Shouldice vs Kang surgery experience

[Colin M.]

Hello all!

I am new to this forum, but I am guessing there are some people who visit here to figure out which is the best surgery for an inguinal hernia, so I decided to join and make this thread.

I have had two inguinal hernias (one on each side), and am probably one of the only people in the world to have had both Shouldice repair in Canada and the relatively new Kang repair in South Korea. So with that, I would like to give my experience with the two.

At Shouldice, I was 13 years old, and I stayed overnight for 2 nights, probably due to my age. The operation took about 45 minutes. With the Kang repair, I was 33 years old and was able to go home 1 hour after the operation. The operation took about 20 minutes. The incision for my Shouldice repair is about 10 cm long, whereas the Kang repair incision is about 3-4 cm.

After both surgeries, I have so far been able to live a normal, active life like nothing has ever happened. The Kang repair seems to have an advantage over the Shouldice repair in my opinion, based on the more appealing incision size which is hardly noticeable, in contrast to the huge Shouldice scar.

I should mention I had the Kang repair done on a Saturday and I went back to work Wednesday without any issues (besides walking slowly and moving carefully, of course). I did not take any pain medication after the first day, despite being given about a week’s supply, as the pain was bearable. I feel like I could have went back to work even on the Monday, but taking some time to rest seemed easier.

Overall, both surgeries were successful. The Kang surgery has the clear advantage over Shouldice, however, due to the much smaller incision.

If you are not sure which operation to get for your hernia, I’d recommend the Kang surgery in Korea, and would steer clear of mesh surgeries due to the potential complications that can arise.

Thanks, and feel free to ask any questions!

[pinto]

At the outset let me state clearly that I long have been a fan of the Kang method but actually of both methods. However for the sake of discussion I must point out, Colin, your comparison being made is applies and oranges. First “A” was done 20 years before “B.” Second, they very likely were very different surgical situations. It’s unfair to both methods. As great as the Kang method may be, it is not proper to put such a supremely classical method as Shouldice in a compromised position as you did. It suggests bias. We can say, however, that from what is presently known about the most recent iterations of both methods, the Kang method appears to have two advantages, incision size and suturing (though some will debate the latter). Another point is how the cremaster muscle is dealt with, seemingly a Kang advantage. As far as your recovery time, etc., here again, is a situational matter. Anyway the three points I mentioned are likely important Kang advantages, but nothing is perfect. Any such comparisons need to be done fairly.

[Colin M.]

Hi pinto,

Thanks for the reply. I am not sure how I was not fair in my comparison. I can only compare the two based on my experience as a patient with both surgeries, and made sure to add my age for clarification. I think I was was completely fair there. I did mention that both were successful, and I was satisfied with both surgeries.

If I lived in Canada, I would likely opt for going to Shouldice due to proximity, saving on travel costs.

However, if I lived anywhere else, I would opt to get the Kang surgery due to the advantages. I couldn’t think of any advantage that Shouldice had over Kang, but that doesn’t mean it’s not a good surgery. Like I said, I’m living a normal life after both surgeries and able to do everything like I’ve never had a hernia in the first place 🙂

[pinto]

Hi Colin,

Your points are well taken. Let me clarify my post by noting your original post began by saying “people who visit here to figure out which is the best surgery for an inguinal hernia.” If we’re trying to do that then wouldn’t we want to be systematic doing it?

Because modern medicine is so technological, taking two cases separated by twenty years surely is lopsided. The earlier one is disadvantaged by its older tech or possibly less developed technique. That has to be an unfair comparison.

If I am not mistaken your purpose was to compare the two IH methods you experienced and concluded by saying that one was better. Perhaps that’s true but technically it’s a weak comparison to say the least. I don’t think you would personally decide on a surgery for tomorrow based on that kind of comparison, right? Your post based its conclusion on a Shouldice incision measurement more than 20 yrs. ago or more. The length of incision possibly has shortened over time. Moreover decision of surgery surely wouldn’t be based solely on incision, right?

