Pinto -our Kang expert….

[Chuck]

Pinto first thanks for your many brilliant posts about your experience with Kang. My instinct continues to say he is the best option for hernia repair given the invasiveness of the Shouldice repair and the question marks surrounding Desarda. Per the usual my only hesitation is due to the expertise of our friend Watchful and his preference for Dr. Conze…There is probably no one on the planet we can trust for hernia advice more than him…i simply do not trust anything doctors say at all. So I have asked Stephen a bunch of questions reqarding Kang’s ability to fix large hernias and his experience with chronic pain. Since you have had two surgeries with the good doctor…you are in the best position to opine on these issues. You say that others here…and i think you are implying our friend Watchful may be misinformed about the Kang repair. I think its difficult for anyone to be fully informed about it…given that kang is in korea and does not consult due to the language barrier….Watchful probably has come the closest to doing a thorough analyis of kang—even employing a korean friend to check reviews…but also Dr TWofigh has raised a number of questions…even looking at one of his surgery videos and saying…Oh he is doing a marcy…we only do that on kids. Sorry if I am coming across as obsessive.. hernia surgery options can truly give you mental illness…so much misinformation…conflicting studies and downright dishonesty –its nearly impossible to know who to trust. But you probably have studied Kang the closest…and you seem like a smart and geniunely nice fellow…so if you say we can trust kang to fix all manor or hernias…I am inclined to go with that even in the face of watchful’s questions. So lets see how stephen responds…but is it your view that Kang has the expertise to handle any type of hernia? Does he ever use mesh? Its a little concerning that you had so much post op surgical pain…thank god it resolved…but several folks that went to Kang have said they were is such pain they could barely walk…one patient said he had to stay another night. So the Kang repair definitely has some downsides….I know that i would probably just book an extra night in the hospital—why take the chance trying to move or bouncing around in cabs?? It really amazes me how this surgery has wrecked my whole life…as you can tell i am obsessively careful about health decisions…I chose lap because of lower risk of chronic pain…i was told…probably dishohonestly that i had two hernias….and i didnt want scarring…very vane of me in retrospect. Carvajal went through my navel….i just have to make sure i dont make anymore mistakes…so any light you can shed on your experience is of great help….Happy to contribute to your favorite charity for your insights!

• This topic was modified 1 week, 4 days ago by drtowfigh. Reason: Disrespectful language

[pinto]

Everything I posted about my experience is as accurate as I could make it. Let me correct your mis-statement (in my view):
“Its a little concerning that you had so much post op surgical pain”

Your statement is wrong—from my perspective. You must be referring to my first surgery. I probably am more tolerant of pain than most others but here are three “pains” to talk about: 1) unavoidable pain, immediately post-op that everyone has; 2) my getting out of bed; 3) the taxi rides. Other than those I had no pain. #1 cannot be eliminated anywhere. #2 only if I was not in a motorized bed. #3 not if I had stayed longer in the hospital.

Given I had a sliding hernia it might have required a longer stay for caution’s sake. Moreover as I posted in the thread “Sliding Hernia,” the hospital staff was a bit unaware even though I had them search locally for a rental hospital bed for my hotel room (= unnoticed red flag). As a matter of fact after a few days in my hotel room going into my shower, I thought “I really didn’t need pain meds” (while excepting the walking + taxi rides). The rest of the 99.9% time it was painless.

I surmise that generally most surgical pain comes from the incision. Stephen says Kang’s incision is the smallest in the world at an inch and a half. I’ve yet seen any smaller for pure tissue repair. My #2 and #3 pain was not due to incision (known by my second surgery); I attribute it to the hospital but I am forgiving because everything else was so fine. Anyway going by other Kang patients, my first surgery was not representative. Nevertheless afterwards I was painless and body fully intact. 😀

You say, “several folks that went to Kang have said they were is such pain they could barely walk…one patient said he had to stay another night. So the Kang repair definitely has some downsides.” Name me a surgeon anywhere in the world who could do better. If you look enough you will find the same for any top surgeon. A million and one variables involved. You will find no perfect scenario.

I cannot answer your technical questions. I think Shouldice’s reputation is great—the gold standard. But too much slicing and dicing in my view. Kang, according to his website, was once vice-president of a Korean national surgical society, a position typically elected based on excellence of reputation. Remarkable because he does pure tissue repair—a minority medical approach! I believe he is a great surgeon. The only downside is that his hospital being specialized and reputable does an immense number of surgeries. The double-edged sword for our most important requirement of a surgeon–experience. A trade-off emerges between skill and personalized attention. For you, you absolutely must have a highly skilled and experienced surgeon.

• This reply was modified 1 week, 4 days ago by pinto.

[Chuck]

Pinto…thanks so much for your quick response. Just a little hard to distinguish between bad pain moving around and painless surgery but your point is taken. I agree that there is a huge danger of surgeon complacency…I read the report of one guy who was damaged by Yunis. He was just on the assembly line of repairs —yunis wrecked him and couldnt even remember his case. Thats a real issue with Kang who performs 12 surgeries per day —thats a lot –it makes me wonder if he might just take a play off on a surgery or two…its just human nature when faced with a lot of work. Watchful do you have any thoughts? You indicated that Conze might be less volume more attention, I am guessing all these surgeons are doing many surgeries per day…good because of the experience…bad because we the patients just become a commodity….it surprises me that any surgeries every turn out ok

[pinto]

Only my opinion but I think your case needs Kang even more than my own. He has seen it all besides being excellently skilled.

