Mesh removal and the legendary Dr Kang
04/24/2022 at 9:14 pm #31491
Folks you know i have been a huge fan of dr kang for awhile now…ever since my own botched lap tep mesh surgery…reading his words is really like reading the Bible when it comes to hernia surgery…everything he says makes perfect sense. And he backs it up with perfect surgical reviews every time. He humbled me recently with a direct reply to a question about mesh removal…generously offering to remove my mesh…the problem is my mesh was installed laproscopically…and i have heard …though this never made a ton of sense to me that lap installed mesh must be removed either lap or robotically…to remove it otherwise would leave an enormous scar and some significant tissue trauma….i always wondered wny open removal was so dangerous…given that getting blasted by a robot for three hours wont be a walk in the park….is this removal must follow installation stuff a real thing…or is it urban legend…i know peterson removes lap installed mesh openly….but he has wrecked many lives with his techniques…from word on this forum and elsewhere….
04/24/2022 at 9:22 pm #31492
for the record i have two large blankets of Bard 3d max mesh…6 x 4 inches each…why i ever agreed to have this junk implanted i will never know…its apparently standard to plant huge pieces of mesh to prevent other recurrant hernias…if any doctors in our country had the brain of Dr Kang this would never be needed….
04/25/2022 at 10:52 pm #31495roger555Participant
I think a doctor needs not only the brain but also the heart of Dr Kang. I think what makes Dr Kang so successful is that he cared enough about the patient well being after surgery which led him to come up with tailored procedures that minimize or almost eliminate recurrence and pain after surgery. Sadly, many doctors today have more greed than heart for their patients. Same for the mesh manufacturers and hospitals.
04/27/2022 at 12:53 am #31496
I happened to visit today and found out that herniatalk is reconnecting.
Chuck, thanks for your compliment. I don’t deserve that anyway.
I have removed about 100 meshes in the meantime, all of them are open meshes.
Unfortunately, there is no hospital in Korea that provide the laparoscopic mesh removal. So, several months ago, I began to perform open removal of the laparoscopic mesh to five patients so far.
Under general anesthesia, about 3 inches transverse skin incision is made in the inguinal area, and the transversalis fascia of the Hesselbach triangle is obliquely opened, and then the mesh is removed manually. It takes about 20-30 minutes.
After the mesh is removed, the open transversalis fascia is closed in a similar way for direct inguinal hernia repair.
The total operation time required to remove the mesh and repair it is about 40-50 minutes.
At first, I was forced to do this surgery by the patient repeated request, but now I think it’s a very good removal method for laparoscopically implanted mesh.
1. The time required for mesh removal is relatively short.
2. The mesh can be removed with certainty.
3. There is no need to insert another mesh to prevent hernia recurrence.
The problem of saving the peritoneum pointed out by Good Intentions in other post is not easy even during laparoscopic or robotic removal. And I think that peritoneal injury caused by mesh removal does not leave significant clinical sequelae.
04/27/2022 at 10:06 am #31499
Dr. Kang….thanks so much for your reply. The fact that the best hernia surgeon in the world takes the time to answer question from simple patients nearly brings me to tears. As usual everything you say makes sense…and given that a robotic removal of my double inguinal mesh would take 4 hours your approach has many advantages. After you remove the mesh…would you execute a kang repair to prevent the return of the hernia in the same operation? I had a large indirect hernia on the left hand side and a tiny one on the right that were both repaird with two large pieces of bard 3d max mesh….just have the following questions:
1. In the 5 removals that you effected…what side effects did the patients suffer? We are told over and over that open removal of lap installed mesh is a big no no. But maybe once again your reputation as an innovator will change the world.
2. i would imaagine that a 3 inch scar would be required for each side of the inguinal canal to remove the mesh and repair the hernia?? Given that many US surgeons leave a 3 inch scar to simply repair a hernia…3 inches to remove and repair seems outstanding! If you believe you can remove the mesh and repari the hernias with 3 inch incisions on either side of the groin…i would seriously consider this option. My main symptomns are continuous burning in the perinuem…and after urination ejaculation etc…some have told me they were completely cured when the mesh was removed,,,,God bless you Dr kang…I tell everyone i know in the US with a hernia that they need to see you and only you….
