How a smart health conscious patient got suckered into lap surgery

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    • #32799
      Chuck
      Participant

      Lap Mesh surgery destroyed my life…and as someone who is extremely health conscious and careful…I am deeply depressed and confused about how i got suckered into this garbage surgery. In retrospect it seems so obvious that it should never have been considered. Like so many of my friends…I did not blunder into this surgery after being referred by my GP. I studied it closely for over a year. So how did i get suckered.

      1. Dishonest doctors…Todd Harris California hernia surgery has several you tubes discussing mesh…he says the “new” mesh has gotten a bad name from meshes used many years ago…the new mesh is “extremely safe” to the point where he says he doesnt even discuss the risks with patients. He cites many studies showing the safety of mesh…and the complete fallibility of tissue repairs which he says large studies have shown have a 20 percent failure rate. Mesh risks are nil per Todd and merely churned up by greedy lawyers. Mesh whore Voeller cites the same theme citing study after study…its a slam dunk on the recurrence front…not even a debate per Voeller where mesh destroys tissue over the longterm…especially after the 5 year mark where voeller appears to contend that tissue repairs just fall apart. Lap mesh he contends is the gold standard for avoiding chronic pain and recurrance in every study. This scumbag went to shouldice for his own repair. The infamous Towfigh Yunis interview…where open repairs are given a 15 percent chronic pain rate…lap is said to be much lower…and Yunis even says mesh is not mesh when its put in lap or robitcally…the risks of complications are sooooo much lower. in other places Towfigh says Shouldice repairs are too tight so she deosnt like them….she also says Desarda repairs have been tried in the 50s and the whole concept is flawed…kangs repair is flawed because its a marcy which was shown only to work in kids. She also says repeatedly in different interviews that lap mesh surgeries have been shown in every study to be superior in terms of pain and recurrance. This is simply not true as there are many studies showing open mesh surgeries to be superior …instead towfigh cites unspecified surgical history where tissue repairs were a big problme, to the point where we dont teach it anymore….I bought this hook line and sinker…heck 95 percent of surgeries use mesh…it must be safe and a better approach than tissue….it never occurred to me that i was seeing hardly any tissue repair horror stories anywhere…Why i took all these doctor statements as fact….i simply do not know….i never suspected that these doctors cared little about us as patients and were simply trying to steer us to the solutions that they themselves were proficient at. I will say i encountered this nonsense from non mesh surgeons too…a complete brood of backstabbing vipers….Peterson bashing grishkan as lying about the number of surgeries he did and Towfigh saying he removed mesh from her patients nearly every month….Grishkan told me that Peterson was a bragger and a liar with an arrogant personality who was working in vegas because he lost his license elsewhere…he also told me he had to fix many Desarda repairs from Tomas a repair which he said was a disaster waiting to happen. Yunis was wonderful in person but his staff told me to beware of Grishkan…and that they had to fix all of his repairs. Kang says shouldice is flawed and invasive in many cases…putting a right glove on a left hand….Desarda he says is flawed because the flap used in place of mesh can lose blood supply and die….causing a recurrance. My local doctors – i went to 6 all told me that tissue repairs would never hold…they said they had NEVER seen any mesh complications in 20 years of practice….they said they had seen MANY chronic pain patients from the shouldice clinic…and warned me that the shouldice repair was painful and invasive. Tomas on his website says the shouldice technique has many problems including pain and foreign body sensation…..the “guitar string” they put in you per tomas is as bad as mesh. The liar who destroyed me Sam Carvajal told me he had done 5000 lap surgeries…why i believed this i dont know he doesnt even specialize in hernia surgeries……Grishkan claims 230000 in retrospect an obvious lie unless he was doing surgeries in his sleep…Dr JAncyck one of the few honest surgeons i talked to told me he has done 2000 in a career…and he is the busiest robotic surgeon in the country…so these others are flat out lying about their numbers…but i was too innocent and ignorant to suspect it. I got Bard 3d max…one of the worst meshes on the market…but i asked three surgeons if it was ok…they all said yes…Dr Belyansky said its total garbage…jancyck said the same…..these two doctors in my view are honest…and well qualified.

