doesn’t sound all that big to me, but it does give something of encouragement for tissue repair for those with hernias of that size.

[Watchful]

Hen egg size is nothing. My indirect hernia was somewhere between zucchini and eggplant size. Not a brilliant idea to do tissue repair for that in my experience.

[Max L]

Hello all. After reading various members reviews of Dr. Kang and Gibbeum Hospital, I am considering having surgery with Dr. Kang. I am not interested in laparoscopic mesh repair, which is the only option I have here in California. What is the best way to contact Dr. Kang and schedule surgery with him? I would appreciate anyone’s advice.

[Herniated]

@maxl – Dr. Shirin Towfigh, who created this HerniaTalk web site, is in California. She is a hernia repair surgeon offering either tissue or mesh repairs.

[Good intentions]

@drkang might work. Or you can go directly to the Gibbeum hospital web site.

Stephen Kwon is the contact person for travelers. His email address is at the bottom of the web page. I copied it from there.

[email protected]

http://gibbeum.com/abroad/From-abroad.php

Dr. Towfigh is a proponent of lap TEP mesh implantation. And, I believe, very expensive. Beverly Hills.

[Herniated]

The following is a quote from the Beverly Hills Hernia Clinic web site (Dr. Towfigh’s clinic):

“Since the introduction of mesh in the 1980’s, most surgeons have lost the art of non-mesh tissue repairs of the inguinal hernia. Dr. Towfigh is experienced in non-mesh tissue repairs and regularly offers it to her patients who she feels are good candidates for that. Dr. Towfigh offers robotic-assisted laparoscopic non-mesh hernia repairs as well!

The benefit of tissue repair is mainly to reduce the risks associated with mesh implantation.”

Cost – I have no idea – but I have heard that everything in California is very expensive.

[Good intentions]

One often cited factor to consider when choosing a surgeon is experience. I am certain that Dr. Kang has much more experience in pure tissue repairs than Dr. Towfigh does.

The text on the web page does not describe what a patient who is a good candidate for pure tissue repair would look like. I think that if a person went to Dr. Towfigh with a hernia and did not request a pure tissue repair they would get a lap TEP mesh repair. That is just a feeling derived from her posts on the forum. She has mentioned in the past that, maybe, women should be getting more pure tissue repairs than mesh. Implying that mesh repairs are over-prescribed for women. Not clear where that thought process is going though. It was just a comment on the forum.

[Jack2021]

Dr Towfigh talked a bit about her thinking re tissue repairs for women in her Hernia Talk video with Dr Andreas Koch. They had similar perspectives on this, if I remember correctly.

The whole talk’s worth a watch for anyone who hasn’t seen it.

[Watchful]

She mentioned on a number of occasions that she prefers Marcy (instead of mesh) on small indirect hernias in skinny women.

I actually consulted with her in person. She was willing to do mesh (either Lichtenstein or lap), but not tissue repair (Shouldice) in my case. I think it was a reasonable call, and most likely the right call in hindsight since Shouldice turned out to be a difficult surgery in my case. She didn’t predict that it would be difficult, but she thought that the risk of recurrence would be too high. Maybe I should say that she reached the right conclusion, just possibly for the wrong reason. We’ll see – hopefully there will be no recurrence. She thought that mesh would not cause trouble in my case, so she saw no reason to go with tissue repair with its higher risk of recurrence.

I had a really good impression of her – she’s thorough, spends enough time (an hour), and writes proper notes (unlike all the other surgeons that I saw). Clearly, very experienced and careful. If I hadn’t been fixated on tissue repair, I would have most likely gone with her for the surgery.

[Good intentions]

It would be very interesting to know what she considers “trouble”, and how she could differentiate your hernia from others. Does she have a belief that she can predict “trouble” with a patient based on the type of hernia repair performed?

I doubt that the trouble she referred to was chronic pain. The vast majority of attempts to define an avoidable cause of chronic pain from mesh have been failures. If anyone has a provable way to continue to use mesh and reduce the chronic pain rate they have not made a good case for it in the literature.

The mesh products seem to have inherent chronic pain properties.

[Watchful]

You would have to ask her, but here’s my impression for what it’s worth.

