No-mesh Shouldice Hernia Surgery in Germany / Europe

[Baris]

Hi all,
i can see that this forum is getting quite intense.
firstly bio hernia hasnt replied to me after they guaranteed money back on a repair that reoccurs in 3 years time.
Secondly i am good. No reoccurrence and i can feel my muscles are strong.to continue, in the first 4 months the mesh was difficult to admit but thats now easing. i went to dr muschaweck in london just to get an update and see what she thinks. Her words were, ‘ if u came from shouldice and they cant fix it you might as-well leave now, speaking very highly of the chief surgeon. We both had a laugh. She was shocked at my story and said as a nation as german doctor i am truly sorry.
yes i did pressure dr koch but i am not the doctor i am not the surgeon my knowledge is minimal and my sole aim is to eradicate the pain. If the surgeon is the cause of the pain its very normal for me to beg for him to get rid of it right?
Dr muschaweck personally spoke to him on the phone as he was supposedly her ‘friend’ as he would not send over surgery reports.
She herself said the whole case is silly from the fact absorbable stitches in a shouldice was used which literally means its on the road to a fail. She told me after i showed my first ever open images dr koch took on the surgery table that my repair could of been done with the minimally invasive technique. Thats how small and straightforward it was. Only a slight bit of fat.
She also presumed that the mesh was used as the second surgery was done too soon and the muscle hadn’t healed up the sutures wudnt of held. When i went to shouldice they were shocked i had mesh as they said my muscle was very strong it just needed healing time. Was this my fault? That a surgeon crumbles under pressure from a patient who he has caused and inflicted pain upon? No.
this was pure greed and il tell you why.
On the second surgery I was told to take out a european health insurance card by dr koch. When i got there he told he will admit me as an emergency so they wont charge me and he wont incur costs. We had to act as if i had a strangulated hernia.
Why did i go through that stress? Wasn’t he supposed to do it free of charge anyway as he had guaranteed 3 years no reoccurrence?
ah and it costs much more than the shouldice clinic.
Theres many doctors out there that perform superb surgery. Dr brown dr kang to name a couple. Dr conze is a great mesh removal surgeon as well. But what dr koch did was solely for a few extra thousand euros.
coming to the cremester muscle. It was a procedure to cut as it reduced recurrences from 4% to the 0.5% they achieve now. This is due to the fact it can irritate/damage the repair.
The technique is a shouldice if it is done the same way as the shouldice clinic, with permanent sutures.
if you go on the newly formed shouldice instagram page you will see Dr Koch being trained by the head of the hospital.
if you go in to dr kochs office you will see a large portrait in a frame of Dr Shouldice. If he’s worshiping the guy and believes so much in it then at least follow it and if you make a mistake ( as it can happen) do your best to ensure the steps taken next are to help the patient recover and progress rather than aiding your pocket to buy yourself a new sporty audi.
Other than that speaking of me i am fine and doing well. The mesh has settled in. The side with no mesh feels as if I’ve never even had a cut before. The side withe mesh sometimes causes a nagging pain but as time goes on this is getting less and less and is not bothering me much. Dr Michael alexander told me it could take up too two years for it to fully heal on the side with mesh but keeping it in was the best course of action at the time as it could of been risky. Never needed it and no one ever needs it unless you have very bad muscle or no muscle. Im running sprinting swimming playing football and feel very strong. I have started lifting heavy since may and it doesn’t bother me at all. I just wish i went there in the first place. I have another appointment with dr muschaweck at the end of the year just for a checkup.
Lastly if you are working for bio hernia or dr koch or if they see this please respond to my email as the following month i will start legal proceedings for medical misconduct neglect and fraud.

[Good intentions]

quote Ben999:

I’m surprised Dr. Conze hasn’t been mentioned yet. He’s absolutetly amazing, removed my bilayer mesh and did a Shouldice repair. He does use mesh in some cases, but only if it’s called for.
https://www.hernia-centre.com/

How are you doing now? Is there a link to your story. I can’t keep up with everyone.

Forest is on the path to mesh. Can’t see the forest for the trees seems to apply, he has a surgeon who plans to use one of the uncommon meshes, apparently, “hybrid mesh–disappearing, with some small kevlar weaved into it”, so no verifiable data just the surgeon’s confidence to depend on. He’s also using the latest tools, “robotic, laporascopic surgery”, which means large pieces of mesh implanted.

So, on the one hand we have the “Guidelines” which imply a verifiable proven method and materials, and on the other hand we have an unproven material and new tools to get the mesh in. Regardless, all of these things are used to justify the use of mesh, when the most important thing, chronic pain, is ignored. Sales and marketing are winning.

https://www.herniatalk.com/12329-patulous-bilateral-inguinal-canals-containing-fat

[kaspa]

Dr. Conze does Shouldice, Desarda, and mesh repairs (Lichtenstein, TIPP and laparoscopic, this one seldom done).

It’s quite amazing being very good in 5 different techniques, but he claims the center did 25,000 repairs in 20 years.

I presume sports hernia, not considered above, is done by Dr. Muschaweck.