[Watchful]

Conze said he does 4-5 surgeries per day. This is one of the things I like about him. Shouldice Hospital surgeons do 6 per day. Yunis told me he does 6-9, which scared me – I kept imagining being the 9th.

[Jtk2]

With Yunis, I don’t think it matters whether you are #1 or #9. I was somewhere around #3. During my pre-op, Yunis rushed into and out of the room off balance and irritated. Yunis refused to answer my question re anesthesia, even though his nursing staff specifically instructed me that this was the time that question should be asked. As previously reported, I woke up half way through the surgery and was forced to endure excruciating pain, as Yunis cut and stitched, completing only 3 layers of a 4 layer rt inguinal Shouldice repair. It has now been 8 months, and each and every day since my knifing, I suffer chronic debilitating pain (far worse than the hernia) with no end in sight. Post Script: 2 months after the “surgery” I had a follow up visit with Yunis, at which time I asked him what went wrong. His highly technical response was,”I had to move and separate a lot of stuff.” I left a comment on Dr Towfigh’s Herniatalk interview with Yunis, and Dr Towfigh responded, that I should contact her office, which I did months ago, but to date have received no response. C’est la vie…

[Chuck]

Watchful exactly….now consider Kang doing 12 surgeries per day….i would bet that Stephen could squeeze you into the front if we went…they roll out the red carpet for foreighners…but still…if you have to do 12 surgeries per day….maybe you cut some corners? Grishckan is another assembly line guy…peterson same thing…and he is downright nasty…I like some of the reports about Koch and weise that i found online….Koch personally visits all his patients at their hotel the next day…Wiese was noted to tell some folks that he would take his time and do it right…I am guessing you got some warm fuzzy feelings about Conze —this kind of stuff might make the difference. I have often thought of offering these doctors a second full fee…if the can fix me without chronic pain….i dont know how to incentivize them to do their best.

[Watchful]

Correct. Conze takes his time in the evaluation and follow-up, and he doesn’t cram surgeries. The evaluation appointment (including ultrasound) is scheduled for 3 hours. Very exceptional, particularly in the hernia field which is typically handled as a high-volume assembly line.

[Mike M]

@Chuck In case you or watchful are wondering – Dr. Kang takes as long as necessary regardless and cuts no corners. He took his time for my repair due to the difficulty and thus lasted a bit longer than expected per Stephen.

Circling back to the first few days after surgery – yes painful but a small price to pay for the overall successful results.

There are so many factors involved in a successful repair but as Chuck has mentioned Dr. Kang has seen it all and has successfully tackled many challenging patients others might have turned away.

[pinto]

GOT YOUR DUCKS IN A ROW?
You guys when talking about surgeon daily load might miss an essential element of comparison: Equivalence. Those load numbers come not from a vacuum but a sure context. But you likely assume that these surgeons all have equivalent surgery teams and process that might be untrue. Efficiency of scales might make a big difference for some surgeons. For example what practice does each surgeon follow to prevent surgical gauze mistakenly sewn up in the patient’s gut? Could certain surgeons have better practice than others allowing them to handle more patients? I’m not suggesting the issue is unimportant; only that the numbers are like icebergs, their unseen is as important as the seen. Maybe more so.

[roger555]

Stephen told me Dr. Kang did ten surgeries the day I had mine and that he has done as many as twelve in one day. It sounded to me that he averages less than twelve surgeries a day. Stephen said the can do two surgeries an hour.

[Watchful]

Jtk2,

Really sorry to hear about what happened to you with your Shouldice repair with Dr. Yunis. My experience with a Shouldice repair has been bad as well, and mine was done at the Shouldice Hospital. My surgery was about 6 months ago, and I also suffer from chronic pain, although I wouldn’t call it debilitating in my case.

The explanation I got upon follow-up wasn’t much more illuminating than what you got: large hernia, deep anatomy, so it was a long and difficult surgery. Well, the fact that it was a large hernia was known in advance during the exam. Not the exact measurements, but it was clearly a large (not giant) hernia with a scrotal component, intestine in the hernia sac, and hard to reduce.

My surgeon said there would be no problem repairing it with Shouldice, and that it would be the best or maybe one of the two best ways to fix it. I really gave him a lot of opportunity to tell me if he thought this wasn’t a good way to proceed, and he didn’t show even a smidgen of doubt. After the surgery, it was a different story, and the size of the hernia suddenly turned from something that wouldn’t be a problem to something that was a problem. Hard to understand, but I guess that’s just the way things are with medicine.

None of the other tissue repair surgeons with whom I consulted said that it might be a difficult surgery either. Maybe it’s just not clear until the surgeon cuts you open, but then they should have the ability to use the right technique for your situation. At the Shouldice Hospital, they almost never use mesh, but Dr. Yunis could certainly do it. I think he checks with patients before surgery if they are ok with him going with mesh if he feels it would be better during surgery. If I remember correctly, he even has some form related to that. Did you give him any guidance on that before surgery?

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