I appreciate the uniqueness of your experience and welcome your sharing. It would be more appreciative, I believe, if it were less evaluative because of the reasons stated. Friendly chat is appreciated but technical talk prized. Some people will make possibly life-altering decisions based on the information at HT. It’s in our collective interest to together develop information most helpful in that regard. Thank you for your kind attention.

[Colin M.]

Hi pinto,

Thanks for the feedback again.

In this case, would it be better to give a detailed walkthrough of my experiences with both hospitals and surgeries (or my most recent one, since Shouldice may be different these days) instead of evaluating the advantages/disadvantages? If you think that would be beneficial to readers, please let me know!

[pinto]

Colin, everything flows from purpose. I’m unsure what you want to do. This thread was couched kind of like a strawman debate, which I think you realize that now. What is it that you want to say? When you’ve got that run with it. There are already existing threads that talk about these individual IH methods. Maybe that’s the way: Fit your experience with what was being discussed. I think you would fit right away. 🙂

[Colin M.]

I just thought after experiencing two leading hernia surgeries, I could compare the two.

A few doctors recommended me to do a mesh surgery before my second hernia operation, saying non-mesh is only for children (which I knew was wrong since Shouldice had many adults, but I couldn’t afford to travel back to Canada from Korea).

Luckily, I found out about the Kang surgery and had a great experience with that. Because of that, I thought I could compare the two since they seem to be two great non-mesh repair methods and they were both very successful. I also want people to be aware of their options and not almost get tricked like I did into getting a mesh 🙂

I will search the forums and see where I can contribute. I probably should have done that before starting a new topic. I appreciate your kindness and understanding as I’m a new user here.

[Alephy]

Hi Colin,

Personally I found your post very interesting, you described your personal experience with the two surgeries, which is what people have been doing here since the very beginning. No one is saying that they are showing scientific results out of one’s experience, for that there are medical articles (which are not submitted to this forum for review as far as I know:)

[Colin M.]

Hi Alephy,

Thanks for your response. I was a patient who had no medical expertise, and I’d assume most patients don’t. I wouldn’t expect patients to know about the tissues involved such as the cremaster muscle previously mentioned, and I don’t think they would care much about that either.

I think what prospective patients care most about is if the surgery will be successful, and if they can live a normal life without complications afterwards. Younger patients may care about the surgical site’s appearance as well, as they could be self-conscious about that, as I was when I was a teen.

I hope my post can help inform some people needing hernia surgery by sharing my story. I think it is especially useful for people living outside of Canada. Had I not searched extensively for Shouldice alternatives, I would not have found out about the Gibbeum hospital in Korea. I was very close to spending thousands more to travel to Canada and get another Shouldice surgery or to take the risk of getting a mesh surgery.

[mitchtom6]

Colin,

Thanks for your stories. You truly are part of a very, very small population of folks who has experienced these two different non-mesh varieties.

How would you describe your lifestyle? Do you do a lot of physical activity? I’m glad both procedures have been successful for you.

Americans are not used to looking internationally for medical care.

Take care!

[pinto]

Almost every post is from personal experience. Personal experience is vital.
Colin, you wrote, >I just thought after experiencing two leading hernia surgeries, I could compare the two.<
Of course you can, Colin. But you also were making a claim that X is better than Y, which surely invites discussion. Please recognize that. As I said, your experience can fit in immediately (and variously).

[pinto]

Colin, did Shouldice use steel suturing? If so were you made aware of it at the time? And if so again, do you ever feel a tinge or something?

[Good intentions]

Thanks for posting Colin. Parents with children would get great value out of your experience with the Shouldice repair. 20 years, and passage through puberty to adulthood, with no problems, is a success and what any parent would want for their child. Even many of the mesh proponents in the community of surgeons recommend against mesh for adolescents, but there are probably thousands of kids who get it anyway.

And the experience at Gibbeum Hospital is one more verification of a non-mesh option. I have the same question as mitchtom6 about your lifestyle and activities, and also how long it’s been since the Kang repair. Are you a runner or biker, do you play sports, physical labor, etc.?

Good luck.

• This reply was modified 2 years, 4 months ago by Good intentions.

[Colin M.]

