My surgeries with Dr. Kang and Shouldice Hospital

Hernia Discussion Forums Hernia Discussion My surgeries with Dr. Kang and Shouldice Hospital

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    • #33437
      WilliamT
      Participant

      Hello everyone! My first post is going to be an epic tome, as just yesterday I joined the exclusive club of those who have had surgeries at both Dr. Kang’s Gibbeum Hospital in Seoul, and at the Shouldice Hospital in Thornhill.

      Reading Hernia Talk this past month has been very helpful, so in following @Colin M.’s footsteps, I thought I would share my experiences, along with why I chose to travel to Korea even though Shouldice is in my backyard.

      Early 2000s – Shouldice

      Had a small inguinal hernia on one side that was causing occasional discomfort. It was manageable for 2 years, until suddenly it became aggravated nearly all the time. I live in Toronto, so my doctor recommended Shouldice. I was in my late 20s, physically active but with a BMI of around 27. Shouldice assessed me quickly, and despite being slightly heavy, they booked me in for a surgery within 2 weeks (it was supposed to be 2 months away, but when I reiterated my nearly constant pain, they were able to find a sooner date).

      I don’t recall the entire experience, but here is what was most notable. On the morning of surgery, I was with maybe 8 other patients in the pre-op room. Oral sedatives were given to all, and everyone fell asleep except for me. While waiting for my turn in the OR, I felt far too alert and aware. Once I went in and they started slicing, I felt horrible pain from the blade. I yelled and tried curling up in a ball, but was held down. After more attempts at cutting, the surgeon told me that some patients need a little extra sedation, which he then instructed a nurse to administer. Soon after, surgery proceeded with much less pain, but there were still times I could feel them aggressively pulling layers together, as well as the stapling of the incision at the end. Overall, I recall those minutes in the OR as being one of the most horrible experiences of my life.

      Despite this, I must admit that the ensuing days at Shouldice were quite pleasant. As many others have described, the meals were decent, playing boardgames with other patients was fun, and the grounds were a nice setting for walking. The only serious pain was caused by laughing too hard while watching movies with my roommate (I swear that Dude, Where’s My Car? nearly caused the staples to burst open). Some other patients who also lived in the Toronto area complained that the lengthy stay (especially the overnight stay before surgery) seemed like a cash-grab and a waste of resources, but I wasn’t too fussed by this at the time. I recall getting discharged on the 4th day. Recovery progressed over the coming weeks and months, with a very gradual reduction in tension, and only sporadic jolts of pain. One thing that took a very long time to resolve was a weird numbness in the area around the repair. The numbness didn’t cause any pain, but it was a disconcerting sensation that felt like the nerves in the area were all messed-up somehow. This persisted for at least 2 years, and eventually disappeared. The repair hasn’t given me any issues since then.

      2022 – hernia #2

      Now in my mid 40s, I experienced a second inguinal hernia on the opposite side. I didn’t get it checked, as I recognized the symptoms immediately, and it was quite tolerable with only brief instances of pain. All was good for 8 months until I was on a trip, and it started causing episodes of sharp burning pain while walking or doing athletic activities. Immediately upon my return to Toronto, I went for a walk-in assessment at Shouldice, as I thought they would be my best chance of getting treated quickly. A nurse checked my height, weight, and BP, and then a doctor did a physical exam. After weeks of over-indulgence on my trip, my BMI was now at 29, so the assessing doctor said that he would like me to lose 25-30lbs., and that I was to call in for a booking once I had dropped 15lbs. He told me about their process and procedures, which sounded the same as my previous surgery. I told him about the pain I had during the previous operation, and he assured me that they would account for it this time. I left rather disappointed that I didn’t have a date scheduled, but was surprised by an email later in the day indicating I was booked for surgery in 4 months, with a mandatory 4-night stay, and with the condition that my weight on admission corresponded with a BMI of 25. After some back and forth with the administrator, I was dismayed to conclude the likelihood of accelerating the timeline was slim this time. They appeared to be holding firm to this new weight requirement (even though my BMI was ~27 last time), and they said I could not even go on their waitlist for a sooner date until I met their weight target. I was having a hard time digesting the prospect of 4 more months with worsening bouts of pain, a bulge that was growing by the week, and a diminished ability to work. I set in-motion a crash diet plan to try to rapidly meet the Shouldice target (not so easy during the Christmas period), and initiated a hunt for other surgical alternatives. I sought a referral to a general surgeon, but the wait time for an assessment was 5 weeks, and his surgeries were being booked for 2024! (Not surprising, as this is the state of healthcare in Ontario). After further research, I concluded that I would prefer to stick with a non-mesh repair. Upon learning about Dr. Kang, and calculating that the total cost to go Korea would be more or less the same as going elsewhere in North America for a mesh repair, the solution seemed clear.