He does “tailored surgery”, which is mesh-free 60-70% of the time.

That’s good you have a nice experience.

But I’m not very sure you make an appointment for a mesh-free repair and don’t leave clinic with a mesh decided it’s best when you’re open.

[Ben999]

I’m surprised Dr. Conze hasn’t been mentioned yet. He’s absolutetly amazing, removed my bilayer mesh and did a Shouldice repair. He does use mesh in some cases, but only if it’s called for.
https://www.hernia-centre.com/

[Bestoption]

The topic got heated slightly and it is perfectly understandable regarding the subject. I am not going to take any sides but I would really like to read more posts and impressions by Dr Koch’s patients.
John Fortem, due the vast of information you poses of Dr Koch and his procedures, I was wondering if either yourself or your brother are perhaps working for Biohernia? My question hasn’t got negative implications.

[kaspa]

quote John Fortem:

I am not being aggressive, I just don’t agree with you.

Not agreeing is fine.

quote John Fortem:

I can see that now. I’m sorry, but English is not my first language.

Me neither.

quote John Fortem:

And “here” is?… at the Rolls Royce factory? UK?

Wherever. But I think so, UK.

quote John Fortem:

And “they” refers to Shouldice Clinic…

Well, “they” refers to Rolls.

quote John Fortem:

So let me get this straight…

1. You equate Shouldice Clinic (surgeons!) to Rolls Royce (engineers!). (You made that comparison, not me. I never suggested you would want an engineer to repair your hernia, I thought you were talking about car drivers, not car engineers.)

2. You like Rolls Royce for its perfectionism. Therefore, you align your preference in surgeons to your car/engineering preference. (Shoot for the stars! I get that, and I don’t blame you for wanting the best.)

I can finally see what Rolls Royce has to do with hernia surgery. Perfectionism! Like I said, I don’t blame you for wanting the best. But don’t ask me to agree that Shouldice Clinic is the best. Especially not on the basis of one single patient report of bad outcome and at the expense of one surgeon’s private clinic. And we have not even filled in the missing details of this patient report, or heard the other party (surgeon).

By the way, I don’t think that Audi engineers are any less of perfectionists than Rolls Royce engineers. If we are going to compare things, then we should make sure to compare apples to apples and oranges to oranges. Both groups are perfectionists, simply because they are engineers. It’s in their nature. In order to become an engineer you have to be more interested in things, and less interested in people. In order to become a doctor (of medicine), you have to be more interested in people than things. And I don’t think Dr. Koch is any less competent, any less skillful or any less interested in people than any one of the surgeons that work at the Shouldice Clinic. I don’t understand why someone would even question that. Based on a single case report?

Why do we even trust the Shouldice Clinic so much? Are they really above everyone else? Are they really the top authority when it comes to hernia surgery?

It’s a good comparison indeed. They’re both perfectionists. The comparison isn’t perfect though. If I could buy a Rolls-Royce, I’m sure I could buy the best possible car according to my wishes and I’m sure I wouldn’t be disappointed.

When I choose an hernia surgeon, unfortunately I can never be that sure. I’m never sure they’re doing the best. So many people complain after hernia repair and that’s quite concerning. Shouldice is no exception.

About cars, Audi engineers are very perfectionist for sure, but when they tell you the best cylinder you can have in an engine is made by Audi, not by Rolls, you’re free to take it or not.

As you know virtually every surgeon in every corner of the world will repair groin hernias with a mesh. If you choose not to have mesh, which is very wise in my opinion, you don’t have many choices. Shouldice Clinic, Desarda Clinic in India, Desarda Center in US, Dr. Kang in Korea, Biohernia in Europe.

You see you don’t have much to choose from. And, whatever your option you need a lot of money.

If you ask me to name the best, I wouldn’t name Biohernia. Perhaps a lot of people would agree with me.

quote John Fortem:

You have to understand that Dr. Koch clinic is not a one-man shop. You can’t do surgery without a team of people. I don’t think he is any less of a perfectionist than the surgeons who work at the Shouldice Clinic.

I think the Shouldice Clinic is a good option for people who live close to it or who can afford the treatment at this clinic. Not many people do. But honestly, I think the Shouldice Clinic is glorified too much. That’s not without reason of course. It has played an important roll in pushing back against the “mesh empire”. It is still influential that way.

He’s the brain. No need to put other people a surgeon needs here, that changes nothing. Yes, he can be as perfectionist as you like. That’s your judgement. Each brain in Shouldice needs other people, too.

As for money, I think that people who can afford any of 5 options named above will likely be able to afford any of them. Not the same with cars. Distance can be a problem for people who don’t like long travel, like me.

quote John Fortem:

The name “Shouldice” is one of the main selling points for the Shouldice Clinic, along with its low recurrence rate. To the point that people avoid other clinics unless they use the “original” Shouldice technique. But remember, Shouldice would be nothing without Bassini. Which serves as an excellent example of that single doctor who went against the establishment at the time and paved the way for what later became known as the Shouldice technique, and fast forward a few years and you have the Shouldice Clinic. Was Bassini wrong?… did he make a sound argument for his technique? Why didn’t other surgeons pick it up until after his death?