@mitchtom6:

I’d describe my lifestyle as quite active. I play sports occasionally, and I used to do heavy weightlifting 3 times a week prior to COVID.

After the Shouldice surgery, I was always worried about lifting heavy due to a fear of causing damage to the surgical site (kind of psychological I guess). However, after some time, I got the courage to start lifting heavy again (eg. 100+ kg bench, squat, deadlift), and I haven’t had any issue.

Due to COVID lockdowns, I haven’t weightlifted yet after the Kang surgery, but if I ever do, I will report back how it goes. I’d assume it should be fine as well.

@pinto:

This is the first I’m hearing about steel suturing. My mother also says she can’t recall. But this is a great question because I do indeed occasionally feel an awkward feeling from the Shouldice location every now and then. A “tinge” is a good description of it. It feels almost like something is poking me, like a splinter kind of feeling.

I had no clue what that feeling is and why it comes every few months and lasts for a couple minutes (sometimes longer). I used to think I had an ingrown hair or something I could just never seem to find, but that didn’t really make sense. But the sensation feels a bit close to the surface of the skin like that. Now that you’ve mentioned steel suturing and a tinge feeling, I guess that might answer that question! You may have just inadvertently solved a 20 year old problem of mine. Thanks!

@Good intentions:

It has been 2 months since my Kang repair. I have been playing basketball a bit lately and I have been riding a bike on weekends for the past 3 weeks so far. Currently, I have no issue with the Kang surgery. I know it has been a short time, but I will continue to update if anything arises. Eventually I will get back to weightlifting and see how that goes as well. However, I do some light exercise at home for the time being.

With the Kang surgery, up until about a month after surgery there has been some burning sensations near the site that were a mild nuisance. These usually happened if I stood or sat in the same position for too long. Dr. Kang also warned me about these uncomfortable feelings that may occur for the first few weeks. However, this no longer occurs and I feel completely normal now. I ride bikes at the same intensity now that I used to without any problem. Running, jumping, etc. during basketball hasn’t been an issue either.

[Spartan]

Did you have to stay 2 weeks in a hotel in S.Korea before getting the surgery? If not, when was that Covid 19 lifted in S. Korea?

[Colin M.]

I currently live in Korea, so I did not. But, at the moment, any visitors must quarantine for 2 weeeks, so you would have to before getting the surgery, I’d assume.

[William Bryant]

I don’t know if anyone who contributed to this thread is still posting but if they are…

Does shouldice Canada still use metal thread? If so what type of metal?

Is Kang method metal and plastic and foreign material free?

Do either or both cut cut nerves?

Finally thanks Colin for the initial post, most useful getting view of someone who’s had both types of repair.

I do take the point made there’s 20 years between them.

[Colin M.]

Hi William,

I hope someone can answer these questions because I’m curious as to the materials as well now.

As for the nerves, I haven’t permanently lost any feeling from either surgery. After the Kang surgery (since I can attest to that, being so recent), I only had temporary numbness at the site and in part of the scrotum for about 3 months post surgery, after which all feeling came back. I was told in advance that this is what would happen as well.

Upon searching, it appears one nerve is cut during Shouldice surgery (probably in both surgeries I’d assume, but I can’t find that info for Kang). I don’t remember how it felt exactly after Shouldice surgery, but I can at least tell you I have all feeling in that area right now as well.

[William Bryant]

Thanks Colin.

Was it Dr Kang who did the surgery himself? Do members of his team carry put the surgery too on occasions meaning you can’t always guarantee having Dr Kang himself?

[Colin M.]

I am quite certain only Dr. Kang and his son are able to conduct the surgeries. My surgery was done by the younger Dr. Kang, who happened to speak English really well btw which was convenient.

[Johnso]

William:

Dr. Towfigh did a Hernia Talk Live Session with Dr. Spencer Netto from the Shouldice Clinic last year. Here is the link:

If you are interested it is worth a listen to hear what they do with the cremasteric muscle, the nerves and why they still use stainless steel sutures.

On the internet I have found 2 different stories as to why Dr. Shouldice started using stainless steel sutures but the most common and probably the actual reason is its minimal inflammatory properties.

