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My recovery 1 month after no mesh Hernia Repair with Dr. Kang at Gipum Hosp in Korea
I had my double inguinal hernia repaired November 2, 2017 by Dr. Kang in Korea and today, December 5 am in almost no pain and extremely happy with Dr. Kang and Gipum Hospital. On Saturday October 28, 2017 I arrived in Korea for business, something that I do about twice a year and was feeling fine. Monday morning I was in a lot of pain and slept it off. Tuesday I messaged my internal medicine Dr. in Korea about where to get looked at for a possible hernia diagnosis and again, tried to sleep off the pain. Wednesday morning she had replied and mentioned Gipum and said that due to my speaking English, she’d call and make an appointment for me. From how she spoke, I do not think that she knows Dr. Kang personally. I believe that she was sharing a hospital that she knows by reputation only. I was in so much pain I didn’t think to ask. Her calling was probably unnecessary. There are enough English speakers there but I’d recommend calling and asking for Stephen and asking for a call back. All Koreans can count to 10 in English so getting a message to him won’t be a problem.
Korean medicine is very advanced and as good as anywhere in the world but I was NOT planning on surgery. That afternoon I met Dr. Kang and Stephen Kwon, the hospital pastor who helps translate. I was planning on them telling me it wasn’t a hernia and to go home. I was wrong, however I was so impressed with them and said that I’d like to think about surgery and talk to my Dr. back home but was leaning towards surgery as fast as possible. Korea prides itself on being Bbali Bbali or “Chop Chop” and I forgot my rule on never saying “as fast as possible” in Korea… Dr. Kang said “Let me see about tomorrow!”
When the time change allowed for it, I called my Dr. back home. He is an ER Dr. with a small practice. He said that he agreed with everything that I relayed about Dr. Kang, especially what Dr. Kang said about the mesh. My Dr. went from “Come home for the surgery I know someone” to “This Dr. Sounds very good. Get the surgery there.” I contacted Stephen at about 7-8pm at night and the next morning was at the hospital for Surgery.
The hospital was professional and both Dr. Kang and at least one nurse at every stage spoke perfect English. From memory, Dr. Kang, Stephen, and at least one nurse at all times had lived abroad in an English speaking country. Everyone’s bed side manner is fantastic. Other posts speak in detail about how high quality the surgery and hospital experience is. I completely agree with what everyone says and have always wanted to pick a Dr. based on experience. A surgeon once told me, before getting a surgery ask the Dr. How many of your operation he did last week. On the day I had surgery, there were five other patients getting the same surgery! That is great!
The evening of surgery I went to my hotel in a taxi. A colleague was driving with an SUV but I didn’t want to wait and didn’t really feel any pain, so I got in the taxi. A taxi in any country was probably the riskiest thing that I did that day. My girlfriend had joined me in Korea and was taking care of me. She speaks zero Korean and was the world’s greatest helper however if I had to, I think I could have been ok alone that first day. The next morning I woke up quite sore, not in pain, but sore and pushed myself to move and by the end of the day was almost entirely pain free. The following day, Saturday, almost 48 hours after surgery, friends came over and after about an hour in the hotel coffee shop, we all moved to my room so I could lay on the floor with my legs raised. The fact that I was sitting like normal in a coffee shop 48 hours after hernia surgery and not in any pain, just a little discomfort from sitting is amazing.
The next day, Sunday, we walked about half a mile to get lunch in Seoul. I didn’t carry anything as I had my girlfriend with me but I was getting along quite fine. We probably walked a little slower than normal. The buffet restaurant (Ashley) seemed to think we were a normal foreign couple with one pretty blonde lady with hair they could look at and of the crazy white man trying to speak Korean and occasionally they understood us. I was happy not to stand out as being injured. I carried my food without problem.