04/27/2022 at 10:18 am #31500
follow up….i assume the total time of the operation doubles if i have bilateral mesh??? but assuming that both sides could be repaired using the superior kang repair at the time of removal…this operation would seem to be a no brainer. Good Intentions do you have any thoughts here? Is Dr. Kang on the verge of revolutionizing mesh removal??? or are there dangers you see to the open removal process? its a little troubling that this has only been attempted 5 times…but i never understood why 5 hours robotic surgery hunting and pecking for mesh fragments was a good idea…what dr kang proposes would seemingly guarantee getting it all out…would love to hear DR Towfigh weigh in as well….
04/27/2022 at 11:20 pm #31503
1. Although observations have not been made for a sufficient period of time, no one has complained of any particular discomfort. I also initially thought that the lap installed mesh should be removed laparoscopically. As I said, there is no hospital that does this kind of surgery in Korea, so after much consideration, I tried open removal. Now, I think that it could be a very good way to remove the lap installed mesh and do a tissue repair at the same time.
2. That’s right. If on both sides, 3 inches skin incisions are made on both sides, and mesh removal and hernia repair can be done at the same time. The size of the wound may be slightly larger or smaller depending on the individual condition. Time is double for both sides of course.
04/29/2022 at 9:27 am #31507
Dr. Kang….thanks for your response, Many have messaged me privately saying this solution would be damaging because it would require you to cut through muscle tissue and open the inguinal floor because the mesh is placed on the backside of the abdominal wall…and that nerve damage would result.Obviously none of these people are prestigious hernia surgeons. So your 5 patients have not had any chronic pain, nerve damage or other adverse findings? I know taking mesh out lap or robotically is no walk in the park–taking up to 5 hours to accomplkish bilaterally…so a procedure that would take 2 hours…get rid of the mesh and repair the hernias with the best repair in the world seems appealing….i wish you had a longer track record here…thanks so much Dr kang
04/29/2022 at 10:07 am #31508
Dr. kang – this is from a knowledgable poster…any thoughts..again he is not a revered hernia surgeon…
If you go in from the front you are cutting through healthy tissue and cutting down all the way to that last muscle tissue and then cutting through that to get to the mesh. if you go in lapro all you have to do is peel the mesh off the backside of the muscle. Going in open, visibility would be poor and it would be hard to see your bladder. If your urinary issues are caused by mesh on the bladder that might be hard to see, You had 2 Bard 3d max meshes…6×4 inches…these are large meshes that extend for left right up and down…i think they would be hard to remove openly. Definitely an appeal to getting a removal and a top tissue repair in one throw.
05/01/2022 at 11:55 pm #31517
In order to remove the lap installed mesh by an open approach, surgery is performed in the same way as you said. However, this method is already being implemented in case of Shouldice or Bassini repair. So I don’t think it might cause serious extra problems like you’re worried about. Of course, there will be general risks with the removal of the mesh.
I was worried at first too, but I found that visibility wasn’t a big problem. The size of the inserted mesh was not a big problem either.
To answer your question, we’ve just checked on the phone with the 5 people who underwent lap mesh removal openly, and we could interview with 3 of them. All three said that their pain had improved by more than 90%. All three said that there were no serious sequelae other than a slight numbness.
05/02/2022 at 3:19 pm #31520
Thanks Dr Kang,,,god bless you. Is there any validity to the notion that lap installed mesh must be removed laproscopically? it seems your procedure is easier faster and more reliable way to remove mesh—why arent other doctors doing this? it would seem safer than robotic surgery.
Have you had to cut nerves when removing lap mesh? How do you deal with mesh that is wrapped around the spermatic chord? the Vas deferens? Does this force you to leave mesh in the body?? I would like to pursue treamtment with you but it is very difficult with the distance and language barrier etc. Do you consult online for $$$? Happy to pay whatever you ask?
05/03/2022 at 3:54 pm #31524drtowfighKeymaster
When the option for laparoscopic/robotic mesh removal is available, it makes no sense to impart extra injury to the inguinal floor by opening through it when the same operation cam be performed with increased precision and less invasively. Robotic surgery by specialists is considered safe and does not impart extra injury. I don’t agree with the sentiment of being “blasted by the robot.”
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