I like history very much. But history won’t help a lot here. According to Dr. Kang, in North America they imported a corrupt version of Bassini. I can’t tell, but Dr. Kang is perhaps right. Anyway, it’s no big deal.

What we can perhaps learn from history is that hernia repair improvement stopped with mesh repair. I believe Shouldice could now be obsolete if industry didn’t introduce mesh.

quote John Fortem:

I understand that. But suggesting that the outcome is much better if they receive the original Shouldice treatment at the Shouldice Clinic is not doing them a favor. So what? We should all travel to Canada and have it done at the Shouldice Clinic? That’s just silly, and not everyone will be able to afford that, and even if they did, it does not guarantee a positive outcome. There are no guarantees in surgery. At best there are some statistics and there is probability. Let me know when the recurrence rate at the Shouldice Clinic drops down to 0%.

Sure, no guarantees as I told before. There are many people who did mesh repairs and are doing fine. But I wouldn’t ever do a mesh repair unless I really had to. We’re now in the philosophical realm. We’re discussing ideas and people are free to make their choices.

quote John Fortem:

We still don’t have all the details, and if you want to be the judge you better gather as many details as possible, and you have to hear out both parties.

A surgeon cannot know what the eye can’t see, and neither does the patient. Some things are only understood in the middle of a process as you are doing it. Which is why my brother and Dr. Koch agreed to decide on surgical technique and suture material intraoperatively. Yes, my brother had his hernia repaired by Dr. Koch as well, and his hernia went all the way down to scrotum, but he is fine now.

I’d like to have all details, too. But when you don’t have all details you must make judgements with the details you have and I think we have enough of them.

quote John Fortem:

Agreed! But they should be uncomfortable for the right reasons. Not that I want them to feel uncomfortable of course… and I have given them more than one reason to feel comfortable about going to Dr. Koch.

I never told anyone to chose a surgeon or a clinic. I said people in Shouldice are perfectionist and that a single surgeon will have a tough work discrediting that team.

quote John Fortem:

I have said it before, but I don’t mind repeating it again. What really made my decision easy is when I read about a number of cases of mesh repair where one surgeon would put the mesh in but refused to take it out because of the difficulty of such operation, so the patient would travel to a different surgeon to have the mesh taken out. I can assure you that Dr. Koch is not one of these clowns who put the mesh in and then refuse to take it out or redo the surgery. Mr. Baris reported himself that Dr. Koch worked on him more than once. In fact Dr. Koch is one of the surgeons in Europe that people come to visit when they want the mesh to be removed. During my visit in fact, he had one such difficult case of mesh removal, where he had to transport the patient to a university hospital in a different city so he could remove the mesh. I know because he told me so, and he was late for my checkup. He had been gone for almost entire day.

Look! I am not Dr. Koch’s lawyer. If it makes people feel better, more comfortable, knowing that they received the “original” Shouldice treatment and they can afford it, then by all means, have them travel to Canada to get it done at the Shouldice Clinic.

I think you did a good decision based on your premise. But your premise doesn’t lead to Dr. Koch only. Your feedback is quite valuable in a forum like this. Feedback is the best you can offer, indeed.

[John Fortem]

quote kaspa:

About your aggressiveness to me, it seems inadequate to the forum, so any dialogue is finished now.

I am not being aggressive, I just don’t agree with you.

quote kaspa:

I don’t mean people who drive Rolls, of course (I thought that was clear). I mean people who plan and build a Rolls Royce.

I can see that now. I’m sorry, but English is not my first language.

quote kaspa:

I’m talking about engineering. What it has to do with hernia surgery? Well, I wouldn’t like an engineer to repair my hernia. I’m talking about perfectionism and yes here they share that with people from Shouldice Clinic.

And “here” is?… at the Rolls Royce factory? UK?

quote kaspa:

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

And “they” refers to Shouldice Clinic…

So let me get this straight…

1. You equate Shouldice Clinic (surgeons!) to Rolls Royce (engineers!). (You made that comparison, not me. I never suggested you would want an engineer to repair your hernia, I thought you were talking about car drivers, not car engineers.)

2. You like Rolls Royce for its perfectionism. Therefore, you align your preference in surgeons to your car/engineering preference. (Shoot for the stars! I get that, and I don’t blame you for wanting the best.)

I can finally see what Rolls Royce has to do with hernia surgery. Perfectionism! Like I said, I don’t blame you for wanting the best. But don’t ask me to agree that Shouldice Clinic is the best. Especially not on the basis of one single patient report of bad outcome and at the expense of one surgeon’s private clinic. And we have not even filled in the missing details of this patient report, or heard the other party (surgeon).

