Koch Conze or Lorenz

[JHawley]

So I have narrowed my choice of surgeons down to three Koch Conze and Lorenz, Consulted with Koch -waiting on Lorenz and Conze. So who is the best of the three. By physician reputation and recommendation -the winner would by Koch. Every no mesh surgeon I have mentioned has mentioned Dr Koch. He can do all the repairs mesh no mesh desarda shouldice. He is a great guy. Free consults which he says he enjoys doing — Honest and caring–he invited his patients to a party he had. Downside is he only uses GA which he says is for the benefit of the patient –a benefit I don’t clearly see. He also did Dr. Lorenz’s shouldice repair. So one of the pre-eminent hernia surgeons selected him –this gives a lot of credibility. He gets lots of good reviews and i have spoken personally to his patients who said their operations were seemless–recovered in two weeks. When I asked Koch who he would go to –he said Lorenz weise muschawek in that order. I asked about conze he didnt answer. Grishkan also did not respond when i asked about Conze. So not sure what is up with that. Lorenz also mention by multiple surgeons –loved his interview with Towfigh –seems like a good guy knows all the repairs. Conze — lots of good reviews…and charges a ton – there must be a reason he can get it. But no other doctors mention him…and they dont comment when asked directly –whats up with that? WAtchful likes conze — and he is the pre-eminent authority on the forum doing more research than anyone. So Jack 2021 Bryant, David M —are any or you leaning to one of these guys and if so why?

[Watchful]

I’m a traditionalist. I prefer it when surgeons stick quite faithfully to the original technique. I’m not a fan of being a guinea pig for creative modifications, combo techniques, etc. This is one of the things I like about Conze and Lorenz. With Koch, I wouldn’t know what I was going to get – absorbable sutures? Combo with mesh? Combo with Desarda?

Tailoring is very important, but I like it only when the surgeon picks among established techniques for inguinal hernias, not when they improvise.

By the way, how do you know that Koch operated on Lorenz?

[Oceanic]

Koch was reported to have engaged in insurance fraud which is what put me right off him personally.

[JHawley]

Thanks for the input. This helps me to cross Koch off the list. Still wondering what the difference is between Conze and Lorenz. Oceanic -can you say why you picked Conze over Lorenz? He does get a lot of favorable reviews and I like the fact that he quotes very low levels of chronic pain. I know he charges more than anyone – I actually think its a positive -because there must be a reason he can get it. As far as i know he preserves the nerves and the cremaster. He uses local anesthesia –he also seems like a nice guy – he called a friend of mine after hours and talked to him for free. The only thing that troubles me about him is that he is not mentioned by other surgeons as someone they would go to. Koch named every other surgeon in Germany but left him off the list. Grishkan same. Tomas had never heard of him. Neither had Peterson. Presumably these guys are going to conferences and they know important colleagues. Lorenz on the other hand was named by everyone –interviewed by Towfigh–so he seems to have the higher profile. Also like that he had his own hernia and went shouldice over desarda. I read on another board he is good friends with Koch and Koch did his shouldice. I asked koch about it…he said nothing but laughed in a way that made it seem I was right about my guess. Watchful David M or Jack 2021 Bryant—would love your opinion on who you would choose of these two. Mark H mentions analysis paralysis..and I am right there. I think Mark is making a mistake with Kang. And I cant really lock on to why he selected him –but i guess he was looking for a less damaging repair. With only a four year track record…and plenty of chronic pain…assembly line surgery…67 years old…a recurrance on this page and a few patients still in pain from kang surgery —I am just not seeing the upsides…especially since well respected surgeons are questioning his technique. Its clearly down to conze and lorenz. Your opinions and my upcoming consults will hopefully seal the deal.

[Jack2021]

I answered this in your ‘Seeking Advice’ thread Chuck, so please refer to that for my response.

[Watchful]

Either one would be fine. Conze spends more time, and will be a higher end experience. Regardless of who you pick, have a discussion about what they do vs any trainee that they may have. Both train, and Lorenz has a particularly strong interest in that.

Note that there’s a pretty high likelihood that all or most of these surgeons will retire by the time you recur, and actually need surgery (if that even happens at all). At this point, why not just wait and see who is out there if and when you actually need them? It won’t be urgent, and you’ll still have time to decide.

[JHawley]

Thanks Watchful I am pretty screwed. I cant get past the removal pain. But every surgeon i talked too says watchful waiting is not good. Fix it soon – much easier. I should have done that. So trying to be prepared. I waited and then covid hit. Selecting lap was such a disaster. It seemed like the lowest risk of chronic pain. All the studies said so. All the doctors said so. But there is a huge financial incentive to push lap surgery –ten x the cost of open. But when doctors are telling you they had a lot of chronic pain patients from shouldice – what would you do? Two years of studying this and still no clear answers.

[Watchful]

That’s how it is with surgery – it’s a crapshoot. There are no clear answers with most other surgeries either – not just hernia. Like I said before, if you think hernia surgery is bad, check out the spine surgery groups on Facebook.

What is your removal pain like and where and when do you feel it?

[William Bryant]

Koch used mesh when Baris wanted a tissue repair. I believe Baris said the Shouldice clinic were of the opinion mesh wasn’t needed for that repair and couldn’t understand why Koch had used it.

[David M]

Oceanic, can you (or anyone else) provide any detail on the supposed insurance fraud of Dr Koch? I’d rather understand it before rejecting based on a nebulous allegation.

[Good intentions]

I agree. That is a pretty serious claim to just throw on to a public internet forum with no source. Easy to get misled by somebody else’s internet memory.

[Good intentions]

I think I found it. It’s in the Baris story.

No-mesh Shouldice Hernia Surgery in Germany / Europe

Post #19478

“…
On the second surgery I was told to take out a european health insurance card by dr koch. When i got there he told he will admit me as an emergency so they wont charge me and he wont incur costs. We had to act as if i had a strangulated hernia.
…”

[Good intentions]

I had a thought about the accusation of fraud, above. All medical systems tend to be huge bureaucracies. While what Baris described seems unusual it looks like the effect was to get Baris in to surgery earlier than expected and to reduce costs for both Dr. and patient. Without the details it’s hard to know what the real purpose was, or even if Baris recalls what happened correctly.

Just something to consider. It might be that whatever condition Baris had was not well-described by the bureaucracy. Or, of course, it could be that Dr. Koch would have to take the cost as a “failed procedure” or something like that.

Hard to tell if Dr. Koch gave these instructions for Baris’s benefit or his own.

[William Bryant]

If I recall correctly it was Baris who wanted further surgery quickly, which is understandable, but not something surgeons recommend so maybe you’re right that’s why Dr Koch came up with the incarcerated plan. Baris though thought Dr Koch did it all for extra money.

Why he used mesh is the mystery in Shouldice clinic view.

[Mike M]

I am the opposite of Watchful. I believe in modifying the wheel to the point of diminishing returns. Keep researching and developing the best way possible to gradually improve on the previous technique and method.

Do this process in the safest and most ethical way using all the knowledge, research, and technology at our disposal that wasn’t available when the original methods were developed.

Some will say Mesh is it. Others will say robotic X is it. Others will say modified bassini, modified shouldice, Desarda?

I agree with the methodologies and approaches of Dr. Kang, his integrity as a doctor, his reputation, and his continued success in the field. Once he retires I hope someone continues to identify and improve his method to the point where we reach diminishing returns with our current knowledgebase and technology.

All of us agree the current methods can be improved, will be improved, and should continued to be improved.

[Author]

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