Kudos to Stephen Kwon/Dr Kang
12/07/2022 at 8:47 am #33166
The more I study the options here the more I don’t understand why everyone with a hernia isnt traveling to see Dr. Kang and his most able assistant Stephen Kwon…as most of you know i was destroyed by mesh surgery…the very able Dr. Belyanksy has given me another shot at life with his excellent mesh removal surgery…but now it appears my direct hernia is back and so i once again need surgery. I have been reaching out to Stephen Kwon for info about a potential surgery…Stephen replies within hours…giving complete and helpful responses…contrast this with the Shouldice clinic where you fly completely blind…who will operate on me? who knows….how will they do it …find out when you get there i guess? Every US surgeon i see is clueless about whether my direct hernia has returned…because i have no bulge they say i have no hernia…and they refuse to do an ultrasound—so i am left to live with obvious hernia pain. Stephen is a simple chaplain…but his answers have been more comprehensive then three doctors i have visited. He advises that a direct hernia can occur without a bulge and that Dr Kang can diagnose it with ultrasound and simple experience. Not endless MRIs and toxic CT scans Its sad that my only real option is to fly 20 plus hours to get competent hernia care. But Dr Kangs operation is first class…from everything i can see. Since i just had removal in september i think its prudent to wait a few more months…but this spring i am going to head to korea for vacation and hopefully an end of this hernia nightmare….
12/07/2022 at 9:48 am #33167MarkTParticipant
What you need is a proper diagnosis and MRI is likely the best tool for that.
With the caveat that your case may be different because you have had mesh removal, MRI is the more reliable imaging method for detecting non-palpable ‘hidden’ hernias:
“Magnetic resonance imaging is by far the most sensitive, specific, and reliable modality to diagnose inguinal hernias. This compares with the very low performance of CT. Ultrasonography historically has been the first line of approach for evaluation of inguinal hernias. Our data show that US may be a good first-line diagnostic tool for patients with typical physical examination findings of inguinal hernias, but it is of poor reliability for evaluating any patient with a possible occult hernia.
Based on our results, we recommend that patients with clinical suspicion of inguinal hernia, without typical physical examination findings, undergo MRI…Certainly, if clinical suspicion exists in light of negative US and/or CT scan results, MRI should be pursued because other modalities are not reliable in the evaluation of hidden hernias”.
Further, imaging reports of any kind may miss ‘hidden’ hernias when they are not read by a radiologist (or hernia specialist) who really knows what they are looking for:
If I were in your shoes, I would get MRI done and I would ensure the results are read by (or sent to) someone who is better positioned to properly interpret them.
Dr. Towfigh has repeatedly mentioned that she is happy to have MRI sent to her for review (she was involved in both of the studies posted above – she has specific knowledge and experience in this area).
Another benefit of MRI is that it may yield more insight if you don’t have a hernia and the symptoms are stemming from some other problem.
12/07/2022 at 11:39 am #33171Good intentionsParticipant
At 19:08 in his video Dr. Krpata talks about dynamic ultrasound. Says it’s not available everywhere but it’s what he uses to diagnose recurrences. His center is all about chronic pain. Might be worth a visit.
12/07/2022 at 12:01 pm #33174
thanks guys…very helpful. most posters here know more than doctors. its pathetic. Maybe the great Dr Kang will chime in. Stephen said he has never known Dr. Kang to need an ultra sound to diagnose a hernia.
12/07/2022 at 1:56 pm #33179MarkTParticipant
I think the same holds true for MRI…if you can get dynamic done, that is the way to go. Unfortunately, as GI mentioned for US not everywhere will offer dynamic with MRI either.
I copied this from an old post by Dr. Towfigh:
MRI Protocol for Hernia for non-contrast dynamic MRI pelvis for imaging of occult inguinal hernias:
1. For all of our groin pain MR studies, we have the patient place a fiducial marker on the site of the pain.
2. We prefer 3Tesla MRIs, though 1.5T is acceptable. Open MRIs are not acceptable, as they lose resolution for the pelvis.
3. The following are then acquired:
– Axial, sagittal, and coronal T2 HASTE with breath hold.
– Axial, sagittal, and coronal T2 HASTE with valsalva.
– Single-slice saggital plane dynamic valsalva acquisitions- typically about 5 individual acquisitions, both through and on either side of the fiducial marker.
– Axial T1 gradient echo.
– Axial T2 fat sat (either fast-spin echo or STIR depending on the machine).
Note that some call it a sports hernia protocol, but it is a bit different (most sport hernia protocols don’t do valsalva components).
No reason to use any contrast with MRI (usually oral contrast for CT, can help show bowel and hernia…or IV for inflammation issues).
Important to do dynamic…yes, it is more labour-intensive, can take 45 min. or more to get everything, but the video aspect is key to showing small hernias.
12/07/2022 at 6:36 pm #33189
12/08/2022 at 6:28 pm #33204
12/09/2022 at 9:02 am #33209
Dr B is prob the best removal guy in the world…but he is not a tissue guy…in my opinion Dr kang is the best. Stephen got back to me and said kang rarely needs mri or ct scan….he has seen so much he knows best i think
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