By the way, I don’t think that Audi engineers are any less of perfectionists than Rolls Royce engineers. If we are going to compare things, then we should make sure to compare apples to apples and oranges to oranges. Both groups are perfectionists, simply because they are engineers. It’s in their nature. In order to become an engineer you have to be more interested in things, and less interested in people. In order to become a doctor (of medicine), you have to be more interested in people than things. And I don’t think Dr. Koch is any less competent, any less skillful or any less interested in people than any one of the surgeons that work at the Shouldice Clinic. I don’t understand why someone would even question that. Based on a single case report?

Why do we even trust the Shouldice Clinic so much? Are they really above everyone else? Are they really the top authority when it comes to hernia surgery?

quote kaspa:

So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

You have to understand that Dr. Koch clinic is not a one-man shop. You can’t do surgery without a team of people. I don’t think he is any less of a perfectionist than the surgeons who work at the Shouldice Clinic.

I think the Shouldice Clinic is a good option for people who live close to it or who can afford the treatment at this clinic. Not many people do. But honestly, I think the Shouldice Clinic is glorified too much. That’s not without reason of course. It has played an important roll in pushing back against the “mesh empire”. It is still influential that way.

The name “Shouldice” is one of the main selling points for the Shouldice Clinic, along with its low recurrence rate. To the point that people avoid other clinics unless they use the “original” Shouldice technique. But remember, Shouldice would be nothing without Bassini. Which serves as an excellent example of that single doctor who went against the establishment at the time and paved the way for what later became known as the Shouldice technique, and fast forward a few years and you have the Shouldice Clinic. Was Bassini wrong?… did he make a sound argument for his technique? Why didn’t other surgeons pick it up until after his death?

quote kaspa:

You’re happy with your repair, and I appreciate that. But many people here are still making decisions.

I understand that. But suggesting that the outcome is much better if they receive the original Shouldice treatment at the Shouldice Clinic is not doing them a favor. So what? We should all travel to Canada and have it done at the Shouldice Clinic? That’s just silly, and not everyone will be able to afford that, and even if they did, it does not guarantee a positive outcome. There are no guarantees in surgery. At best there are some statistics and there is probability. Let me know when the recurrence rate at the Shouldice Clinic drops down to 0%.

quote kaspa:

It seems clear that Baris case was perhaps complex (not that sure), but it’s a surgeon’s task to explain that to patient (before surgery) and even reject it if they feel incapable to repair it. I’m sure surgeon already had a lot of info from Baris even before they met.

We still don’t have all the details, and if you want to be the judge you better gather as many details as possible, and you have to hear out both parties.

A surgeon cannot know what the eye can’t see, and neither does the patient. Some things are only understood in the middle of a process as you are doing it. Which is why my brother and Dr. Koch agreed to decide on surgical technique and suture material intraoperatively. Yes, my brother had his hernia repaired by Dr. Koch as well, and his hernia went all the way down to scrotum, but he is fine now.

quote kaspa:

No one feels much comfortable about Baris case, as you can understand. For people who are deciding, all experiences are worth the same, and it’s good yours is positive.

Agreed! But they should be uncomfortable for the right reasons. Not that I want them to feel uncomfortable of course… and I have given them more than one reason to feel comfortable about going to Dr. Koch.

I have said it before, but I don’t mind repeating it again. What really made my decision easy is when I read about a number of cases of mesh repair where one surgeon would put the mesh in but refused to take it out because of the difficulty of such operation, so the patient would travel to a different surgeon to have the mesh taken out. I can assure you that Dr. Koch is not one of these clowns who put the mesh in and then refuse to take it out or redo the surgery. Mr. Baris reported himself that Dr. Koch worked on him more than once. In fact Dr. Koch is one of the surgeons in Europe that people come to visit when they want the mesh to be removed. During my visit in fact, he had one such difficult case of mesh removal, where he had to transport the patient to a university hospital in a different city so he could remove the mesh. I know because he told me so, and he was late for my checkup. He had been gone for almost entire day.

Look! I am not Dr. Koch’s lawyer. If it makes people feel better, more comfortable, knowing that they received the “original” Shouldice treatment and they can afford it, then by all means, have them travel to Canada to get it done at the Shouldice Clinic.

[kaspa]

quote John Fortem:

I don’t understand the Rolls Royce reference. Are you saying that people who drive Rolls Royce cars are paranoid? Paranoid about what exactly? And what does this have to do with hernias or surgery? If it makes your mind at ease, Dr. Koch drives a sporty Audi. I’m not sure if that makes him paranoid… by your definition.

I’m still reading your post, but this part needs a comment now. I don’t mean people who drive Rolls, of course (I thought that was clear). I mean people who plan and build a Rolls Royce. I’m talking about engineering. What it has to do with hernia surgery? Well, I wouldn’t like an engineer to repair my hernia. I’m talking about perfectionism and yes here they share that with people from Shouldice Clinic. You’re happy with your repair, and I appreciate that. But many people here are still making decisions. It seems clear that Baris case was perhaps complex (not that sure), but it’s a surgeon’s task to explain that to patient (before surgery) and even reject it if they feel incapable to repair it. I’m sure surgeon already had a lot of info from Baris even before they met. No one feels much comfortable about Baris case, as you can understand. For people who are deciding, all experiences are worth the same, and it’s good yours is positive.