Colin:

I wonder if a highly sensitive metal detector would be able to detect stainless steel sutures and therefore satisfy your curiosity.

johnso

[William Bryant]

Thanks Johnso… I dont suppose anyone knows if the stainless steel shouldice use has nickel in it?

As I’ve said elsewhere I do get skin irritation from some metal watch backs, some belt buckles and some coat zips if they go up to neck.

[Johnso]

William:

Here is a link I found wrt stainless steel sutures. Nickel is listed and I believe it is generally used in the manufacturing of stainless steel. I don’t know what percentage of nickel is in the sutures used at Shouldice.

Stainless Steel Sutures

I believe most surgeons doing Shouldice repairs outside of the Shouldice Clinic use a synthetic suture such as prolene but I am not an expert.

johnso

• This reply was modified 1 year, 11 months ago by Johnso.

[William Bryant]

Thanks Johnso I’ve read that medical stainless steel uses about 8% nickel

I dont know I have a nickel allergy for sure but surface skin reaction to metal items suggests some metal items cause rash, itching and small sore areas on me

I can’t believe no allergy testing is undertaken. Seems a bit lax.

Also seems every way I turn there’s a problem.

If I react badly to steel/nickel it seems to rule out shouldice Canada as once the sutures are in, I’m assuming it’s unsafe to take out?

Now I’m looking for non mesh with no nerve cutting and no metallic sutures… Any suggestions or recommendations anyone?

[MarkT]

Just last night, I watched the HerniaTalk Live with Dr. Samer Sbayi (Stoneybrook in NY) as guest. He trained for 1yr at Shouldice and offers that repair.

Shouldice does use stainless steel (316L), but seems to ‘fallback on Prolene’)? Dr. Sbayi uses the exact same stainless steel, but he also uses Prolene.

Start at the 10:00 mark…at 16:55, they discuss environmental allergies, including nickel and manganese. Dr. Sabyi also mentions having removed stainless steel in a patient who had a reaction and replacing with Prolene.

• This reply was modified 1 year, 11 months ago by MarkT.

[William Bryant]

Maybe its an impossible dream?

[William Bryant]

Thanks MarkT

Google suggests prolene is probably less likely to cause a reaction.

[William Bryant]

Actually Pinto, for me, if Colin’s experiences of two different surgeries were hidden in other posts, not sure it would be as easy to see. I’m finding it difficult searching back to things I’ve read in posts that I’d like to remember… for instance:-
I read things to ask UK non mesh surgeon, think it was about cutting cremaster nerve in a thread – not able to find it again.

Also in another were the supplements that had be taken prior to operation.

There can’t be many people who have had 2 different non mesh operations so it was good to hear from someone who has. I dint think there was any intentional bias anymore than there would be if I said “gas” at dentist when I was 8 but injection in my 30s, I found injection better for me.

[dan]

From what i know, Dr Kang uses pds suture which are slow absorbable (130-180 days to fully absorb)

I am a korean american looking to get dr kang’s surgery once the pandemic ends. I will probably update once i get one. However, there is a story written by a korean woman on her blog about her experience with the surgery. She became pregnant 1 year after surgery and gave birth through c-section. According to her, her hernia did not reoccur even after holding a baby inside her.
Do what you will with that info

[William Bryant]

Dan, I’m not sure the pandemic will be short lived. UK rates are on the rise for example. I’d be interested in a Dr Kang repair too but I am not keen on flying! And at the moment I think it would be 14 day quarantine although not sure if that applies if you are double jabbed and or had third/booster.

Do you know the quarantine procedure requirements by any chance?

The pregnant woman anecdote. Thanks for that. It does go along with the Gipum hospital low reoccurrence figures. And I’d imagine having a baby inside, with the turning and pushing, etc would put a lot of pressure on her body.

[dan]

Yeah the quarantine requirement is 14 days unless you apply for a quarantine exemption. If you want to go get dr kang’s surgery, it’s likely you would have to wait until the lockdown is over.

[Colin M.]