      2. My experience with friends….virtually every friend that had open surgery with mesh or without had an issue….nearly everyone got a hematoma…that was almost universal….also nearly everyone had some kind of nerve damage…dead spots on the testicles…deadspots in the groin from the cutting. Also everyone had to endure the healing ridges that took time to get better. I spoke to shouldice patients who were still feeling pain three years after their surgery….I spoke to desarda patients who said the surgery took a year to heal…but even years later if their dog pulled on the leash too hard they would feel pain for several days after. The three friends who had lap mesh all claimed no problems …no pain and had surgeries over ten years ago…this led me in the lap mesh direction…i was also decieved by the minimally invasive nonsense….what i did not know then but do now…is that lap mesh surgery is anything but minimally invasive…its actually maximally invasive under the surface of the skin…requiring large dissections that are done inarftully with chopsticks while the surgeon watches a big screen across the room….oversized plastic beach blankets are then shoved in…in many surgical videos you can see them folding over shortly after insertion….then tacks are fired into the body to hold them in place…its a completely barbaric procedure…assuming these meshes are installed properly patients are not warned about the longterm risks…i was not though my op report says i was….Carvajal told me no risks no pain chance—1 in 5000 had pain he said…imagine my luck…flat out lie.. these meshes can degrade get infected move about and merge into critical organs….you can be fine for years and then the mesh will simply dissolve as has happened to several friends of mine who have had to undergo 6-8 hour surgeries to remove all the pieces… in sum if i had to do this all over again…without knowing what i know now…i may well have made the same mistake….i had possible hernias on both sides of the groin…lap was attractive because both hernias could be addressed at once…i had single incision lap surgery….only one incision in the navel…i thought that would minimize my chance of chronic pain….I did not take a play off here…i was as diligent as watchul and others…i just got lied to and confused and i trusted doctors…something i will never do again…..i hope this message will be helpful to those just starting on this journey….if i ever get another hernia…i would go to kang knowing what i know now…and then i would pray hard….

    • #32800
      Mike M
      Participant

      Grischkan states 20k repairs not 230k repairs. He is used as a legal expert witness so the number of repairs he has completed is most likely part of a court record somewhere. Whether or not he is good or bad? I have no experience outside of my first consultation. My experience with Dr. Grischkan was very positive despite choosing Dr. Kang.

      “mesh destroys tissue over the longterm…especially after the 5 year mark where voeller appears to contend that tissue repairs just fall apart.”

      Why ? Maybe I am missing something but no one against tissue repairs have laid out a clear and concise reason why the repair issue (when done correctly) would just spontaneously “go bad” at X Mark. This ideology lends itself to the thought that other soft tissue components in other parts of your body, not related to hernias, would also randomly go bad and even before the hernia repair tissue?

      The healthy tissue that is compromised causing the hernia is resolved through surgery and unidirectional scar tissue forms with permanent sutures are placed providing a “rebar” effect to further strengthen the newly formed scar tissue. Scar tissue provides about 70% strength as I understand vs. bidirectional non-scar tissue. It is considered completely healed in most cases after 6 months? If you aren’t tissue compromised with another pre-existing medical condition that prevents you from forming healthy scar tissue then I would think after 6 months you are solid? Or at least as solid as any other soft tissue component of your body. Especially if a specific form of abuse you placed on your body (squats, coughing for 3 months, etc) caused the initial damage creating a hernia in the first place and not fathertime.

      Uni directional tissue vs. Bi directional tissue strength start becoming less apparently when you have something like permenent sutures as a bonding structure?

      I think most Hernia doctors (especially those who prefer mesh) do an extremely poor job of explaining why so many no-mesh open tissue repairs are successful over the long term.

      So are mesh repair experts claiming then it is how the mesh is attaching to the body that make it superior? Aside from more surface area to attach ( not always a pro ) how is mesh magically better than scar tissue + permanent sutures? Outside in vs. Inside out approach? I don’t buy it.