About your aggressiveness to me, it seems inadequate to the forum, so any dialogue is finished now.

[John Fortem]

quote kaspa:

I appreciate very much Fortem’s reports and am happy he’s doing well.

Thank you! It’s been close to 2 months now. The scar is even less visible now and the “sausage” underneath the skin (along the incision line) is almost completely gone now. The absorbable sutures are likely more than 50% dissolved by now and I still don’t have any signs of reccurance.

quote kaspa:

However, Bari’s case can’t be disregarded and there seems to have been not much dialogue there.

Let me add that any type of “alternative repair” is better than the “one size fits all” approach done world-over using meshes. Be it Shouldice, “not so much original Shouldice”… whatever! I have said what I think about the “originality” of these different techniques.

As for this particular case, first of all, I really hope that this person gets the help he needs and deserves. As I recall, the operation at Shouldice clinic is already done with by now. I hope he will report back about the results. If you want to be scientific and objective about this then you want to make sure to document the Shouldice side of the story here. It’s one thing to talk loudly about this and that, how one doctor is doing it wrong and the others would never dare to… but let’s see some results please.

Now, the very first thing that came to my mind while reading Bari’s report is the number of hernias he had. Did he in fact have 2 hernias? Two indirect hernias? As I recall he even had a third one? I posted these questions before and I am still waiting for answers. Also, did the hernias go all the way down to the scrotum?

Sadly, this strikes me as a difficult case, and yes, Dr. Koch does do mesh repairs where he finds that it is inevitable or in other words where he does not feel confident to do it without mesh. And yes, surgeons will sometimes go against what was discussed previously with the patient. A bad surgeon will do that irregardless of what the patient wants. A good surgeon will only do that when the current situation forces his hand to do so and he sees no other option, other than aborting the operation. Look! When the patient is breathing through the laryngeal mask and his abdomen is cut open, he has nothing to say about what is to be done. His life is in the hands of the surgeon! Now, if the patient is so paranoid that he does not want a mesh implant under any circumstances then this should be agreed upon beforehand. Then the surgeon can just close him up and send him off to a different surgeon or whoever the patient thinks will fix his problem his way… the “original” Shouldice clinic or whatever.

It’s not easy being a surgeon! It’s a fine line you have to walk. But when it comes down to following the wishes of the patient, vs. saving the patients life, wishes of the patient have to be put on reserve. First priority becomes saving a life. I understand this is a more dramatic example, but nonetheless, the surgeon has to take charge, not the patient. This is just common sense. Unless of course the patient wants to operate on himself or expressly states that he does not want mesh implants under any circumstances, because the surgeon can then abort the operation if he finds that a mesh must be used.

It also seems that the patient was not patient enough. If the surgeon tells you everything is normal, and you have to wait for the body to heal properly, then you do what you’re told. You don’t immediately start pressing his buttons to do something about it and then complain how the Shouldice clinic has told you how they would never have used mesh and how they would never have done a second or third surgery without allowing at least several months to pass before they re-operate. It becomes apparent here that Dr. Koch was giving in too easily and bending to the wishes of the patient. Sorry to say this! But this is the picture I am seeing here, given what was said previously.

As for Cremaster muscle, Dr. Koch will not cut it unless he has to. The “original” Shouldice repair as done at the Shouldice clinic does that routinely, as a preventive measure, even if the current situation does not call for it. So that’s keeping up with the tradition for you. In my case, Dr. Koch did not cut the muscle. But my hernia was not scrotal. In my brother’s case he did make a cut. But he had waited for it to go down to the scrotum before having it repaired. Same surgeon! Different patients (brothers!)! Different clinical presentations! Different approach!

This is all the more reason for people with hernias to get them fixed as soon as possible! Don’t play the waiting game. I did that for about 8 years. I still had to have it done! In the end, most of us end up getting the surgery, and I think it’s better to do it sooner than later. I was lucky that my hernia was not extensive and did not go down to scrotum.

quote kaspa:

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

I don’t understand the Rolls Royce reference. Are you saying that people who drive Rolls Royce cars are paranoid? Paranoid about what exactly? And what does this have to do with hernias or surgery? If it makes your mind at ease, Dr. Koch drives a sporty Audi. I’m not sure if that makes him paranoid… by your definition.

Of course, Dr. Koch is highly untrained and he has no team?… that’s just rubbish! If the majority had to decide, then the Bassini technique would never have happened, and since Shouldice technique is derived from Bassini, the Shouldice clinic would never have seen the light of day.

quote kaspa:

They don’t simply follow original Shouldice teachings, hopefully. They even do mesh repairs in selected cases, less than 2% according to them.

Well, of course they don’t! They “only” use steel sutures and cut the Cremaster muscle routinely. And sometimes, they also use mesh. Go figure! For starters, you have to define exactly what the “original” Shouldice technique is.

According to them, yes. In the end, we all believe in what we want to believe in. Humans are biased by nature. Do whatever you think is good for you, and do your own research. But there is no good reason not to get rid of your hernia if you have one, free yourself of this problem and move on with your life.

