Dr. Kang – Direct Hernia repair – Update 3

[Mike M]

I wanted to give a quick update on my progress to those still interested in the Dr. Kang repair.

15 months into the repair:

#1. I started lifting again 2 weeks ago, every other day. No squats, no deadlifts but everything else full body including significant weight on inclines, declines, pullovers, bench, etc.

#2. Started high intensity intervals with a hybrid stepper system for 30mins per day. Aerobic heart rate levels. Tons of stair step like movement (arguably the most challenging for hernias?)

#3. I gained around 15 lbs since surgery by “taking it easy” but have lost all of it now.

#4. I noticed 2 weeks after the repair and early on with very mild exercise the more I did the less I noticed the repair at all until it “disappeared” completely.

#5. Zero movement at original hernia location. Where as before a cough or anything really caused hernia to pop in and out significantly. Additionally the pain previously was a 7 at times. It was bad and only 2 months into discovering I even had a hernia.

Now – no issues so far. I don’t want to jinx but thought reading recent posts thought it could add something positive to the conversation.

Goal is to get back to my normal bench of 300-400lbs, lose another 30lbs, and resume some light MMA training. Taking it one day at a time.

The psychological factor of a tissue repair is there but I feel a lot better choosing the non-absorb sutures.

I feel like I am a great ongoing “stress test” for Dr. Kang’s method because of my build and hopefully this helps someone out reading it.

To reiterate again – My hernia was a *direct* hernia about the size of a hen egg on my left side. Challenging but successful repair due to being on the upper end of a tissue repair BMI for most doctors.

[Jack2021]

Thanks for the update Mike, that’s brilliant to hear. Not sure I’d dare go as hard as you, but sounds like you’re doing great!

Re the psychological factor you mention, I think there’s the possibility that after having hernia surgery and many other surgeries and illnesses, there’ll often be the shadow of it lingering for many people, due to the fear of a recurrence and potentially PTSD. Hopefully this fades in time the longer things go well.

I hope things continue to go really well for you and look forward to future updates.

[John]

Will you ever squat and deadlift again? How will you work your legs?

[Mike M]

I was never a fan of either because of easy of injury. I have done both but I have also seen many a friend from high school to present with linger issues as a result of simple mistakes, slightly bad technique, or even going a tad bit too heavy.

Kettlebell swings is my current replacement at the moment.

[pinto]

Congratulations, Mike, great you’re well on your way. I imagine there’s much less guidance for direct than indirect hernias, so there may have been a bit more concern in that way. Please continue to be prudent and good luck here on out.

[William Bryant]

Good news Mike. And thank you so much for continuing to update us as such reports are all us “deciders” have to go on.

[Oceanic]

Why did you wait 15 months to start lifting again out of interest, I’ve read 6 months and the repair is as strong as it’s ever going to be.

[Good intentions]

Have you considered that the hernia might have developed because you stressed your body to the limit and the groin was the weakest area. Now, even after the repair, it will still be the weakest area. So if you push to the limit as you did before you’re almost certain to get another hernia, probably a recurrence on the same side, because there’s no reason for the repaired area to be stronger than it was before.

“Stronger than before” is the great selling point of mesh repairs. The mesh is essentially a prosthetic fascia, stronger than the original fascia. The risk of discomfort and pain from mesh is easy to overlook, by both patients and surgeons, because of this fact.

Many surgeons and researchers still focus on burst strength as a critical measurement for mesh, ranking products by the measurement even though all can be well above the required strength to exceed normal fascia burst strength. Mesh looks great from a mechanical engineering standpoint. If only people were machines.

[Mike M]

@Oceanic – Mainly because I was being overly cautious / paranoid. I think I did a disservice to myself to some extent because of the gained weight during that period by waiting.

@Good Intentions – I still have a strong belief that my extreme self-inflicted coughing is what caused it originally. Could there have been a small tear previously and maybe noticed when I got older? – perhaps.

However Dr. Kang’s instructions were to go about my business like I did prior to knowing I had a hernia and I intend to do so. At some point you just have to trust your doctor knows best regardless of all the other noise. Don’t get me wrong I take all the data and outside opinions very seriously (perhaps too much). However I am only in my 40s so avoiding things like training / weight lifting is not really an option. There are probably some things I will avoid like deadlifts and squats but if I get a hernia again hopefully I will have the same options available to repair it.