    • #32801
      Chuck
      Participant

      Mike sorry…i meant grishkan claims 23k hernia repairs…that is still a clear lie…i talked with someone who did the math and he concluded Grishkan would have had to have been operating since he was 5 years old…read GRishkans other silly testimonials about all those body builders being back in the gym throwing up weights a week after surgery…its all lies…for the record he was a total Ahole to me…when i refused to see him for mesh removal surgery…a surgery he said he could only do partially he hung up the phone on me….saying no one could get all the mesh out…yet another lie. As far as Voeller…he argued that mesh repairs were much more likely to last in the early years and then as time went by the difference became even greater….who the hell knows the recurrance rates quoted by all these liars are all manipulated…just how long are patients being followed??? they never say….Peterson said i have a 2 percent recurrance rate when i questioned how he came up with this rate he just mumbled some nonsense…Grishkan same thing 1 percent recurrance….how they hell does he know Yunis would tell you GRishkans repairs fail all the time. Like i said in retrospect…i should have gone to kang and prayed…kang seems like a decent fellow…but it was so hard to cut through all the lies and marketing to find him

      • #32807
        Mike M
        Participant

        @chuck It is definitely hard to decipher who is telling you the truth. Circling back I think the biggest issue is with doctors pushing mesh exclusively and have limited experience in open tissue non-mesh repairs. It seems like these doctors are closed minded to the success, updated methods, as well as the solid history of successful open tissue non-mesh repairs.

        Innovation and re-thinking hernia repair is what this field needs badly as well as patients willing to try the new methods that do not involve mesh. I like Dr. Kang’s ideology on the state of the current hernia repair options and their shortcomings. This is what I was trying to elude to but was not quite as articulate in conveying in this the thread:

        from Dr. Kang’s website:

        “Direct closure of the hernia hole is not that easy because of the complicated anatomy around hernia holes. So, elaborate surgery is needed. A hernia hole is a gap between tissues that were originally attached to each other. So, even if you suture them together, there will be no tension, as they have been restored to their natural state. Therefore, by directly suturing the hernia holes, we can achieve the goal of using non-mesh and leaving no tension. It’s similar to the two birds and one stone analogy.”

    • #32802
      Watchful
      Participant

      Mike M,

      The issue mentioned typically in this context is tension. Tissue repairs have varying degrees of tension in the repair, while mesh is supposedly tension-free. Tension is believed to cause problems, including an increasing risk of recurrence with time.

      In the world of tissue repair, Desarda seems to have the least amount of tension, and then Shouldice. A good thing about Shouldice is that it distributes the load over a number of layers of repair.

      Kang has the opposite view, and says that tension isn’t actually an issue. I don’t know who is “correct” on this. There are risks and unknowns with all these techniques, and results vary from person to person, and even from side to side in the same person. There aren’t solid answers, which makes decisions very difficult.

      • This reply was modified 3 months, 2 weeks ago by Watchful.
    • #32803
      Chuck
      Participant

      i will be surprised if i am still even on this forum once Dr TWofigh reads my post…i should give her some kudos…she did reach out to me to offer her assistance and was kind to do so…

    • #32805
      Chuck
      Participant

      Watchful…i dont envy you…you have reseaerched this to death…and still seem perplexed about what to do…i sympathize…i dont know what to do even today….kang seems to be the most innovative and experienceed….the germans are experienced but i have read some bad things about them too…i suppose only unhapppy people post…but you get one swing here and if you miss your life is over…i deal with pain daily that might not ever resolve—and i thought i made the best decision i could…all that cutting in the groin seemed to carry lots of risks…lap mesh bypassed all that,…but it still took me out

    • #32806
      Mike M
      Participant

      @Watchful – Tension issue. You’re just closing the area and resolving it to the state it was in prior to the damage occurring. If I cough, pop a hole in my wall forming a direct hernia what’s the big issue? Prior to the “pop” there was already my body’s natural “tension” Right? So the tension free side is stating there is no way to effectively recreate the natural tension in the wall permanently? It’s 2022 and modern medicine can’t restore a body’s natural tension without it breaking? Seriously? The only solution is just to “plug n go “? Embrace and accept the new “expansion” of that area of the body that never existed before and just go ahead fire and forget some new material in the “void”? That seems like lazy medicine to me. Maybe I’m missing something.

    • #32808
      Watchful
      Participant

      Mike M,

      You can’t just close the defect area with stitches and resolve it to the state it was in before. That would just tear open in no time. For example, if you look at the Kang repair for a direct hernia (which is what you had done), you’ll see that it’s a modified Bassini or Shouldice done in a more limited area than the original. It still includes suturing the conjoint tendon to the inguinal ligament, etc. Not sure why he mentioned something about just closing the hole in the quote you provided – it’s more elaborate than that.