[kaspa]

I appreciate very much Fortem’s reports and am happy he’s doing well.

However, Bari’s case can’t be disregarded and there seems to have been not much dialogue there.

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

They don’t simply follow original Shouldice teachings, hopefully. They even do mesh repairs in selected cases, less than 2% according to them.

[I couldn’t edit and this jumped to next page, that’s why I repeat previous post]

[kaspa]

I appreciate very much Fortem’s reports and am happy he’s doing well.

However, Bari’s case can’t be disregarded and there seems to have been not much dialogue there.

Shouldice Clinic is a reference in inguinal hernia. They’re a highly trained team who only do that and they’re as paranoid as people in Rolls Royce. So, one single doctor, however good he or she can be, will have a hard time formulating a sound argument they’re wrong. If they say something is important, chances are more than 99% it is.

[John Fortem]

Ah yes! I got it now. Dr. Shouldice was influenced by Dr. Bassini. Here is an excerpt from a book called Textbook of Hernia, published by Springer in 2017, where Dr. Koch is a contributing author. I believe he penned the part about tailored approach and history of hernia repairs. Here we go…

quote :

“The ancient history of inguinal hernia is remarkable with many creative but mostly futile approaches to its treatment. One illustrated and informative resource for the work and workers of that era are the early chapters in Hernia Healers by Stoppa et al. [14,15].

The modern era of inguinal hernia repair began with the works of Bassini [16]. He recognized that the transversalis fascia was the Achilles tendon of the groin, the layer through which hernias develop. He proffered that to correctly repairan inguinal hernia the groin must be dissected layer by layer knowledgably and carefully from the skin into the preperitoneal space. Only then could the muscles, fascial elements, vessels, nerves and vassal structures be identified and preserved. His reconstruction began with the posterior wall opened. After checking for a femoral hernia,he dissected the peritoneal sac to its true neck and ligated it there. He then used a three-layered interrupted suture repair to reconstruct the canal’s posterior wall. His deepest suture line included the lateral edge ofthe rectus muscle, the internal oblique muscle, the tranversus abdominus muscle, and the medial edge of the transversalis fascia. He approximated that four-layer composite to the lateral edge of the transversalis fascia and the inguinal ligament. He replaced the spermatic cord in its normal position and sutured the external oblique aponeurosis to comfortably re-create the obliquity of the canal and the external inguinal ring. In his earlier operations, starting in 1844, Bassini insisted his patients be awakened enough from anaesthesiato perform straining motions to prove that his repair was sound. Bassini’s results for inguinal hernia repair was astounding compared to the poor results of other surgeons of his time. With 90 % personal follow-up of 262 casesover 4 years, his failure rate was less than 3 %. He eventually reported this in a paper entitled, Nuovo metodo operativo per la cura dell’ernia inguinale. While some have noted that Bassini never specifically wrote about the importance of opening the posterior wall, illustrations by his devoted pupil, Catterina, clearly showed that he did open it and that he had described doing so in his own paper, Bassini’s operation for the radical cure of inguinal hernia [17].

Bassini’s true repair was altered and became known as the Modified Bassini Repair/North American Bassini Repair as was its impressive results. Many North American surgeons, influenced by Andrews, did not appreciate the importance of completely reconstructing the canal’s posterior wall. Most simply ligated the peritoneal sac and pulled the transversus arch to the inguinal ligament, frequently under enough tension that a relaxing incision was needed. The short-and long-term result of the Modified Bassini repair was not good. Most failures could be traced to the inability of tissues pulled together under tension to withstand normal intraabdominal forces associated with ordinary bodily functions.

In the early part of the twentieth century severalother suturing techniques were used to approximate the internal oblique and transversus abdominus muscle, with or without the medial flap of the external oblique, to the shelving edge of the inguinal ligament. The “Darn” technique was popular in the UK, Europe and the Far East [18]. Continuous single or double strands of nylon or silk suture that bridged the canal created a mesh-like structure. This technique never gained much interest with American surgeons.

E.E. Shouldice, a Canadian surgeon, revitalized Bassini’s original principals of inguinal hernia repair [19]. Using a local anaestheticShouldice dissected the structures of the groin including opening the posterior wall into the preperitonealspace. Differing from Bassini’s interrupted suture technique, Shouldice used continuous 34-gauge stainless steelwire to reconstruct the posterior wall and repair the hernia. The results of many-thousand repairs at the Shouldice hospitalare impressive. Shouldice championed using local anaesthesiaand insisted on patients ambulating early. His detailed dissection through the double layers of transversalis fascia, along with the contributions of Rives and Stoppa of Franceand Nyhus and Condon in the USA and the earlier work of Henry and Cheatle helped set the stage for the eventuality of posterior repairs.”

There is more to read. This is the book:

https://www.amazon.com/Textbook-Hern…/dp/3319430432

[John Fortem]

I’m sorry you had this bad experience Baris. I know it’s of no comfort to you, but it needs to be said that not every operation has the same outcome. We are all unique, and there are many variables that influence the outcome. I think that’s also what makes surgical studies difficult, because you have so many things to consider and measures to compare across, the results easily become diluted and incomprehensible or inconclusive.