Who knows maybe technology in the field will progress even more where I can have my cake eat it too if (God forbid) a recurrence happens or I get one on the other side. What is involved in any type of mesh surgical procedure is too much for me to sign off on for a hernia repair even though I do think the “mechanics” behind certain mesh procedures make sense.

[Chuck]

Mike M. Thanks soooo much for your report. Can you advise how you are feeling in terms of pain? You have said nothing of mention. But you can still feel the repair. I know mark t hates this but outside of him I have yet to speak to a soul that says their tissue repair makes them feel the same as before. There are always zings some pulling. Stretch sensation etc. I suppose it’s to be expected that the body will always have some differences. You said you would never get a shouldice or a desarda. Can you say why?
Thx Mike.

[Mike M]

Shouldice – Cremaster stump / shave, perhaps overkill, higher chance for chronic pain over Dr. Kang imho, Shouldice doctors are limited in numbers (not sure who I would even have used or who would have admitted me for this procedure). Pros: Been around for a long time. Millions with good results? Lots of data.

Desarda – Read some bad stories (enough to dissuade me). Dr. Kang’s opinion on the procedure. Dr. Towfigh concerns previously expressed. Perhaps the least performed of the pure tissue repairs? Other “modified” hernia repairs are at least similar in many respects to traditional methods like Bassini or Shouldice whereas Desarda is an entirely different approach? Reservations about it being strong enough over the long term vs. Dr. Kang method with non-absorb sutures. No doctor I would trust in performing it.

No chronic pain. I’m 40s so if there is pain in my body it is in other parts that is actually measurable and has nothing to do with the hernia surgery but more to do with me overdoing something thinking I am still 20.

[G]

Mike M, congratulations on your good result from your pure tissue repair done by the honorable Dr. Kim. I’m nearly 70 years old now and I had a pure tissue repair (not Shouldice) done by the esteemed Dr. William Brown (now retired) several years ago. No pain or problems and I’ve been working out at the gym and running ever since. I mean hours on end berserker stuff along with working over 40 hour work weeks. I’ve noticed the “old school” no mesh craftsmen like Dr. Kim and Dr. Brown seemed to care more and also got better results. The one bit of advice I have about working out is look at the big picture, observe others. I’ve noticed weekend warriors on up to pro athletes seem to acquire nagging injuries and limitations from over-use and miscalculations over time. There seems to be a point of diminishing returns. Be smart, do your research and make intelligent modifications when warranted. Now hit the gym and leave it all on the floor bro. You’ll be fine.

[William Bryant]

Hello Mike M,

Thanks for continuing to post it is much appreciated as some who are over surgery just, understandably, stop posting and get on with life. So it’s appreciated very much when someone takes this time to keep us all updated. Thank you.

Like you, I have reservations about Shouldice being like using a sledgehammer to crack a nut. But the fact hernia surgeon’s themselves seem to favour it must stand for something. Never the less it’s a worry for me that it’s so extensive when Desarda and Dr Kangs, Kang and Gibbeum repairs, are less so.

So I flit from one to other mainly due to the travel aspect so if it’s not too much to ask could you let us know a bit more about the negative comments you’ve seen ref Desarda. It’d be greatly appreciated I believe.

[Chuck]

Thanks again so much Mike M. I am not talking so much about chronic pain per se…but about feeling the hernia. Again nearly everyone i have chatted with about a tissue repair says yes i can still feel it. Sometime when their dog pulls or when they lift their grand baby…or working out in the gym…25 pound dumbell i dont feel…35 i do. I am a fanatical student of natural health and made a catastrophic error here putting mesh in…but i like being active and was concerned about all the cutting and sewing a tissue repair requires..and its all under tension and prone to failure long term. KAngs repair is less than 10 years old…his most recent version is less than 5 years old. Voeller implies that tissue repairs outside of those performed at shouldice will just start falling apart after 5 -10 years. So i went mesh…lap mesh which every surgeon told me had few if any complications. Of course it destroyed me. So now its out and trying not make another mistake. Desarda is tension free and no foreign body..thats big…i havent read a lot of terrible stories outside that of casimir. And desarda himself stated he saw no recurrances…likely a lie but still. Does your hernia zone feel exactly like it did pre-surgery…no pulling or tension or zings in the absence of chronic pain? And please elaborate on your Desarda horror stories…thanks brother

[Mike M]

@G Thanks for the advice. I am glad to hear you are doing well with your repair too. The biggest thing I do which is probably not the smartest is a lot of strenuous outside work and lifting huge conduit reels for my workers at work. I am going to try and be smarter about that going forward.