      • This reply was modified 3 months, 2 weeks ago by Watchful.
    • #32811
      Watchful
      Participant

      Chuck,

      It sounds like you still have pain after the removal – sorry to hear that. Did any of your symptoms resolve or improve?

      I have decided what to do in my case, which is Shouldice. I haven’t decided where to do it yet. Going to the Shouldice Hospital would be the natural choice, but I don’t like some aspects there such as the cutting of the cremaster and nerve, the size of the incision, and the requirement to be hospitalized for a few days.

      As I mentioned before, I’m far from enamored with the Shouldice technique, but there aren’t many options. If you don’t want mesh, you’re left with just Shouldice, Desarda, and Kang. I think these are all reasonable choices, each with its own uncertainties and potential issues.

      • This reply was modified 3 months, 2 weeks ago by Watchful.
    • #32813
      Chuck
      Participant

      Watchful thx so much. Admire and respect your research fanaticism. I was exactly where you were. But without the knowledge of the effectiveness of tissue repairs. Even the great Dr B who I respect a lot says mesh is safe and way more effective than tissue repair. Before your great research and the constant discussion here I became convinced that tissue repair was destined to fail and might cause chronic pain due to all the cutting and tension. Doctors told me I would be back and have to do mesh anyway. Fix it right the first time they said. I was at a loss. Now I am screwed. Pain in both inguinal canals. Difficult to know if it will resolve or if the hernias are back. I feel suicidal. Despite what you will read it seems like most people do best with open mesh. Sure you get a hematoma maybe d as one dead spots but Boston hernia claims their chronic pain rate is .003 percent with hardly any recurrance. The mesh is placed differently than it is in most open mesh cases. The fact that mesh is used so much I think shows there must be some merit in it. I don’t think it’s all due to ease of repair. My problem is now what to do. I have few options. Assuming my hernias have returned kang May be the only one who will fix them. It’s such a mess. I hope it works out for you. All my research was in vain.

    • #32816
      William Bryant
      Participant

      Chuck, I think it’s a case of when mesh works it works really well as in my ex partner’s brother’s case. He had mesh recently. No pain from moment he came round till now. And still no pain.
      Of course whether that’s the case in one year, five remains to be seen but I know of someone else who had mesh no issue. Bit then I know others who have had nothing but trouble.

      I hope the pain subsides for you. It may once the mesh removal surgery settles down.

    • #32817
      William Bryant
      Participant

      Watchful:-

      What’s made you choose Shouldice over Dr Kang.

      I’m strongly favouring Dr Kang myself and would be very interested in your view.

      • #32821
        Good intentions
        Participant

        Forum software placed reply under wrong post… Posting below instead.

    • #32818
      Watchful
      Participant

      Chuck,

      Your research on the techniques was correct. Chronic pain is an issue with tissue repair, not just mesh. However, surgeons who told you that tissue repair is not effective were misleading you. No one who is truly knowledgeable about tissue repair (and honest) would say that.

      I decided to go with tissue repair mainly because I think that when mesh goes bad you’re likely to be in a worse situation than when tissue repair goes bad. Most inguinal hernia surgeries turn out quite well regardless of the use of mesh or tissue repair. If I end up being one of the unlucky ones, I prefer to deal with the consequences of tissue repair rather than mesh. Maybe there isn’t much basis for this, but this is how I feel after much research and talking to many surgeons.

      How well did you vet the surgeon who did your lap mesh? I think you didn’t go to one of the well-known ones. I don’t know if he did anything wrong or not, just curious why you made that particular choice.

      I hope your pain improves with time, and that you don’t get a recurrence, and don’t need any more surgeries.

    • #32819
      Watchful
      Participant

      William,

      I have an indirect hernia, and I’m concerned about getting a recurrence with the technique he uses for that. There isn’t enough data about it. He has been performing his current version of it for less than two years, and had 50 versions of it before. It may be fine, but it feels too much like being a guinea pig, and I prefer to go with a more established procedure. Also, I really wish he documented his technique.

      For those who are more willing to take the risk of something different, I think it’s perfectly reasonable since the established approaches certainly have their issues. If I didn’t fear recurrence so much with his technique, I would go for it.