Monday I resumed going to meetings. Koreans are very formal and I have to wear a suit and tie everywhere. The incision sight didn’t hurt from the formal clothing. Nobody noticed anything was different and the few people that knew said I seemed to be doing well. By later in the week, I was working days and we were going many of Korea’s great tourist and sightseeing locations and I was fine. The only thing that seemed to hurt was pulling off the old bandage every two days to change the dressing. My week progressed normally and I even contacted Stephen to ask why I wasn’t in pain and he said not to worry. I hope he replies to this post and mentions how many people contact him to say they are not in pain.
The following Monday I went to Gipum on my way to the airport. They said I was well and I went home. The flight was uneventful. Luckily, all along the way I found people to lift my carry-on and bags.
Starting about 4 weeks my Dr. back home pushed me to start back with daily push ups. I had been walking all along and occasionally ran to catch a green light but really only walking for about a month. Now I am doing some wall push-ups as well as other limited, high incline push ups. I am taking that part very slow and will probably start with the elliptical in a few more weeks.
In conclusion, I feel very lucky to have found Dr. Kang and would recommend him as a surgeon and his hospital to anyone especially reading about the different recovery.
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19 Replies
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[USER=”3103″]Spartan[/USER]
I am afraid that you may misunderstand my word a bit. Desarda has no mesh complications, but its recurrence rate might be a little higher than that of Lichtenstein. Because both are surgery of a similar concept and the EOA is less durable than the mesh. I don’t know what Desarda claims about external oblique aponeurotic extensions, but I think it is to emphasize the importance of external oblique aponeurosis in hernia repair. But from my experience I am convinced that the transversalis fascia has full responsibility for hernia occurrence. I think external oblique aponeurosis has no role in the occurrence of inguinal hernia. If some abnormality is found in external oblique aponeurosis, it is the result of hernia, not the cause of hernia. In parables, the clothes could be torn because of their weight gain. Gaining weight is not because the clothes are torn.
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[USER=”3103″]Spartan[/USER]
I am afraid that you may misunderstand my word a bit. Desarda has no mesh complications, but its recurrence rate might be a little higher than that of Lichtenstein. Because both are surgery of a similar concept and the EOA is less durable than the mesh. I don’t know what Desarda claims about external oblique aponeurotic extensions, but I think it is to emphasize the importance of external oblique aponeurosis in hernia repair. But from my experience I am convinced that the transversalis fascia has full responsibility for hernia occurrence. I think external oblique aponeurosis has no role in the occurrence of inguinal hernia. If some abnormality is found in external oblique aponeurosis, it is the result of hernia, not the cause of hernia. In parables, the clothes could be torn because of their weight gain. Gaining weight is not because the clothes are torn.
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[USER=”3103″]Spartan[/USER], I am afraid that you may misunderstand my word a bit. Desarda has no mesh complications, but its recurrence rate might be a little higher than that of Lichtenstein. Because both are surgery of a similar concept and the EOA is less durable than the mesh.
I don’t know what Desarda claims about external oblique aponeurotic extensions, but I think it is to emphasize the importance of external oblique aponeurosis in hernia repair. But from my experience I am convinced that the transversalis fascia has full responsibility for hernia occurrence. I think external oblique aponeurosis has no role in the occurrence of inguinal hernia. If some abnormality is found in external oblique aponeurosis, it is the result of hernia, not the cause of hernia. In parables, the clothes could be torn because of their weight gain. Gaining weight is not because the clothes are torn.
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I disagree with that statement. It’s also not based on any documented observations, such a matter anatomy dissections, etc.
Also note that when we talk about closing the internal ring, we usually mean closing the gap. The internal ring remains open enough to allow for the spermatic cord contents to run through it. The rest of it tightened up to reduce risk of other content squeezing through.
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Great, I appreciate your quick and thorough response with the only comment, that Dr. Desarda reports his success rate around 2% and that agree that Lichenstein mesh defective rates are significantly higher How much higher we will ever know, as the mesh companies have been caught in scandals during the late 80’s and 90’s monetarily influencing the FDA and those who are suppose to tabulate such results independently.