Even if you’ve had your 2 shots, you still need to quarantine for 14 days. However, you can apply for an exemption from your Korean embassy/consulate, and maybe in the case of surgery they’ll exempt you.

Otherwise, starting in November, the government will be easing restrictions and gradually start treating covid similarly to the flu.

[pinto]

@William Bryant, in apparent reference to my point about Colin’s comparison, you wrongly imply I stated his bias was intentional. I never said nor implied it. Actually your recent remark about prolene proves my point. I agree his experiences are quite interesting and useful–indeed–but as I tried to point out technology over 30 years surely has advanced Shouldice in some way. (Your example of dental gas/injection is inapplicable because those techniques do not separate methodology; whereas this thread as titled has methodologies in contrast.) Thus Shouldice of 2021 should be the focal point not that of 1970 (approx.). As long as medical methods are fairly compared then all will be well I’m sure. Thank you.

[William Bryant]

Sorry Pinto I didn’t mean to imply you meant Colin’s “bias” was intentional.

Whether the shouldice technique has changed at all is an unknown, apparently. It may have changed, it may not have done. It cant just be assumed it has. And even if it has changed it may not have been for the better!

So unless we can find someone who has had both Kang and Shouldice operations with only a short time between them, Colin’s experience is pretty unique and I appreciate his time posting it.

Albeit I fully take on board your point about the time difference between the two. But then what should be the ideal time difference for comparisons? 1 minute, 1 month, 1 year, 1 decade? Simultaneously?
And then is it fair to compare if one is carried out by the inventor and the other by someone other than the person responsible for it’s existence.

Basically Colin’s comparison is about the best we have got and are likely to get.

But I always enjoy reading your posts so thanks for your comments too.

[William Bryant]

And even better that Colin still posted all this time later when asked questions.

[pinto]

@William Bryant, gracious of you to say sorry. Thank you. My message was as much for Colin as for you because originally, way back when, I don’t think he understood my point about comparison making and may have taken it personally. So I didn’t want the “intentional” matter to reinforce that. Let me clarify please.

You suggested prolene might be an advancement on steel suture demonstrating that over time technology can improve medical practice. The Shouldice treatment Colin received in 1970 (approx.) is likely not the same as that done today.(Shouldice is also not a unified method: variants exist.) It has likely improved in some way. Because Colin expressed some disfavor comparatively with Shouldice, his comparison is therefore biased. The comparison was not equivalently made because the other surgery method was from 2021! It’s apples and oranges.

Furthermore, I never stated nor implied that comparison should not be made. As Colin later stated, he did not know his Shouldice treatment likely used steel suturing, which he now attributes the steel to his periodic tinges felt. Those tinges may have influenced his apparent disfavor with the Shouldice. In short, the basis of this present thread is faulty–it sets Shouldice up as a “strawman” in comparison to another surgery method (even if not intended!). It is irrefutable: an already disfavored older version of Shouldice is compared with a different surgery method of today.

Yes, compare the two methods or any others you want, but do so fairly. And yes, too, look at Colin’s experiences with both methods. That’s fine but again do so fairly. I think Colin’s purpose was simply to say, “Hey, I had both operations. Ask me whatever you like about it.” Of course very interesting and useful but what also came out–whether intended or not–was some misdirection by pitting the two approaches against each other unfairly.

Here’s something that probably many of you overlooked: Colin’s Shouldice passed the test of time: No recurrence. How about the other method? We don’t know yet: Colin’s operation was just months ago. Also, Shouldice has a lot of verifiable research studies in support. The other method does not.

[William Bryant]

Brilliant Pinto, that answer was very thought provoking. Got me thinking anyway!

[Colin M.]

Just to clarify, I wasn’t yet alive in 1970. My Shouldice surgery was in 1999 – still quite some time ago, but almost 30 years ahead of the time being mentioned here.

I believe I have mentioned as well that I have had no major issues after my Shouldice surgery, and it definitely was a great success. I also haven’t thus far had any issues with the Kang surgery since fully recovering, and I have been back to my regular life. But like pinto mentioned, it’s only been a few months.

Out of curiosity, I wonder what the differences between a 1999 and 2021 Shouldice operation would be. Does anyone know where I can find information about what improvements have been made?