    • #32820
      Mike M
      Participant

      @Watchful I jumped around a bit on the discussion and over simplified. The point I was trying to make is Dr. Kang’s ideology is the tension from the hernia repair is not the primary issue but instead the failure to directly close the hernia hole itself. This was apparently common place with a lot of older non-mesh tissue repair methods.

    • #32823
      Good intentions
      Participant

      From #32816, William Bryant –

      “Chuck, I think it’s a case of when mesh works it works really well as in my ex partner’s brother’s case. He had mesh recently.”

      No offense intended William Bryant, but you’ve fallen in to the all-and-any-mesh is “mesh” trap. Again, no offense, but your statement is essentially worthless for making a decision, without the details. “Mesh” does not actually mean much in the chaos of today’s hernia repair field. Even the surgeons give up and talk about “mesh” without defining what they mean.

      Type of mesh, size of mesh, type of implantation method, type of hernia, intended usage/activity by the patient, etc., all of these things should be considered in order to make an informed decision, and to correlate results to expectations. And even to improve mesh devices.

      The mesh making companies love the confusion, it gives them excellent cover for liability and continued production of their specific products. The more confusion the better for the mesh making companies.

      That’s one reason to focus on the surgeon. A good surgeon will keep track of their patients and the success of their work. Most surgeons today just go to work and do what they’ve been taught, satisfied with “haven’t heard anything bad” as a measure of success, or not satisfied but not allowed to seek out the results of what they’ve been taught.

    • #32825
      William Bryant
      Participant

      Yes Good Intentions I accept that but by the same token that means not all mesh is bad which is the point really. Id favour the register that was talked about as that would establish which make/type of mesh and which method worked best and which didn’t. That said I’d still like a reversal where mesh was used only as a last resort and tissue repair was first choice, the gold standard etc.

    • #32826
      Chuck
      Participant

      Watcthful…I chose Dr Carvajal after watching a TV special on him and the SILS technique…then i interviewed him and he claimed to be one of the busiest hernia surgeons in the country with over 5000 lap mesh surgeries performed….in retrospect this was just a flat out lie….i never trusted doctors…but I never suspected they would flat out lie…and the special i had seen on him had taken place 7 years before…he was approaching 60 with 32 years of practice…but he was a general lap surgeon…i read that proficiency in lap takes place after 250 surgeries…so i thought i was covered…in addition he wasnt doing any cutting…just going throught the naval…he said virtually no pain ,,,no scarring back to work in 2 days….and he could fix both of my hernias in one procedure….after being told about all the horrors of tissue repairs…long healing times…continued issues with pain on exertion years later….Voellers flat out lies about tissue repairs being way more likely to fail long term…and then the experience of three friends who had lap for over 10 years without any issues…i thought i was making the right decision. These friends were active cyclists and weight lifters…they claimed no pain of any kind on exertion. I would encourage you to talk with some folks who have had shouldice desarda etc….everyone i talked to said they continued to feel the hernia years later….with activity…like lifting weights walking dogs holding kids etc….this really spooked me…especially when reading Voellers moronic debate with Bendavid where he kept saying weak tissues are sewn to weak tissues inviting future issues….Todd harris made the same point saying tissue repair showed a 20 percent failure rate in one year….plus all my local docs made it sound like i would be back in year or two for surgery with mesh that would last. Have you spoken to any patients about their longterm results with shouldice desarda etc….maybe i just got some bumraps….but they were sincere….i didnt want to be sore the next day after walking my dog or lifting a few weights…maybe you have to accept that to avoid putting plastic crap inside you…..i suppose once you get a hernia your former life is over and you become a delicate porcelain doll…its sad..had i known how problematic hernias were i never would have gotten one..The other thing that threw me was all the BS about hernia surgery being a small thing…routine outpatient…in retrospect its anything but…it can end you life like it might end mine if i cant arrest the pain. You really do have to travel the world to go to the best surgeon…i wasnt afraid to do this…i went to Cali to see that criminal carvajal…and people laughed at me. I still think you should consider Kang….his recurrance numbers are the best there are…he may be changing his procedure…but he is improving it based on observations and he has a light touch…the shouldice procedure is a sledgehammer…and those studies showing 26 percent chronic pain spooked me….its sad…i still dont know what to do even now but i would go to kang and pray hard