She has a lot of experience with mesh problems and revisional surgery. This enabled her to develop a profile of people who are more likely or less likely to develop problems from mesh. Things like sex, age, body type. Similarly, she has experience with tissue repair, and tissue repair going wrong. Based on her experience, her assessment in my case was that I should be more worried about the risk of recurrence with tissue repair than the risk of trouble from mesh.

The size of my hernia played a part among other factors in her rejection of tissue repair in my case. I wasn’t 100% sure about one thing, though. It wasn’t clear to me how much her concern about Shouldice in my case had to do with what she thought the results might be in her hands specifically. She did say that some other surgeons would do it, but she wouldn’t, and it wasn’t clear to me how to interpret that. Did she mean that others might be able to do it better, or did she mean that others might be less conscientious or less concerned about recurrence? This wasn’t clear.

[Max L]

@herniated and @good-intentions

Thank you both for the helpful advice. I have emailed Stephen Kwon and hope to hear from him soon. I may consider a consult with Dr. Towfigh if I do not hear back from Stephen Kwon in the next few days. I am also open to contacting Biohernia and the Desarda Clinic. One thing I am sure of is that I do not want mesh due to the high incidence of chronic groin pain being reported post mesh implant. Thank you all.

[pinto]

Not until recently had I heard that Dr. Towfigh also does pure tissue repair. Could it be that she is a “unicorn” mesh doc in the same way that the great Yutani baseball player is called that—-unusually adept at two very different approaches? All the mesh docs I talked with spoke as if there was no other possible approach. Would a mesh doc even risk professional standing to be seen appreciably offering it? I know of a non-mesh doc who spoke of feeling ostracized because of his choice. Would Dr. Towfigh also feel some pressure within her medical circles in the same way if she spoke too positively about non-mesh surgery?

Another point concerns Marcy repair mentioned. I believe someone posted that Dr. Towfigh considers that repair suitable for children but not adults. Yet above in this thread, a post reports that she identifies Marcy doable with slim women patients. If these hearsay reports true, then why not also for slim men? And as I recall her saying, Kang repair seemed Marcy-like, thus questionable. (He though posted at HT his is not to be so characterized.) Any ideas for tying these loose ends together?

• This reply was modified 4 months, 2 weeks ago by pinto.

[David M]

I continue to be amazed at the open-minded ness and thoroughness with which Watchful approaches his post surgery and the sharing of his journey.

[David M]

Let me reword that:

I continue to be amazed at the thoroughness with which Watchful approached his surgery and the open mindedness with which he shares his post surgery journey and thoughts. Very nice.

[ajm222]

@Watchful – can you perhaps explain in more detail what you’re lingering symptoms are today? i may have missed that recently. could be useful to some. thanks.

[William Bryant]

Yes Dave And Ajm, and also if they are improving Watchful.?

[Watchful]

Thanks for the kind words, David M. I was thorough in talking to a variety of surgeons, but I didn’t have an accurate picture of my hernia because of a grossly inaccurate ultrasound. If I had known how bad it was, I wouldn’t have pursued tissue repair. I was aware enough to avoid tissue repair on a hernia of this magnitude. No one knew, though. The only way for me to find out would have been to go to an expert in hernia imaging, and I don’t know of any in the US. Maybe Dr. Towfigh could have arranged that, but she didn’t want to pursue tissue repair in my case, so there was no opportunity for that. For mesh, it didn’t really matter.

ajm222, William – I have chronic pain and discomfort. It’s not severe, and it’s not debilitating, but it’s definitely annoying and disturbing occasionally. I’ll write more around my 6-month anniversary. There has been an improvement, but it has been extremely slow and gradual. I do expect things to improve further with time, but I’m not sure by how much.

[ajm222]

Thanks, Watchful. Looking forward to it.

[William Bryant]

I’m sure there will be continued improvement Watchful. As I say I had surgery, not deep nor hernia, but surgery and it was painful at times for ages after. My mum had surgery it was painful at times for years after, even causing her to double over, but eventually resolved. My partner had surgery and had pain on and off for ages.

I’m confident you’ll ‘settle’ similarly in time.

[Watchful]

Thanks, William – I think there will indeed be further improvement. That’s the reason I don’t like writing updates on the pain and discomfort which are too frequent. Once it gets to the “chronic” stage, you need to give it a lot of time to assess how things evolve.

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