[Colin M.]

Sorry, my math was wrong when I calculated the date (I was calculating using my Korean age which puts me 2 years older). I turned 13 in Dec. 2000. So the surgery was in 2001. Not a significant difference though.

[William Bryant]

Hello Colin thanks for coming back on and clarifying, I really appreciate your post/s.

I’m not sure if there have been any advancements, I’ve just read an article from a Canadian, hernia and general, surgeon, feels the shouldice Canada results are skewed a bit because in the surgeons view, shouldice is selective about who it performs the surgery on. In their the “healthy”, apart from hernia. The surgeon was also critical that shouldice Canada doesn’t follow up, patients, more long term than it does. So disappointed clients years later won’t show as anything but successes as they were pleased to start with.

I don’t know if that’s all true.

At least in your case shouldice Canada has been a success. And it looks like the kang one too.

The Korean age? How does that work? Is there any around the world that would make me younger?

[William Bryant]

The problem with Shouldice or The most dangerous phrase in the English language- “We’ve always done it this way.”

Here is the link for the article above in case anyone is interested. Being, relatively, new to this forum if my posting contravenes any forum rules. Please just delete it. Thank you.

[Good intentions]

Don’t overlook that people create sites on the internet for many reasons. That surgeon created her site just to voice her opinions about various things she sees at her work, and other causes she is concerned about. As she says, she writes for pleasure. But, really, she’s just another surgeon who does hernia repair.

She is a political candidate. She has Twitter, Facebook, and Instagram accounts. She wants her voice to be heard. In today’s world, taking an opposing view, to almost anything, is enough to get your name out there. But, besides being a surgeon, there is no sign that she is an expert in hernia repair methods. No publications or presentations about hernia repair methods. Just another person with an opinion. She seems to be involved in good causes but that might not transfer to surgery results.

The scientific papers and especially the studies that look at long-term results are where people should get the data that they use to form their own opinions. The numbers show the reality of what’s happening. The typical surgeon will stay in contact with their hernia repair patient for three to six weeks, then never hear from them again. Anecdotes from surgeons are not really very useful.

Just something to consider. You can find internet information to support any opinion these days. Understand your information sources. Good luck.

Canadianfemalesurgeon.wordpress.com

https://www.instagram.com/drlesleybarron/?hl=en

[Colin M.]

Hey, no need to thank me for anything, I’m just happy there’s a discussion going and people can get some information as a result.

I quickly read through that link, and I don’t know… She recommends mesh surgery… I’m not a medical professional, but I strongly oppose mesh repairs based on anecdotes I’ve read from patients, as well as based on my own experience. With recurrence rates being so low for Shouldice, Kang, etc. there’s no reason to opt for a mesh.

I see she brought up the point of the length of stay at Shouldice, and I think that varies a lot from patient to patient. I know I stayed at least 2 nights at Shouldice, and my “roommate” I guess you’d call him, who was a firefighter, also stayed at least that long. So if that’s the norm at Shouldice still, I’d definitely say Kang has an advantage in that regard since patients are able to go home 1 hour after surgery (as was my case), or stay the night if they wish.

As for the Korean age, when you’re born in Korea, they consider that to be 1 year old, and you age every New Year. So since I was born Dec. 1987, the next month, I’d be 2 years old. Therefore, my Korean age is almost always 2 years above my actual age, and I use that age over here, which is why I got the surgery year wrong by 2. I’m not sure there is any country that reduces your age unfortunately!

[William Bryant]

I agree Good Intentions, it’s so difficult to know what is best. For my part Im thinking non mesh is better for me but then one day it’s shouldice the next Kang. It gets very confusing. And already feeling apprehensive about surgery just clouds the issue further.

I didnt pay too much attention to that blogger as she did seem keen to push mesh, so no surprise she didn’t write supprtive of non mesh.

[MarkT]

I have read that surgeon’s long blog post before and have problems with a lot of it. I may write a more detailed reply later, but I’ll say two things for now:

1. She ignores that the surgical community has not ‘moved on’ because the Shouldice method has been judged an inferior repair…in fact, it seems to have moved on primarily due to outside influences and pressures to public healthcare systems.