@William Bryant If Kang wasn’t available I would have done Shouldice. Maybe I am being a little too selective but I just thought Kang was a better option. I believe it was this forum where I read some of the horror stories regarding desarda. It has been about a year ago since I researched it a few months prior to my surgery. I will try to find them again. I know Dr. Yunis speaks highly of that method and he is well respected.

@Chuck With all due respect, I trust Dr. Kang over Voeller especially if Dr. Voeller made a wide open arbitrary statements like that without data specific to Dr. Kang’s method or even keeping an open mind. There are Bassini repairs that last a person’s lifetime. So if in fact he did say that he is 100% incorrect. I suspect Dr. Krpata would also disagree with Dr. Voeller. Also I would rather take a chance at a less invasive method first then go a lifetime with chronic pain by choosing a more aggressive method. Also I do not know of a single friend of mine who has had mesh that did not feel SOMETHING after the repair. Some major and some minor. I do not have any friends who had pure tissue repairs like me to compare to but a year later I do not notice anything in the repair area. Maybe if I am sitting static for a long period of time in my gaming chair and close my eyes and meditate – perhaps? You are asking the impossible with the human body. 🙂 Answer your question – I have no chronic pain and I am exercising full force. I am only paranoid about left leg kicks, squats, and/or deadlifts which I am not doing yet.

[G]

Mike M, I think you are very prudent to pay attention (and modify if needed) your work practices to minimize any problems in the future. As they say “we’re not getting any younger”. I noticed a similarity from my own situation and others I have read or talked too regarding their hernia development. Lateral movement and lateral stress. I had an indirect hernia, but I do think a direct hernia might also be affected. My hernia first “exhibited itself” when I was running sideways while doing intense “soccer type drills” in my earlier 60s. The internal stress from my legs swooping sideways and in I believe contributed to the stress in the groin area. I felt like my testicles were in a vise (Interestingly I had worked my way up and was able to lift all the weights on the abductor/adductor machine at the gym, so I was strong there). They say the indirect hernia is from birth but mine didn’t present itself or become noticeable until my 60s. Mike M I would be careful with heavy lateral stress movements towards the inner thigh. MMA “scissor leg locks”, lateral basketball and soccer movements have been communicated to me as being when others experienced their first hernia signs. I wonder how may other posters on here felt their first signs from lateral movement? I mean the lateral movement (and over development) wouldn’t seem to be as prevalent in ancient times as people would just pivot and avoid prolonged or extensive lateral stress.

[Mike M]

@G I haven’t started grappling back up. Not sure how I am going to be able to get around avoiding some heavy lateral stress when I start. Probably just have to go real light and just go through the motions. Muay Thai I punch with my hips but its not that extreme. I don’t throw right hooks which is probably a good thing in terms of a big twist motion. I’ll have to play around with it and go easy for a bit and/or when training. I need to do some exercises to start strengthening that area possibly making it a little less susceptible in the future?

[roger555]

I got my hearnia on my right side by doing side strecthes:raising my left arm over my head while lowering my right arm down the outside of my leg. That definetely streched the area where I got the hernia. I could feel some mild pain right where I got the hernia repair incision. I had bought a stationary bike and the instructions had some strecthes that you could before going on the bike. The side streches were two of the streches. Also, I stopped doing abdominals streches while lying down on my side because I thought that could cause a hernia which I had some 18 years before but I wasn’t thinking that when I was doing the side strecthes.

[G]

Mike M, I think easing into your MMA workouts and strengthening (up to a point) your weak points is a good idea. I would avoid any “sports hernia” (Athletic Pubalgia) type injuries as they can progress into Inguinal hernias. And as many of us (myself included) discovered forceful, powerful coughing is best avoided. I think in my case the sideways soccer drill running produced a “sports hernia” that diminished in pain when I stopped those training protocols. A few weeks or months later I was coughing as hard as I could to break up a pesky cold when I felt the burning rip sensation of an avocado sized hernia pop out for the first time. That’s when I knew for sure I had a hernia. If I understood you right Dr. Kang said you can go back to doing what you’d been doing before. That means BJJ grappling from the guard, boxing, kickboxing, etc. are good to go at this point. Enjoy your life Mike M.

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