Marcy Repair

[KC]

Dear Watchful
I have no data camparing both method. I only suggest that my modification can be at least equal to Marcy operation theoretically.
There are reports concluding High recurrence rate with Marcy operaion.
I hope some surgeon get to be interested in this idea when they try tissue repair.

[Watchful]

Let’s hear from KC, but I think I understand what he’s doing. Instead of closing the defect on one plane with a simple stitch, he uses some kind of a transverse stitch which makes the closure multi-plane – it has depth which makes it more solid.

[pinto]

Watchful, you ask excellent questions. Thanks to both you and KC.

[Watchful]

KC,

Thanks for giving us some idea of the difference in the technique. Sounds like stitching vertically instead of horizontally. Is that correct? Why would this improve the outcomes?

[Watchful]

Bills44,

The lack of long-term data is a concern, but it doesn’t mean that the technique doesn’t work. It just means that we can’t tell yet.

[KC]

Imagin that you are infront of shutter door, which is open half. How will you close the shutter door. Will you close the shutter door approximating two lateral pillars or drawing down the shutter? Marcy operation is closing the shutter approximating two lateral pillars, and my modification is drawing down the shutter.

[Watchful]

Thanks for posting here, KC. Would you be able to explain why your modified Marcy works in adult males and in large hernias, while the original doesn’t?

[KC]

dear William Bryant, I am practicing at the Ewha womans univsersity hospital and a surgeon practicing kidney transplatation and also adult hernia. if you have read my article, you will know that I repair the posterior wall of Pantaloon hernia with Shouldice operation in classic two layer method. if you tightly occlude the deep inguinal ring I think that two layer Shouldice repair is enough

[William Bryant]

Hello KC, please tell us more about yourself and if you are a surgeon where you practice.

The modified Marcy seems to be gaining ground as an option which is good as it seems less invasive. However I noticed in the linkec article it mentions pantaloon hernias, how were the direct hernias repaired in this scenarios?

Many thanks

[KC]

I am the author of above mentioned journal “Novel modification of Marcy operation for indirect inguinal hernia reconstituting deep inguinal ring shutter action”
My modification is applied to all cases of adult indirect inguinal hernia no matter how large is the deep inguinal ring. and actually it’s detail is much different from old Marcy operation.
any question I appreciate, I would like to answer in detail about my practice.

[Watchful]

There’s also a study from Japan cited here before that shows that a Marcy-type repair worked well for adult male indirect hernias. It’s not clear why it’s inappropriate if there’s all this experience with it working well (Kang, Brown, and these studies).

Dr. Kang has reported great success with it on the whole gamut of adult male indirect hernias. He doesn’t cherry pick his cases other than that they’re mostly Korean. There’s the theoretical concern about recurrence, but it looks like in practice this hasn’t been shown to be a problem, so the basis for the objection isn’t clear.

[drtowfigh]

The Marcy repair is a great option for children and women with very small inguinal hernias. It’s an old technique that has been around for over 50 years. I use it in specifically those situations. It is not appropriate for direct inguinal hernias or in most male hernias.

I believe Dr Kang’s repair for indirect inguinal hernias is a modified Marcy repair as well.

[bobbyj900]

@drkang
Hello Dr. Kang,
What do you think about this study?
Novel modification of Marcy operation for indirect inguinal hernia reconstituting deep inguinal ring shutter action

https://pubmed.ncbi.nlm.nih.gov/36129572/

Thank you.