2. She is largely not approaching this from a patient perspective. The bulk of her criticisms are irrelevant for many individual patients, especially to those who meets Shouldice’s patient criteria.

[pinto]

She’s disgraceful. Her peers ought to sanction her. She has sour grapes because she works as a general surgeon who likely earns less than her specialist counterpart and maybe has a more demanding job. She rationalizes why her job is better however by nearly slandering Shouldice doctors using questionable evidence.

She is an example how we laypeople can overestimate the intelligence of doctors. Note she gives lip service to following fact-based practice, yet contradicts herself by criticizing Shouldice by false or frivolous claims. She lacks the critical awareness or mindfulness that we would expect from a medical professional.

[William Bryant]

I’m a bit ashamed of posting the link now but anyway it did strike me at the time that her views on non mesh would be clouded by the fact she does mesh.. a case of well she would say that wouldn’t she, to paraphrase that UK legal case quote from years back.

Getting back to shouldice or Kang… That’s the nub of it for me at present and I can’t quite decide which would be best for me. I’m not good at decisions and this is a big one which makes it harder still.

[pinto]

On the contrary you can be applauded. Did you read the comments to her piece? In totality, we learn a lot from it. I appreciated the post because I haven’t seen such before for both the wretchedness of the doc and then the info from the outpouring of comments. Don’t rush your decision unless of course your doc tells you. Apparently there are a lot of people who manage well despite hernia. I think you are from the UK. Did you catch the recent post from a UK-er who appeared to find a great doc in Germany? He was gleeful how attractive the option was for someone from UK.

[William Bryant]

Not sure I have Pinto, thanks for mentioning it. What thread was it on? I am from the UK, you’re right, and by sounds of it, it sounds like the German repair was very successful. Was it Dr Koch? Thanks for thinking of it for me. Anymore info greatly appreciated.

[pinto]

Here is one item about surgery in Germany but I don’t think it’s the one I had in mind. But it looks just as good:

My meshless hernia repair in Germany

[William Bryant]

Thanks Pinto. It sounds as though that went well. One thing that does bother me is Dr M has one or two bad reviews and I believe she is within biohernia umbrella.

[William Bryant]

Thanks Pinto. It sounds as though that went well. One thing that does bother me is Dr M has one or two bad reviews and I believe she is within biohernia umbrella. Anyway I note one of the replies mentions UK patient got in touch with PALS to ask which is UK surgeons may do mesh free – so might try that. Thanks again, more food for thought for me.

[Jack2021]

And the Desarda repair is a third option to consider as well isn’t it?

I might be wrong, but I think Pinto may have been referring to Scarletville from the UK, who recently posted about his experience in Germany with regard to ‘local anaesthesia and conscious sedation’ – https://herniatalk.com/forums/topic/german-covid-19-restrictions/

Although not mentioned in that post, I believe Scarletville’s operation was possibly carried out by Dr Ralph Lorenz, one of the German doctors I mentioned to you in another post, William. Dr Lorenz is a member of the European Hernia Society Board and he offers both a modified Shouldice repair or a Desarda repair for his tissue based repairs.

Here’s the set of posts where Scarletville talks about booking in with Dr Lorenz. https://herniatalk.com/forums/topic/dr-js-own-hernia/

I’ve messaged @scarletville to ask if it was Dr Lorenz he saw and how his recovery is going, but he hasn’t replied as yet, but hopefully he will soon.

What do others think about the Desarda repair, as there is an option for this in the UK (and I don’t mean with the consultant in London who in the end referred Scarletville to Dr Lorenz)?

I know there are posts here on HerniaTalk that list issues for some and positives for others re a consultant in the US, but all other research and meta studies I’ve seen, appear to be very favourable with results seemingly on a par with the Shouldice repair.

My experience from contacting a number of consultants across the UK and Germany is that they all know each other pretty well. Some mentioned that the hernia specialist community is relatively small, which is perhaps a concern considering the number of repairs carried out worldwide.

