No mesh

[Good intentions]

quote kaspa:

When will my post flagged as spam be revised and published?

It might not. Dr. Towfigh has to have the time to look at it and release it if she decides to.

[USER=”935″]drtowfigh[/USER]

[kaspa]

When will my post flagged as spam be revised and published?

[kaspa]

I spent a lot of time writing a post and when I finished it it was flagged as spam! So we must wait until it’s revised by someone… This is my second time.

[Bestoption]

Hi Dr Kang.
Thank you for elaborating mine and Kaspas queries. From what you’re saying and on the basis of ultrasound scans there is a high percentage that I really have bilateral inguinal hernias.
You’’’re also right to say that my situation is more complex due to the joint pains, especially in the hips and lower back. I’’’ve been living with musculoskeletal issues for quite some time and seems they do get progressively more complex. Unfortunately without the correct diagnosis I cannot deal appropriately with existing health issues and therefore I am confused by the symptoms. But I am pretty sure that hernias have enhanced certain pains in my legs and hips.

[drkang]

[USER=”2658″]scaredtodeath[/USER] As I said, there is a part of your question that I do not understand. However, I will answer based on how I understood your question.
There are many tissue repair methods, which result in different outcomes. Most of the tissue repairs before the start of mesh hernia repair were modified Bassini repairs, which showed a recurrence rate that was too high back then.
However, the recurrence rate of original Bassini repair reported first in 1870 was 2.7%. I think the ‘modified’ surgery, which corrupted the original method, caused the recurrence rate to go as high as 30%, while that of the original method was 2.7%. As far as I understand, the fundamental difference between the original and the corrupt Bassini repair is that the one firmly saws together the defect margin of transversalis fascia to close the hernia opening created by a tear or a gap and the other does not.

I think that sawing the transversalis fascia defect should become the most important principle of hernia repair surgeries. In this context, there is nothing strange about the recurrence rate of Shouldice repair which fully embraces this principle, being as low as 1 to 2%. I believe that any tissue repair that fully embraces such principle can show the recurrence rate as low as 2%, and a better designed repair method may reduce the recurrence rate down to almost zero. Meanwhile a tissue repair not following such principle may result in the recurrence rate of 10 to 30%. Such principle of surgery is the most important element of a successful surgery for both indirect and direct hernias.

A tissue repair carried out fully following such principle will allow the patients to quickly recover, and the patients who received such repair will be able to return to their normal lives much faster than the patients who received other type of tissue repairs. So, I impose no restriction on my patients who received our inguinal hernia repair to engage in strenuous exercise, once three weeks pass from the repair surgery.
Meanwhile, the repairs that do not follow such principle – sawing transversalis fascia defect to close the hole there in – are relatively and inevitably vulnerable to recurrence and require a longer recovery period. Various forms of modified Bassini repairs and the mesh repairs administered nowadays, as well as Desarda repair recently attracted attention, are the repair methods that do not follow such principle.

McVay repair may be considered to follow the principle of inguinal hernia repair surgery, but it will cause the structure of the inguinal canal to be deformed after surgery, because it is not an anatomical repair (as Bassini repair or Shouldice repair are). That is, McVay repair is sawing the medial margin of the defect of the transversalis fascia laterally to the Cooper’s Ligament which is located deeper to the inguinal ligament. This repair method can close the gap that may cause femoral hernia. However, femoral hernia does not occur so frequently. Also, even the surgeons with considerable experience sometimes cannot accurately administer McVay repair, because it is so complex. So, McVay repair has a longer recovery period than those of Bassini or Shouldice repair, and the recurrence rate thereof could be higher. So, I do not prefer McVay repair.

[USER=”2908″]Bestoption[/USER] I am not sure whether you have an inguinal hernia or a sports hernia, because your symptoms are not typical and complex. You said that you have no bulging on coughing or sneezing. However, if the ultrasonography found bilateral inguinal hernia, I think we should believe that. FYI, sports hernia cannot be diagnosed by ultrasonography. Sports hernia frequently occurs to athletes who make sudden change of direction while rapid running, such as professional soccer or American football players. It rarely occurs to others who engage in light exercises. And it is hard to be found not only by ultrasonography, but also by any other testing methods. Thus, it can often be diagnosed by history taking and physical examination.