So do you agree with Dr. DeSarda’s observation that nearly all people with inguinal hernias(direct or indirect) are missing External Oblique Aponeurotic Extensions in their abdominal wall(some kind of fibrous material derived from the EOA)? If you agree, do you have theory to explain such a phenomenon?
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[USER=”3103″]Spartan[/USER]
Hi,
1. Dr. Kang says he closes the inguinal ring in doing a indirect hernia repair where others before have not been able to for fear of cutting certain channels like the spermatic chord, testicular vessels, lymphatics and sensitive nerves. Please tell me what enables him to do this where other physicians have feared to tread? a piece of machinery? a tool? a technique? sheer skill?
Answer) Directly closing the internal inguinal ring was already begun by a surgeon named Marcy around 1870. However, Bassini repair, which was introduced later, has become a typical operation for inguinal hernia repair. This is probably because Bassini repair was easier for doctors to follow, anatomically easier to understand, and could be applied to both types of inguinal hernia, indirect inguinal hernia and direct inguinal hernia in one way. I think. Since this concept has been solidified for over 100 years, it is believed that all the inguinal hernia repair methods introduced afterwards have been out of this framework.
Surgery to close the internal inguinal ring is not a high risk of damaging the various structures that consist of the spermatic cord. The reason why this operation is not performed is because doctors who are accustomed to operating in one way do not think that they can close the internal inguinal ring for indirect inguinal hernia repair and they don’t know how to securely close it.2. The Desarda Method uses External Oblique Aponeurosis(EOA) to close up the inguinal ring in a indirect hernia, why does Dr. Kang believe Traversalis fascia is as good or better?
Answer) The Desarda technique, which uses a narrow strip of external oblique aponeurosis, is the same concept as Lichtenstein mesh repair. The only difference is that the strip of EOA is used instead of the mesh to cover the inguinal canal. Lichtenstein repair, however, is estimated to have at least 5% recurrence rate, besides its mesh complication. I personally think that recurrence rates might be higher if EOAs are used that are less durable than meshes.
It does not matter, I think, which is stronger, EOA or transversalis fascia. What’s really important is, that Desarda doesn’t close hernia openings directly, while Kang repair closes hernia openings directly.3. I noted that in Dr. Desarda’s Hernia Repair video that the posterior wall and many accompanying muscles(EO or IO) are a-dynamic or weak. Dr. Desarda could not stimulate one of these muscles even with a strong electrical current– according to Dr. Desarda happens every time he operates. Hence, they have to re-anchor the External Oblique.
What is Dr. Kang’s theory of why the posterior wall is a-dynamic and associated muscles are so weak and filled with fat? How does he remedy this problem of posterior wall and associated muscle inertness in the indirect hernia case because it just sound like he works on the inguinal ring?Answer) All skeletal muscles respond to electrical stimulation. Thus, the transversalis fascia which is the skeletal muscle (also called the voluntary muscle) is also expected to respond to electrical stimulation. However, since it is not a thick muscle like an external oblique muscle or an internal oblique muscle, the response will be minimal. For reference, muscles that do not respond to electrical stimulation are smooth muscles that are involuntary muscles, that is, muscles surrounding the bowel wall or blood vessel wall.
Therefore, it is not well understood to explain the surgical technique by explaining the difference in the electrical stimulation response between the same skeletal muscles. Another thing I don’t understand is that the primary tissue Desarda actually uses is not external muscles that respond to electrical stimuli, but external oblique aponeurosis that cannot respond to electrical stimuli at all.
And in fact, kang repair uses not only the transversalis fascia but also the surrounding strong tissue and structure to close the internal inguinal ring together.(Even I notice by feeling that my hernia side has a lot more fat in it, then the non- hernia side. I am assuming the all the fat is due to these muscles being inert)
Answer) I think that’s just a guess. Sometimes fat degeneration occurs in muscles, but it is not caused by inert muscles. And it does not happen to any particular muscle, but often to the surrounding muscles.