    • #32827
      Chuck
      Participant

      The other thing about the shouldice repair that spooked me…was the amount of suturing…some calculated that the prolene sutures uses amounted to about the same amount of plastic as a piece of mesh…Bruce Rosenberg also told me the repair will feel tight for several years like towfigh said…he also said the new shouldice clinic is just not the same as the old one…they are value engineering it with more trainees…sending out for the stainless steel sutures instead of making them. It started to make me lean towards desarda until thunderrose and towfigh weigned in to say it damaged uninjured tissue and manipulated it in a creepy way….i should have followed up with her to ask her about her four layer sushi roll…I think the happiest people are the people that just go to the first doc recommended and have mesh shoved in open…it seems like the vast majority of those repairs are seemless and lasting….though you almost certainly will get a hematoma…and a few dead spots….Appreciate all your guidance watchful and keep posting your opinions if they change on this stuff…I had a direct that feels like its coming back…maybe thats just mesh removal pain…really hard to know….all i know is that this surgery has been a complete nightmare…and ruined years of my life…and may still end it permanently…those fools who told me it was routine…i feel like punching them

      • #32847
        MarkT
        Participant

        Shouldice Hospital uses stainless steel, not Prolene. Some people don’t like the idea of stainless steel for whatever reason, so they elect to get a Shouldice repair done elsewhere.

        AFAIK, Shouldice has sourced their stainless steel from the same supplier for a very long time. When Dr. Sbayi left Shoudlice after about a year and a half and setup in NY, he chose to source the same stainless from the same supplier (he talks about it in the HerniaTalk vid).

        The four-layer repair is the ‘standard’ Shouldice method…it is strong and meant to reduce the likelihood of recurrence. Others surgeons may offer a two- or three-layer ‘modified’ repair. I believe ThunderRose had a two-layer repair using Prolene done by Dr. Yunis and is happy with the result.

        As for all the talk of ‘tension’, I had no ‘tightness for several years’ with either my left or right side repairs that were done many years apart.

    • #32831
      drkang
      Participant

      I think some people are curious about the long-term result of Kang repair, so I recently reviewed the data after 2012. Since 2012, when I started the non-mesh repair, I have been managing detailed data of all surgical patients with Excel. Of course, the recurrence is also recorded.
      During that time, there were about 50 changes in the surgical method of indirect hernia. And the main purpose of managing this data was to improve the surgical method because evidence such as the recurrence rate of each version was needed. For this, it is sufficient to check the relative difference between each method, so we did not conduct thorough management such as an patient interview to know the exact recurrence rate, but based on the case of a revisit.
      However, patients who come to our hospital have a clear preference for non-mesh repair, and since Korea is within 5-6 hours from anywhere in the country, I think that most of the relapsed patients would visit again. Therefore, it is thought that there is no significant difference in the actual recurrence rate.
      Nevertheless, research for future thesis submission will be conducted through a very thorough follow-up.

      As mentioned above, although the recurrence rate is not very accurate, out of 9,822 indirect hernia repairs performed from 2012 to November 2019, 157 (1.6%) patients had revisited with recurrence. The follow-up period was 3 to 10 years.
      From December 2019 to last month, only one out of 1,753 indirect hernia repairs operated with the current version was revisited for recurrence. It is true that additional observation is necessary because a 1 to 34 months follow-up is not enough.

      In the case of Kang repair for indirect inguinal hernia, I think actual tension rarely occurs. This is because the conjoined muscle and the inguinal ligament are separated from each other forward and backward, not laterally. In the case of a direct hernia, the width of the muscle defect rarely exceeds 1 cm at most. Therefore, when Kang repair for a direct hernia is performed, some tension is generated, but it seems not to exceed an acceptable level.

      It is true that almost all doctors point to tension as the cause of the very high recurrence rate of past tissue repair. Based on this recognition, mesh repair appeared, and Desarda repair is also developed under this recognition.
      If so, why does a considerable number of recurrences occur even after tension-free mesh repair or desarda repair?
      For reference, a study that analyzed more than 500,000 hernia surgery patients published in the United States in 2018 found that 13% of them had surgery for a recurrent hernia. (Murphy BL, Ubl DS, Zhang J, Habermann EB, Farley DR, Paley K. Trends of inguinal hernia repairs performed for recurrence in the United States. Surgery. 2018 Feb;163(2):343-350.)
      Considering that most of the hernia surgeries are using meshes these days, the recurrence rate of mesh hernia repairs probably exceeds at least 10%.
      Perhaps the cause of these high recurrences of mesh repairs is to claim a technical error. Then, shouldn’t the technical error be pointed out instead of tension as the cause of the high recurrence rate of past tissue repair?
      I believe that the high recurrence rate of past tissue repair is very likely due to failure to perform the type-specific repair. The exact meaning of my past remarks when I said that non-direct repair was the cause of recurrence also meant that not performing type-specific repair was the cause of the high recurrence rate.