You will find that many doctors have their own different definitions of sports hernia. Although the same name of ‘sports hernia’ is used, doctors have different opinions on which area is damaged. So, the area of surgery also differs frequently depending on the doctor. Thus, many of you who searched information of sports hernia might have been confused.

I have so far performed about 500 sports hernia repairs mostly for professional soccer players. From my experience, I believe that the sports hernia is an event where the external oblique aponeurosis of inguinal canal is injured. So, I have administered a simple surgery, which repairs the external oblique aponeurosis only. They successfully recovered and made come-backs to their sports.

[Bestoption]

Hi Kaspa. I apologize for not being clear. My concern was due the long term spasms and acid re-flux which might damage esophagus and not the Lomeprazole. I try to look after my diet and really struggle to loose weight.
I have been very precautius with not overstraining myself and more resting than usual and have brought down the pain quite a lot. I suspect sports hernia but nothing is defined until I get professional diagnosis.. Indeed would be good to see Dr Kang’s response regarding sports hernia and his repairs.

[kaspa]

Hi, Best. I think Lomeprazol won’t damage your esophagus.

Dr. Kang is able to repairing both direct and indirect inguinal hernia. I’m not sure about sports, but he may be able to repair it or at least advise you on best options.

I hope Dr. Kang will come here soon.

[Bestoption]

Hi Kaspa. I just noticed that my response hasn’t been published for some reason. I just came back from my GP and was prescribed Lomeprazaol despite I explained that have been using in the past and it didn’t help. I have raised concerns regarding possible long term damage to esophagus but had no effect to her decisions.
You might be onto something when relating hernia to the gastric pain and issues.

Am i correct to say that Dr Kang is capable of repairing any type hernia either direct, indirect or sports. I a currently looking at private diagnosis of what type of hernia i have as my appointment is few months away.

Also does anyone has any news about Dr Koch?

[kaspa]

I always appreciate reading Dr. Kang’s opinion. There aren’t many experts in inguinal hernia like him, unfortunately.

I think the most important part in his statement above is that most doctors do a lot of repair techniques which they think it’s better in each case in stead of doing a single technique, or two at most for direct and indirect. That way that’s much more difficult that they are experts in any technique and thus have small rates of complications (we can add that most surgeons do a lot of surgeries and only some hernia repairs, which makes that more important).

When I searched for hernia surgeons in Europe I found one that could use more than 7 or 8 techniques with training in centers worldwide. Too much technocracy for me and I discarded him right away (later I even learned that training in Shouldice Clinic consists in watching a few surgeries without touching anything).

Also, I’m not very sure that most surgeons are aware that high ligation is mandatory in indirect hernia repair…

[kaspa]

Bestoption , perhaps you should ask that to your GP. He’ll probably ask for an endoscopy, if need, or simply prescribe medication, IMO. Anyway this is not the best forum to discuss that.

I have discovered something interesting since my hernia appeared 4 months ago. I use to have some epigastric pain from time to time, most often after meals. It’s happened a few times in the past 10 or more years. Sometimes it’s quite intense and I even went to an emergency department once and they thought that was some kind of gastritis and gave me omeprazol IV without any benefit.

Recently that happened after breakfast and it was so intense I thought I had to go to ED again, but it disappeared after some 30 minutes.

Later I found that that this epigastric pain is related to my hernia and it completely disappears if I reduce my hernia.

It’s interesting not only to see this is related to hernia, but also how meals seem to influence hernia’s tension.

Also, it’s interesting to have had that episodic pain for more than 10 years before hernia appeared. I think this can mean that something in my inguinal area was wrong long before hernia appeared.

By the way, this is the only symptom of my hernia so far (apart from bulging of course).

[Bestoption]

t was today unkindly reminded about something else. I’ve been suffering for about 2 decades with pains below sternum combined with belching and acid reflux Originally the symptoms were mild but in the recent years pains got intensive and lead to spasms, breathing difficulties and bloated upper abdomen. I guess this often happens after overeating, greasy foods, laying down, heavy lifting or stress. I was given regular chest X ray which shown nothing. My GP never looks for any connections but happy to prescribe drugs.
I find symptoms very similar to hiatial hernia and hence I have gastrointestinal issues. My presumtion might be wrong, but I do wish I would listen and observe my body long time ago. I am wonder how much damage has acid already done to my esophagus.