Thank you! -
I have 3 questions for Dr. Kang pertaining to his surgery or any one else that might know:
1. Dr. Kang says he closes the inguinal ring in doing a indirect hernia repair where others before have not been able to for fear of cutting certain channels like the spermatic chord, testicular vessels, lymphatics and sensitive nerves. Please tell me what enables him to do this where other physicians have feared to tread? a piece of machinery? a tool? a technique? sheer skill?
2. The Desarda Method uses External Oblique Aponeurosis(EOA) to close up the inguinal ring in a indirect hernia, why does Dr. Kang believe Traversalis fascia is as good or better?
3. . I noted that in Dr. Desarda’s Hernia Repair video that the posterior wall and many accompanying muscles(EO or IO) are a-dynamic or weak. Dr. Desarda could not stimulate one of these muscles even with a strong electrical current– according to Dr. Desarda happens every time he operates. Hence, they have to re-anchor the External Oblique.
What is Dr. Kang’s theory of why the posterior wall is a-dynamic and associated muscles are so weak and filled with fat? How does he remedy this problem of posterior wall and associated muscle inertness in the indirect hernia case because it just sound like he works on the inguinal ring ?(Even I notice by feeling that my hernia side has a lot more fat in it, then the non- hernia side. I am assuming the all the fat is due to these muscles being inert)
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quote drkang:Hi, SighFigh.
For a direct inguinal hernia, I fix the Hesselbach triangle after putting the cremaster muscle and the spermatic cord aside.
So the cremaster muscle is not injured during my direct inguinal hernia repair.For an indirect inguinal hernia, I open the cremaster muscle by splitting the muscle fibers to find the hernia sac inside.
After treating the hernia sac, I close the deep inguinal ring by stitching.
So the cremaster muscle is not cut or removed but slightly injured during my indirect inguinal hernia repair procedure.Thank you!
This may be a stupid question, but one that’s been on my mind:
For the type of indirect repair you do, would it be theoretically possible to make the incision right at the superficial ring, push the herniated tissue back up the canal, tie off the sack, close the internal ring and then sew up the incision, in order to do the repair without cutting through any muscle?
I’m sure there is something obvious that I’m not thinking about here, in terms of how anatomy works, and given that my understanding of it is based entirely on diagrams/descriptions online…
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Hi,
I see.
To take out some blood sample from the vein, they usually apply a tourniquet around your upper arm to block the venous return.
If you are obese then, more pressure is needed because your fat works as a cushion.
But if you lose your fat, the vein can be blocked more easily.
Sorry for this sort of example, but it’s the same story.So, they remove some of the bulky cremaster muscle to decrease its cushion effect when they are trying to close the deep inguinal ring inside by squeezing the cremaster muscle from outside.
It is for an indirect inguinal hernia repair.Yes, I understand what they intended to.
But I don’t know whether it works and whether it is necessary, because the tubular cremaster muscle contains the bulkier spermatic cord inside as well.As for me, I close the deep inguinal ring not from outside but directly from inside for indirect inguinal hernia repair.
Thank you!
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Hi Dr. Kang,
I copied this from the doctor’s website where the technique was described as doing an excision of the cremaster.
“If there is a significant bulk to the cremasteric muscle, then we excise some of the cremasteric muscle to allow the internal right to be made tighter, but if the muscle is thin and does not compromise repair and he leaves it undisturbed.”
Thank you
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Hi SighFigh,
I think if the ilioinguinal nerve or the genitofemoral nerve is injured while operating on the cremaster muscle, it might cause chronic pain.
If the cremaster muscle was cut or damaged a lot, you could get some testicular discomfort because it would sag down.I am sorry but I don’t know about that technique you mentioned.