      January 2023 – Dr. Kang

      Just before New Year’s I got in touch with Stephen from Dr. Kang’s team. I had already learned a lot from various postings and videos on here and elsewhere, so I had only a handful of emails with Stephen before I was comfortable with committing. On Jan 4th I proceeded with booking a flight for the 8th, arrival on the 9th, pre-op on the 10th, and surgery on the 11th!

      This is my first time in Asia and I am travelling solo, so I am glad I had almost a full day to get settled in and explore Gangnam. At my appointment on the 10th, Stephen met me at the hospital entrance to guide me through all the paperwork and testing. Besides being a good translator, Stephen is just generally a very kind and reassuring presence to have by your side. After registering with the hospital, the first step was meeting with Dr. Kang for a physical exam and discussion. Dr. Kang answered my questions and allayed my concerns in English. He said my hernia was likely indirect. My scar from Shouldice is quite long, so when I suggested that I didn’t mind a matching one on the other side if it gave him space to add extra reinforcement to unaffected areas, he said that he was intending to do that anyways (and without the oversized incision). He said my weight was not a concern, and that he hasn’t turned away anyone else because they were heavy. After this initial meeting, the next step was an ultrasound, after which Dr. Kang came in again to discuss the results and confirm the gameplan. Subsequent steps involved going to other parts of the hospital for a bloodwork, urinalysis, Covid test, EKG, and a chest X-ray. I don’t recall Shouldice having such extensive testing during their admission (and they definitely didn’t do an ultrasound during their assessment).

      During my entire pre-op appointment at Giddeum, I was impressed by what seemed like a thoroughly clean and modern facility, and the number of attentive staff at every station along the way. I was at the hospital for 2 hours in total, with minimal waiting time at each stage. This was a very stark contrast to my recent experiences at my local hospital in Toronto, and at Shouldice (I forgot to mention how if I wanted an actual assessment appointment at Shouldice, I would have waited for months, but they encourage people to show up on weekday mornings and wait hours in their “living room” for a walk-in assessment. Also, at my December assessment, they confused my file with another past patient, and the doctor tried to tell me they had already repaired both sides).

      And that brings me to yesterday, which was THE day. I walked from my hotel to Gibbeum at 9am. It took maybe 45 minutes to check-in, get changed, and settle into my portion of the 4-man room. The 4-man room was perfectly adequate for a day or overnight stay. Each bed has a code-locked cabinet for personal belongings, and I barely noticed the presence of other patients. I was led to the operating room around 10:15. Right up until surgery, I was asked repeatedly by various English-speaking nurses for me to confirm my name, DOB, surgery type, and which side. I’m not sure if this is a typical protocol at home, but it was a reassuring check. After maybe 15 minutes of prep while I was in the surgical suite, Dr Kang entered and asked how I slept the night before, and how I was feeling. And that was the last thing I recall before waking up outside the operating room. It was like I blinked, and it was all done! After the painful ordeal of my previous surgery, this was a massive relief.

      By 11:40 I was back in my room, and although I had been jet-lagged and underslept, I was feeling alert and only minor discomfort. Stephen came by for regular check-ins. A tasty Korean lunch was served at around 1pm, and Dr. Kang came by at 4pm for a follow-up before discharging me. Stephen accompanied me to the entrance and hailed a taxi from down the street. I had some discomfort from the bounciness of the taxi, but was otherwise perfectly fine with the trip back to the hotel. I managed to shuffle down the block to pickup some snacks at 7-11, and then retired up to my room. I didn’t feel any real pain; it was more like soreness and weakness that I might feel after a harsh abdominal workout.