[Bestoption]

Big thanks to everyone and their contribution. I’ve been following every single response including privately. Dr Kang I am also very thankful for your participation on this forum including my topic. Platforms like this one are great so the specialists can be reached out.

English is not my first language therefore I apologize ahead for any nonsense and the long winded post.

I’ve been experiencing some long-term pains and aches so I cannot tell for how long I had these hernias. I struggle to distinguish which symptoms are hernia related and which not.
But I would like to know what has contributed to the development and what could potentially cause reoccurrence of hernias after the repair.

Pain relief with an osteopath. His sessions involved deep pressing onto inguinal ligament and this was extremely painful. He had good intentions and he is not a culprit of hernias (as both didn’t knew at the time I even had hernia) but I am confident that he made same tears to them. After the treatments stabbing and slashing pains in the abdomen were more pronounced than before. Ironically he has temporarily reduced the pain elsewhere.

Eventually I managed to persuade my GP to have an ultrasound and despite I the operator that I feel pains on both sides he insisted on inguinal hernia in the right groin.
I wanted assurance so I booked ultrasound privately and they identified a bilateral inguinal hernias.

Till date I still don’t know whether I have direct, indirect or sports hernia. Neither when performing the NHS or the private ultrasound have confirm the type. Therefore I have no choice but to wait for the scheduled appointment.

I am not good with describing pains and don’t know which ones are hernia related and which aren’t. No bulges and no pains when coughing or sneezing, Occasional abdominal stabbing or slashing likely if sitting down or standing. Everything below the waist feels heavy especially legs and there is some dragging feeling in testicles. Aching pelvic, pubic bone, buttocks, thighs, lower back, hips and down the legs. Gastrointestinal system is out of control: bloated & upset stomach (belly is surprisingly large now), flatulence, constipation… Urinating is ridiculous as I need to strain to pee and the bladder never empties so I have to repeat the process multiple times. Sitting down or standing up is unpleasant. I had to stop cycling (I really enjoyed cycling). I am avoiding lifting heavy objects. I sleep mainly on my back or sideways and with the pillow under my knees or between them. Laying on my back doesn’t hurt.
I manage pains quite well with mild massage, tiger balm, TENS machine. I take some baths with Epsom salts and magnesium flakes. Although I like the feeling of heat I am not sure if it is beneficial. I had to stop breathing technique exercises for straightening the core as it triggered the pain.

I will go with a non mesh repair but not decided on the procedure which will be the most suitable for me. Indeed I am perplexed. The costs are another concern.
Some time ago I was pretty much decided to go via Biohernia and DR Koch.
I became quite worried after reading the post on this forum by user Baris and his horrible experience with Dr Koch. It may be the only unsuccessful procedure done by him but it needs special observation and understanding.

Despite above it might be shocking to some, I haven’t yet excluded DR Koch, at least until I get a better understanding.

[drkang]

quote scaredtodeath:

Thank you dr Kang for your reply… if you have still interest in this thread of discussion would you mind giving your opinion of tissue repair success/challenges/risks of direct vs indirect hernia and also how each repair may impact flexibility

I am sorry that I can not catch the point of your question exactly. I have sometimes difficulty to understand English which is not my mother language. So please let me know your point again particularly about ‘risks of direct vs indirect hernia’ and ‘how each repair may impact flexibility’.
And your question could not be answered briefly in several sentences, so please give me a couple of days. Thank you.

[scaredtodeath]

Also can you enlighten me what you would expect healing wise and activity wise for a patient if a MCvay vs bassini vs Shouldice was the procedure used

[scaredtodeath]

Thank you dr Kang for your reply… if you have still interest in this thread of discussion would you mind giving your opinion of tissue repair success/challenges/risks of direct vs indirect hernia and also how each repair may impact flexibility

[drkang]

[USER=”2658″]scaredtodeath[/USER] It is a kind of simplified Bassini or Shouldice repair. The scope of repair is just limited to Hesselbach triangle where the direct hernia occurs without the excision of the cremaster muscle. So it can be done through a smaller incision. Thank you.