    • #32832
      Watchful
      Participant

      Chuck,

      Thanks for your advice based on your research. Where did you find people who had a Shouldice procedure done? It’s extremely hard to find anyone to ask about their experience. There are evidently some good results. For example, MarkT on this forum had both sides done at the Shouldice Hospital, and he claims that he has no issues or abnormal sensations whatsoever on either side.

      I think some minor discomfort or pain during some activities isn’t rare with both mesh and tissue repair. I remember Dr. Felix mentioning in one of his talks that he has some discomfort, and he had lap mesh done bilaterally by Dr. Chen after his old tissue repairs recurred. He said you just need to be a man about it, and live with it. It’s unfortunate, but I think it’s pretty much the norm with these surgeries. Your groin isn’t likely to feel 100% normal after you go under the knife. Maybe it’s worse with Shouldice, but how can you tell?

      The Thunder Rose criticism of Desarda never made sense to me. I don’t know why she would find the Shouldice Picasso job to be less jarring than the Desarda style of Picasso. Healthy tissue is cut in both, and unnatural stitching of tissues is done in both.

      Regarding open mesh. My understanding is that this surgery actually has a higher incidence of mesh-related issues and chronic pain than lap mesh. Also, some surgeons regularly cut the ilioinguinal nerve when performing this surgery.

      If you have more information about Shouldice-related issues, please share. One thing that surprises me is that there aren’t more reviews for the Shouldice Hospital since they’ve been doing 7,000 a year for many decades now. Most of the reviews they do have don’t say much about the recovery and the long-term effects. Instead, they talk about the food, the grounds, and other peripheral things. Very strange.

    • #32833
      Watchful
      Participant

      Dr. Kang,

      The recurrence numbers that you report are extremely good. Thanks for posting this information.

      The numbers look even more impressive when taking into account that you don’t reject overweight patients. The Shouldice Hospital and many surgeons will not perform the Shouldice procedure on patients who are overweight or obese. They claim that the recurrence rate is too high with those patients. The Shouldice procedure is quite solid in repairing both the direct and indirect areas. Any thoughts on why your procedures work well even on overweight people, while Shouldice doesn’t?

      • This reply was modified 3 months, 2 weeks ago by Watchful.
    • #32835
      drkang
      Participant

      Since 2012, there has been only one patient with acute leukemia for whom I have refused surgery. The reason was the fear of infection after surgery.
      To be honest, Koreans have relatively few obesity problems compared to Westerners.
      But I would like to point out that Shouldice performs mesh repair on some high risk patients.
      Unfortunately, their policy is to admit that mesh repair is more robust than their tissue repair. But I do not agree with this at all.
      So, I have always performed only tissue repair for all patients since 2012.

      If there might be a shortcoming in Shouldice repair, it might be the successive repair of both the direct and indirect areas in all patients. The deep inguinal ring through which the indirect hernia sac emerges is located between the conjoined arch and the spermatic cord. However, Shouldice repairs the area below the spermatic cord for the indirect hernia. I don’t think it is the proper area to be fixed.
      In addition, too many stitches might be applied due to the 3-layer repair in Shouldice technique. Too many stitches can lead to tissue necrosis and subsequent suture line rupture because blood circulation is possibly disturbed. Not enough is a problem, but too much can be even more problematic.

    • #32836
      Watchful
      Participant

      Their requirement is a BMI of 25 or under, so they reject anyone who is overweight, not just obese. The rare cases where they use mesh are those with bad quality tissue, which means tissue that’s too weak to be held together and resist a hernia with stitches. German surgeons do the same thing – mesh instead of Shouldice when they feel the tissue is too weak.