If you give me any link or information of the technique, I could give you my thought more precisely after reviewing them. -
Hi Dr. Kang,
Do you feel there is any risk of serious or minor chronic pain by operating on the cremaster muscle?
What if the cremaster is reduced in thickness by surgery? I’ve read that this is another doctor’s technique.
Thank you !
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Hi, SighFigh.
For a direct inguinal hernia, I fix the Hesselbach triangle after putting the cremaster muscle and the spermatic cord aside.
So the cremaster muscle is not injured during my direct inguinal hernia repair.For an indirect inguinal hernia, I open the cremaster muscle by splitting the muscle fibers to find the hernia sac inside.
After treating the hernia sac, I close the deep inguinal ring by stitching.
So the cremaster muscle is not cut or removed but slightly injured during my indirect inguinal hernia repair procedure.Thank you!
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Dr. Kang, do you modify or remove part of the cremasteric muscle during your procedure?
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Thank you, Chaunce1234!
Since I started new no mesh hernia repair five years ago, I have continued to change and improve my repair methods.
And three to four months ago, I made the final version.
So now, I am collecting surgical cases and would submit a paper on my new repair method sometime next year.Although I have personally confirmed good results with less than 1 % recurrence rate for the repairs of last five years, I think the results of my final no mesh inguinal hernia repair are more critical.
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This sounds like an excellent option for individuals in Korea or nearby. Or if you feel like taking a vacation to South Korea to also have a surgery.
Do you know if Dr Kang has published a paper detailing his specific repair method? Does Dr Kang teach the repair method to other surgeons so that this approach can offered beyond South Korea? If not, perhaps those would be two useful avenues going forward for Dr Kang, particularly given the positive patient experiences reported. Share the knowledge, it is undoubtedly valuable.
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Oh I’m very sorry for late reply. Seven days will be good enough for your stay in Seoul.
The day you arrive you take a rest. The next day you check your hernia by Dr. Kang with ultrasound. Based on the test result you have a surgery or repair that day or you can set up a date for repair. At the repair day if you don’t sense any serious pain, you can be discharged in the evening. For a few days rest at a hotel room with walking and small excercise, you can fly back home anywhere in the world.Today an American man in his 50’s came to Gipum hospital and went through the test and no mesh hernia surgery/ repair by Dr. Kang. This evening or tomorrow he will go back to his hotel room for recovery. Four or five days later according to his schedule he’ll go back home. He may want to have a small sightseeing in Seoul before he leaves for home.
The total medical cost is 2,950 US$ for one side hernia (for both sides the cost will be 3.950 US$). No more extra charge unless you stay at a upper class hospital room(100-200 US$ additional). It’s a lump sum deal. If you are in financial difficulty, ask Dr. Kang for discount. He’s a generous man.
I just give you a link of my interview clip with Bruce from Boston MA, USA. -
Hi, Stephen!
I have had a left inguinal hernia for several years.
Actually I had the fear of mesh problem and was reluctant to have my hernia so repaired. Sometimes I feel dull pain there. I heard that Shouldice is good at no mesh surgery. But the incision was so big when I saw the youtube. So it didn’t come to my favor.
Recently I came with Kang repair and have much interest in it. I just want to know how many days I should stay in Seoul and the hospital cost as well. My finance is not so good these days.Thank you so much!
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Sorry David, I haven’t found it for a long time.
Don’t know the reason but am very happy to read it today after two moths you wrote it.
Ever since you went back home, a US man from Cambodia, an Australian youngman from Melborne, a UK man from London, and a US man beauticianist from Los Amgeles have come to us and gone back home successfullywith their no-mesh inguinal hernia repairs, either direct or indirect, so far no comlication, recurrence, or complaint has been reported. One American artist is to come tomorrow for the same meshless repair.
David, if you can, you post up your story in about a year, so that we may know how your repaired hernia is healed.
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