Did you say you had triple hernias? Two indirect hernias? Scrotal even? What was the third one?

I had my surgery at the hands of Dr. Koch about 1 month ago now, and I can assure you I am 99% recovered, I have fully restored function in my groin, I have no pain or discomfort. Frankly I can’t believe it ended up being this good. If I knew I would have had it operated on years ago. But I only had one, indirect hernia on the right side. I had it for about 8 years, and if I had not repaired it I think it would have gone down to the scrotum which would have complicated things. So the lesson I learned is that as soon as you recognize that you have a hernia you need to start doing your research and making plans for repair. It should not be postponed. The trouble with postponing is that you start stacking problems one on top of the other. This is true for all ailments, not just hernias. Problems are meant to be dealt with, the sooner the better.

Dare to ask questions! I knew exactly what type of inguinal hernia I had (indirect), why I had it (congenital), and what type of repair would be done, and I even knew what type of sutures and gauge would be used. I was told all these things by Dr. Koch. But I got many of these details by simply asking him, it’s not something he will tell you unless you ask. Most people will find this level of detail boring or even frightening, and while my experience with ordinary general surgeons who don’t specialize in hernia surgery don’t even tell you what type of mesh they will use, Dr. Koch is ready to answer all your questions.

Yes, Dr. Koch uses a modified Shouldice repair. But I knew that before I even came to Germany. Because I knew what the so called “original” or genuine Shouldice entailed, because I did my research beforehand. Using steel wire for suturing? Are we still living in the 18th century? I am glad that Dr. Koch uses a combination of absorbable and non-absorbable synthetic sutures. And why would he cut the cremaster muscle unless he needs to? Just because the Shouldice clinic dictates so? Because the inventor of the technique – Dr. Earle Shouldice – who lived in the 20th century used a steel wire and used to cut the cremaster muscle? The technique used should be fluid, not a static teaching from the previous century, just so you can say that you are staying in touch with the tradition.

What I liked the most about Dr. Koch is that he is approachable, he listens and adapts to your specific needs. There is nothing worse than blindly following the teachings of an old school just for the sake of preserving the tradition. Be water! As Bruce Lee would have put it. Formless! Shapeless! Dr. Koch uses the same principle. Could it be that Dr. Koch is the Bruce Lee of hernia surgeries?

All the major and minor hernia repair techniques are improvements or modifications of one or the other. You have McVay, Desarda, Shouldice, Bassini… I don’t recall now what order these came in, but I am pretty sure the “original Shouldice” borrows from some other technique, and that’s alright, that’s how it should be. Borrow freely what you find useful. That’s the only way to a better way. How does that old saying go… all artists borrow, the best ones steal?

Losing fat prior to surgery is always a good idea, if you can manage, regardless of type of repair or even type of surgery being done. I started doing strength training and conditioning 2 months prior to my surgery.

As I recall I got 10 big wound dressings in my goodie bag. On day 2 after the surgery I could hardly get out of the bed on my own and stand up straight. I walked like a robot. I did not have much pain, but I was feeling very stiff and my abdominal muscles were tense and I even had episodes of twitching. That’s because it was sutured in. Dr. Koch told me that this is normal and that the muscle needs to remodel itself, and so it did. I estimate that for each day that went by I was feeling 9% better. So right about day 10 I was nearly 100% recovered and I was feeling like myself again. I thought to myself this is amazing… Dr. Koch has accurately assessed how many wound dressings I would need. From that point on I saw nothing but improvements.

Right around the end of week 3 I reactivated my gym membership and started doing some light cardio workouts. After week 4 I started doing some weight lifting. I could not wait to start hitting that gym again, and I am dead serious about exercising now. I have never exercised this much in my whole life. I exercise 5 times a week with 2 days off during weekend. I am nearing the end of week 7 now and I am doing squats and pull ups, something I could never do before. I have never been a fat guy. I used to compete in athletics for a local club, I did that for 7 years, I trained karate for 3 years, I gave tennis a shot, among other things. I am what you would you might call a normal guy, just a little bit over the “normal” limit if you look at the BMI or waistline. My hernia is/was mainly congenital, but having a sedentary job did not make things better for me and frankly I believe that’s largely what contributed to my hernia (loss of supportive lean muscle).

There are a lot of things to be said about the surgery, but I have nothing but only positive things to say about my experience with Dr. Koch.

I can highly recommend Dr. Koch to anyone looking for…

1. A surgeon who listens and tailors the surgery to your wishes and needs.
2. A highly skilled hernia surgeon with special training in Shouldice repair.
3. Well educated and informed surgeon who keeps in touch with the literature and the hernia field.
4. A surgeon within Europe that does mesh-free hernia repairs.

[kaspa]

I found an article by 3 German surgeons who did Desarda repairs in Rostock:

“Inguinal Hernia Repair According to Desarda – Implementation of a Mesh-Free Method in a German University Hospital” (2015)

The article is written in German and requires subscription. It’s a 2-page article and first page can be read as preview in Thieme’s site.