      • This reply was modified 3 months, 2 weeks ago by Watchful.
    • #32838
      ajm222
      Participant

      I believe Dr. Belyanksy and some others do a two-layer modified Shouldice. I wonder if that’s better for the reasons you mentioned (except for the location issue). Also wondering if prolene sutures are truly best or if PDS sutures are normally sufficient. I assume both could potentially have their own problems but are usually well tolerated, even by folks who have had mesh issues.

      I am likely going to need another surgery soon post-removal due to a bulge where some fat is protruding, and I was told it might not need to be a ‘full’ hernia repair where the inguinal canal is opened up, but instead essentially just tightening a space where fat is emerging. I don’t really understand still the distinction where one thing needs to be done versus the other. I wonder what the nature of the defect is when a ‘full’ hernia repair is needed, versus the nature of the defect when just a few stitches are needed to strengthen the area. all so confusing, even after all these years.

    • #32839
      Chuck
      Participant

      Dr. Kang…thanks so much for weighing in….I recently had double inguinal removal of Bard 3d Max……about 8 weeks ago now…some pain issues appear to be resolving…but it also feels like my direct hernia is coming back. Dr Belyansky said he did not see any hernias and he said the indirect hernia would likely not return…All I know is i am through with dealing with Dishonest bragging US surgeons who criticize each other. I believe you to be not only the best hernia surgeon in the world…but also the kindest and most humble. I have had mixed results with ultra sound for hernia detection. Would your crack team be able to diagnose a recurrant hernia with certainty? Its sad that you are so far away…but given my past experience…flying to see you simply for a consult would be worth it in my view. Do you foresee any difficulty in repairing hernias recurring after 3D bard max removal???? Again thanks so much.

      Watchful – Sadly i did not use this forum as much as i should have pre surgery…i was mostly on the facebook forums…natural hernia cure…other hernia forums…i even posted on the complications sites…another reason i got suckered into lap surgery is those sites were mostly filled with women who didnt have the same mesh i was getting …and they were only several thousand strong…I thought if millions of surgeries were performed each year…the rooms would be much larger…I just really screwed up…and it makes me sad so much research still led me to the wrong decision. But talking to FB folks is where i got the info….a woman who had desarda told me she was fine with ordinary activity…but anything strenuous even walking a dog brought pain on….several weightlifters claimed hernia pain from shouldice repairs after working out….years after the repairs…I know you think tissue repairs that go wrong are easier to fix then mesh,,,but i am not sure that is true…there is so much cutting with tissue…if nerves get hit and damaged you might feel it for life….and what do you do with all the suturing material from a four layer shouldice if it goes bad….hernia surgery in general is such a cluster. Kids in school should be taught about the dangers of hernias…they are a nightmare…

    • #32848
      drkang
      Participant

      @Watchful,
      A BMI under 25 seems too strict.
      I’ve just noticed my BMI is 26.1. I never thought I’d be rejected by Shouldice.
      I haven’t paid attention before, but I think at least 10-20% of my patients probably crossed this threshold.
      I wonder if these very strict requirement are for patients or to manage their own statistics.

      Some patients have exceptionally weak tissues, but I hardly ever felt that a mesh was absolutely necessary for them.


      @ajm222
      ,
      I have the same question as you. Furthermore, I cannot understand why the healthy floor of a Hesselbach triangle has to be opened and sutured again during surgery for indirect hernia, where the deep inguinal ring is enlarged. I am sure that the results of Kang repair have proven that this process is not necessary at all.

      @Chuck,
      Thank you for your unwavering trust in Kang repair.
      Ultrasonography can accurately identify recurrent hernia. However, I don’t think there is any need to worry in advance if there is no bulging. If you do feel bulging, though I hope you don’t, then you go and have an ultrasound at that time. In case of recurrence, even if after removing the 3D bard max, there will be little difficulty in performing Kang repair.

    • #32849
      ajm222
      Participant

      fascinating that you have the same question. i guess it’s nice then that Dr. Belyansky suggested that a more minor procedure to strengthen the area would likely be sufficient. makes me wonder why this wasn’t a surgical option when i first started consulting with surgeons prior to getting the mesh. i think the same issue may have been responsible for my initial problems, and a more simple tissue repair may have been all that was needed in the first place. and now i’ve been through two surgeries and likely looking at another. perhaps they all still think mesh is great and might as well totally cover the whole area with plastic so that it’ll hopefully forever be repaired (while ignoring all the dangers).

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