[scaredtodeath]

Dr Kang what method would you employ for a direct hernia

[drkang]

Hi Bestoption,

Thank you for considering my surgery method as one of your options.
And I also thank Good Intentions – you have always been so devoted to this forum.

As I read the statements and questions posted to this forum, I have always wanted to say about a few things. I noticed the statements related to such things were posted here, so I would like to give you my opinion thereon.

The biggest difference between most of other inguinal hernia repair surgeries and Marcy repair is: while most of other inguinal hernia repair surgeries are type-nonspecific repair method, Marcy repair is type-specific repair method for indirect inguinal hernia. In other words, Marcy repair is, as far as I know, practically the only surgery method which repairs indirect inguinal hernia in type-specific way. (Unfortunately, it is difficult to find any information as to how Dr. Marcy administered direct inguinal hernia repair surgery.)
So, many people seem to think that any type-specific indirect inguinal hernia repair is always Marcy repair. However, what I think is that Marcy repair is just one of type-specific repair methods that can be administered for indirect inguinal hernia repair. This is the same as there being many different methods of type-nonspecific repair such as laparoscopic mesh repair, Lichtenstein, Bassini, Shouldice, Desarda and so on.
I have been administering non-mesh repair (where indirect type and direct type hernias are repaired by different surgery methods) for the last 7 years. And there is a big difference between the indirect type-specific repair I administer and Marcy repair.

Some think that Marcy repair is for children. In most hernia repair surgeries for children, only high ligation of hernia sac is administered. However, Marcy repair additionally closes the deep inguinal ring after administering high ligation of the hernia sac. (The high ligation of the hernia sac is a mandatory process of all existing surgery methods conducted when repairing indirect inguinal hernia.) Thus, Marcy repair is an indirect inguinal hernia repair method for adults. As far as I know, the recurrence rate of Marcy repair is very low (1~2%), once it is accurately administered. However, it is my understanding that there are not so many doctors who are used to this surgery method. Thus, when administered by inexperienced hands, the recurrence rate of Marcy repair would naturally increase.

Another thought I had after reading the postings to this forum was that a lot of people seemed to think that mesh repair is appropriate to some and non-mesh repair is appropriate to the other, depending on the patient’s condition of herniation. Also, it seemed that there were many people who thought that even if the mesh repair is administered: there is a better mesh repair method according to a patient’s condition of herniation; or it is better to choose the most suitable surgery method among many non-mesh repair surgery methods, such as Marcy, Desarda, Bassini, Shouldice, etc, according to a patient’s hernia condition.

Such thoughts may be quite reasonable and correct. However, what I have learned from my experience and convinced of is that whether a patient’s hernia is severe or in early stage; whether a patient’s muscles in the inguinal region is strong or not; whether a patient is exercising a lot or not; or whether a patient is obese or thin, the best result can be achieved by a method in all cases, as long as a good method is administered. Thus, I believe that different hernia repair surgery methods should be administered depending only on whether the inguinal hernia is indirect type or direct type, and I have been administering more than 10,000 non-mesh inguinal hernia surgeries as I believed. Thank you.

[Bestoption]

quote fidel18:

Dr Brown of Fremont, CA used the Marcy-Desarda technique on me during my May 22, 2019 operation. Good outcome, specially as it pertains to pain and inflammation and healing. You can check his website and schedule an online consultation.

He sounds also promising. Thank you will read more about.

[Bestoption]

quote Good intentions:

As I understand things, both Dr. Brown and Dr. Kang understand groin anatomy and the various named techniques well enough to produce appropriate variations as they see fit. They asses each situation as they go and choose the most appropriate way to solve the problem.

Also, as I understand things, the “Marcy” technique is used for indirect hernias. So the type of your hernia will matter.

Both Dr. Brown and Dr. Kang have seen the damage that mesh can cause and have made a conscious and informed decision to avoid using mesh if possible. Named techniques, by their nature, are self-limiting. I would choose a surgeon who knows all of the techniques, and understands the basis behind them, and uses them in the way that is best for the patient..

Good luck.

Thank you for your response and it does make sense what you’re saying. I am seeing lots of positives for Dr Kang.

Procedure in Germany would be convenient for me
(distance and potential reimbursement). It interests me if how comparable is Dr Koch approach and procedure to the above surgeons. Unfortunately I am not seeing many recent comments about him.