      24 hours after leaving the hospital, I’m feeling some pain with movement, but nothing severe. Walking in slow and hunched, but I don’t have the same tightness and sensitivity that I recall after my Shouldice surgery. While there is no way that I could tolerate flying home today, I’m hopeful I can play tourist in a few days. Since I’m staying for another week, Dr Kang suggested that I pop by Gibbeum to see him next week.

      While it might have been nice to have someone accompany on this trip, it really hasn’t been necessary. So far, I’m very happy with my decision to come see Dr. Kang. He seems like a genuinely nice guy, Stephen has been an extraordinary help, and even though I’m not yet able to do the Gangnam horsey dance, the overall experience has been as good as I could have hoped.

      I’ll add to my report if anything notable happens, or if recovery doesn’t proceed as expected.

      In the meantime, feel free to post any questions on my experience, and I’ll try to respond.

    • #33438
      William Bryant
      Participant

      Thanks a lot, brilliant resume. The waking up and/or feeling pain at Shouldice is a bit of a worry.

      Was Dr Kang using local anaesthetic for your operation?

    • #33442
      Alan
      Participant

      Excellent write up – I agree with your words on Stephen, a really nice guy and without him it would have been very difficult.

      He injects locally in addition to the sedatives – I woke up during the last part but couldn’t feel anything.

    • #33444
      William Bryant
      Participant

      I think it’s because he uses local, he can operate on wider age and weight range and even medical conditions like the cyclist who had heart problem maybe a pacemaker fitted.

      Has the pain gone now Alan?

    • #33445
      Alan
      Participant

      Yes, no pain at all now, just a bit sore after walking more than a few miles.

      He’s only turned down one patient I believe, I think they had leukaemia.

    • #33446
      Watchful
      Participant

      William,

      Both Kang and Shouldice use local with sedation, so that’s not it. Being overweight is a risk factor for recurrence, and makes the surgery a bit harder, so the philosophy at Shouldice is that weight loss is part of the treatment.

    • #33447
      Watchful
      Participant

      WilliamT,

      Thanks for the detailed write up.

      I had an inguinal hernia repair at Shouldice recently. Their sedation protocol is very different now. They use IV sedation with midazolam and fentanyl. Sometimes they add propofol as well. I woke up toward the end of the surgery while the surgeon was performing some stitching, and it was very painful, although not as excruciating as what you describe. They increased the sedation when they noticed that I woke up. Seems like a common thing there based on reviews. The anesthesiologist also told me that it’s normal. I think they try to go with as light a sedation as they can get away with, which is a good thing – this stuff isn’t good for your brain and other organs. Unfortunately, the local anesthesia isn’t as effective as one would hope. Not sure why – maybe skills of the surgeon, maybe they don’t want to use too much of that either, maybe it really needs to be done ultrasound-guided and they don’t do it that way, I have no idea.

      I also have abnormal skin sensations around the area – similar I think to what happened in your case. Some numbness on one side of the incision, and paresthesia on the other side. It feels like something more than just the nerves being cut at the incision – I think ilioinguinal nerve irritation is causing the paresthesia.

    • #33451
      WilliamT
      Participant

      Hi William Bryant,
      Yes, Dr Kang uses both IV sedation and local anesthetic. My records don’t specify which ones, but I can ask if it matters.

      Hi Watchful,
      Completely understand the impact of excess abdominal fat, and I knew I needed to drop some pounds regardless, which is why I immediately started aggressive efforts. I still found it odd that a stricter standard was being applied this time, as my broad frame and muscle % hadn’t changed. Funny thing was when soon after my assessment, I was seen by an ER physician and a nurse for a different matter, and they were both baffled when I told them of my prescribed weight loss. The young physician, who was not familiar with Shouldice, said “I don’t get it, you’re not that heavy, and you don’t look that overweight. Do they only treat skinny people?”