Authors are Phillip M, Förster S and Klar E. I could only locate Dr. Ernst Klar who is Director at the center where repairs took place.

I don’t know how many patients were operated and results (abstract in English at Pubmed doesn’t disclose that).

All information in center’s page in Rostock is in German, so it seems they’re not looking for foreign patients, but this can be an additional contact in Germany for people wishing to have a Desarda repair:

Prof. Dr. Ernst Klar
Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie
Universitätsmedizin Rostock

In clinic’s site there’s contact information for Prof. Dr. Klar (Secretaries Anja Meschke and Frau Stein).

If anyone can find info on the other 2 authors, please share here.

Rostock is in Northern Germany and I could find a single flight there. It’s operated by Lufthansa and travels Hamburg-Rostock in about 1 hour.

Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie
https://allgemeinchirurgie.med.uni-rostock.de
Universitätsmedizin Rostock. Spitzenmedizin für die Region. Forschung für den Menschen.

[kaspa]

It’s quite worrisome and depressive reading [USER=”2468″]Baris[/USER] such bad experience in Germany.

People who search for Dr. Koch want a non-mesh repair and most of them are thinking about Desarda, but I think Desarda is the repair least done by him.

Anyway, I thought that he could tell before surgery which repair would be most suitable in his opinion, either by examination, or requesting any exams.

Deciding on the operating room for a mesh or non-mesh or Desarda or “modified” Shouldice doesn’t look nice.

After reading this I think that one can get the surgery one wants only if they go to specialized clinics like Desarda’s in India, Shouldice in Canada, or Dr. Kang in Korea.

When searching for surgeons I found one in Germany that could do some 8 repair types with training in lots of Clinics throughout the world. I discarded him right away because only a superman could be enough proficient in so many repairs… Any normal surgeon would do any of them once in a while and hardly would be that proficient.

I really hope Baris is finally in good condition with his repair in Shouldice after so many bad experiences and spending so much money with all those experiences.

All this makes me think twice as my hernia is only esthetic, everything working fine and zero pain. Even if esthetic is quite important too and makes me miss a lot the time I had my groin area in perfect condition and didn’t know I lucky I was.

[John Fortem]

quote Chaunce1234:

Dr Andreas Koch in Germany (unsure of location)

He is based in Cottbus, east Germany.

[Baris]

Hi good intentions,
in terms of mesh i am not against it. I understand that it is needed in some cases especially with elder patients with direct hernias. What frustrates me most is the fact that i had two indirect hernias which with the shouldice technique mesh is pretty much never needed as stated by the chief surgeon. I have images of the hernias whilst in surgery and the space the fat has come out of is very small. And maybe that explains why im in so much pain.
In terms of mesh i wouldnt be able to say but for no mesh surgeries i really do believe losing weight especially fat will enable a better repair and also recovery.

[Baris]

Hi chaunce,
yes maybe tgat was the case but would it be right to state uve learnt the tecnique in canada and do the same thing but change a main area to it in terms of sututres?? That just becomes a new technique in my eyes and maybe if yhat was discussed prior to surgery that would of been much more ideal in enabling me to make the best desicion. The diet is a very low carb one and specifically states that it is temporary due to the sudden changes and reduction in calories consumed. I just believe its super healthy and i can manage it forever if i really needed too and a lot of previous shouldice patients have stated that they actually do continue with the main concepts of the diet. Id certainly say i feel much better.

[Chaunce1234]

[USER=”2468″]Baris[/USER] Thank you for the update and for sharing your experience, this is important data to know and it will undoubtedly help other patients in decision making. I’m sorry to hear that your initial procedures failed and I wish you the best in your future re-do surgery, and please keep us updated on you progress and how that goes.

I believe the Shouldice clinic uses ultra-thin stainless steel sutures, which are presumably very strong and maybe that’s another reason why they have such great success at the Shouldice hospital in Toronto. Just theorizing here but maybe the absorbable sutures used in your first repair dissolved before the muscles had a chance to fully regrow to one another.

Out of curiosity, what is the general weight-loss diet that Shouldice recommends to their patients? Low carbohydrate?

[Good intentions]

Thank you for posting that Baris. It sounds like you’ve been through the wringer.

It’s a shame that these professionals can’t get together and discuss the pros and cons of what they do without criticizing the other methods, and guarding their own. All of the methods seem to have horror stories attached, and all seem to have inherent flaws. But they all seem to have some positive stories too. If they could just share the knowledge with a combined effort to determine the best method for the individual patient, everyone would be better off.

Here is a link to a thread I started about good mesh stories. The last one I posted, #30, is one of those positive stories. Keep it and the surgeon he used in mind if the Shouldice technique doesn’t stick. It’s a mesh-based procedure but the person had very good results. I wish we knew why. I’m not promoting mesh by any means, just offering a “known-good” repair’s surgeon. Good luck.

https://www.herniatalk.com/6883-successful-good-mesh-stories/page2