      I’m very sorry to hear that you became alert during your surgery. I know that administering anesthesia is a tricky balancing act, but if intraoperative awareness is frequently noted in Shouldice reviews, then perhaps they should at least look to improve their monitoring protocols and/or monitoring equipment. Because of my alertness during my first surgery, it wouldn’t surprise me if I have some level of PTSD that was making me increasingly anxious ahead of this recent one. I must reiterate that it was a tremendous relief that I felt nothing throughout the procedure with Dr. Kang.

      In regards to skin sensations after my first surgery, now that you mention paresthesia, I recall that also was present for some time. However, the numbness was more persistent, and covered a larger area of around 2” x 4”. I’m only on day 3 after my Kang repair, and so far I am not feeling either symptom. The incision area is neat, slightly tender, and has a bit of swelling.

    • #33502
      WilliamT
      Participant

      As I head back home today, I thought I would add how the rest of my post-op time in Seoul progressed:

      Days 1 and 2
      More uncomfortable/painful than the day of surgery. Spent most of the time in bed. Could walk halfway down the hotel hallway before feeling the need to lie down again.

      Day 3
      Felt ready to get moving. Tried the hotel treadmill at 1km/hr, but found this a bit fast. Then tried walking outside, and eventually made it to a restaurant 1.5km away. Despite barely being able to cross intersections before the lights changed, I was pleased with the progress, until….I got stuck in a super painful position trying to get into bed. Getting in and out of bed is a definite challenge in the first few days, so I wish I had practiced a safe technique pre-op so that I was in the habit of being careful.
      Total distance walked for the day was 5km

      Day 4
      After the previous night’s incident, I was feeling more pain with movement. Couldn’t walk for very long without sitting down.
      Total distance walked was 3km

      Day 5
      Set out on a mission to see some tourist sites. It took 3 attempts before making it to the subway, however, once out and underway in the tourist areas, I managed to just keep walking for nearly 7 hours.
      Total distance walked was 20km!!!

      Day 6
      Walking pace and stride were improving, and I was better able to handle all the subway staircases. There were frequent tugging/ripping pains, so I needed to sit down periodically (but could usually resume walking after 30-60 seconds of rest). I visited Dr Kang for a follow-up ultrasound, and everything looks good.
      Total distance walked was 13km

      Day 7
      Similar to day 6 with improving pace of movement, but still the need for periodic breaks. Covered most of the remaining tourist sites that I wanted to see. Seoul is quite an impressive city, and am glad I had the time and strength to play tourist for these few days.
      Total walking for the day is 13km

      Day 8
      Flying home! While I could have comfortably flown home 1-2 days prior, I was grateful to have the buffer, and it ended up giving me ample time to enjoy the city.

    • #33510
      William Bryant
      Participant

      Sounds as though progress being made William! Well done for perservering! And thanks for up date!!!

      • #33515
        WilliamT
        Participant

        Yes, the progress feels great! Today I’m very tempted do a strength workout, but I’ll hold off for another week.

    • #33512
      ajm222
      Participant

      The “tugging/ripping pains” would scare the heck out of me. I guess that doesn’t indicate that damage to the repair site is being done?

      • #33514
        Watchful
        Participant

        I’d be freaked out too. It seems that the post-surgery pain with this technique can be really bad, but this resolves in most cases. Still, I would be frightened because how can you tell initially if it’s the “normal” pain, or something more serious? You really need to have faith during those first few days.

      • #33523
        WilliamT
        Participant

        Sorry, I didn’t describe this accurately; the discomfort from walking and standing is more of an inflamed and abrasive-type feeling.
        Tugging hasn’t happened much with walking, and when it did, it was mostly on stairs and walking down steep declining slopes.
        Tugging was mainly around movements that involve either excessive stretching/extension, or compression of the repair area. The only time it was scary is when I got “stuck’ in what was essentially a single-leg squat while trying to get into bed. Fortunately I had my follow-up with Dr. Kang scheduled for a few days later, and the incident doesn’t appear to have set me back.
        The tugging sensation feels the same as after the Shouldice repair, but it is less frequent and resolving more quickly this time. It may even be gone now, as gentle stretching, crouching/squatting, and bending are all no problem as of today.

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