[Scarletville]

Hey, despite booking in with Dr Lorenz due to Covid politics I wasn’t able to travel to Germany for surgery and was left in limbo with no dates as to when it would be possible. Given it was a key time in my life and this was the 2nd tissue repair surgery I painstakingly tracked down and booked in I gave up and got a mesh repair. Had the repair done under a local and made a post about it, recovery is going amazingly. I couldn’t be more happy to so far in not be in the category of horror stories.

[William Bryant]

Which is the surgeon in the UK that dies the desarda repair Jack? I’d it the Leicester doctor or the younger surgeon in Northumberland (I’ve lost track of names).

Yes Jack, desarda is another option and thanks for reminding me.

So, of the 3 ( Desarda, Shouldice or Kang). Which would be forums members first choice if there were no limiting factors such as time, distance, etc.

[Colin M.]

If I consider ONLY the surgery, then for me, I feel practically the same right now after both surgeries, like I’ve never had either operation. The only difference is the incision size, which I mentioned at the beginning of the thread. And as a patient, I only care about how I feel after the surgery, if I can still do everything I did before, and to a lesser degree, what the site looks like. It’s basically a tie between Shouldice and Kang, with a small edge to Kang for the smaller incision.

But if we factor in other things such as recovery, I give Kang a greater edge. The fact I was able to go home after 1 hour and felt good enough to go to work after 2 days was really beneficial and also a surprise to me. I didn’t have that experience at Shouldice, but perhaps someone with a more recent Shouldice experience could elaborate on recovery time there to give you a more fair comparison.

[pinto]

Jack, thanks for the backup there. I couldn’t find the thread you mentioned. That’s what I had in mind.

[William Bryant]

Hello Scarletville,

Good to hear you are mending well. Hope it continues.

Do know …

Which surgeon did the mesh repair and which type of mesh was it?

Was it NHS or private?

Good Intentions has a “good” mesh successes thread – maybe if you have time post details there as they may be of use to others.

Once again glad it’s working out well for you.

[spinotza]

Hey there @Scarletville. I’m also getting ready to get a mesh repair privately in the UK. I am also curious which clinic you chose/was assigned to. I’m thinking of getting it at the Oxford Hernia Clinic butI can still change my mind! Kang/Desarda/Shouldice would normally be options too but I’m not comfortable getting a surgery abrod in covid times, just in the small chance something bad happens I’d rather be in my home country where I have a support network.

• This reply was modified 1 year, 11 months ago by spinotza.

[Scarletville]

I got mine done in a small private hospital in a small place called Scunthorpe https://trentcliffs.co.uk/. The Surgeon has a recurrence rate of about 2%. The logic behind it was basically that I wanted it done under a local, please see my experience post of that if you’re interested and that if you go to a place where the approach is sort of local first rather than general the price is wildly different. I paid 2k for the entire experience, Martin Kurzer with the St John & St Elizabeth Hospital in London was charging like 3.7k for the same thing. I initially spoke to Martin but seriously the guy was so rude to me it’s just obscene anyway besides the point. Simply put under a LA you can get treatment considerably cheaper if that’s their focus, if you go to a place that does generals all the time then you get given that price. I wanted a LA because I didn’t like the idea of a general and the experience was fantastic while also saving me £1.7k. The small hospital offered incredible care and wait times were non-existent. You can quite literally book in for surgery same week, go to the hospital and practically walk straight into the operating room. At all points there were at least 3x the number of staff to patients looking after us.

[KC]

Colin M,
when you had your hernia repaired by Dr. Kang, did you use absorbing or non-absorbing suture for repairing your internal structures (not the external skin which is always closed up by absorbing suture)?
If I am not mistaken, with Dr. Kang, patients can choose either absorbing or non absorbing sutures for internal structures.

[Mike M]

@KC

I recently had a Dr. Kang repair (7 weeks ago) and was initially dead set against using permanent sutures.

However after doing a lot of research I found that using permanent sutures is probably the one main talking point that both mesh and non-mesh doctors can agree on in regards to hernia repair.

This is the only option I went back and forth on up until I was literally on the operating table. Dr. Kang asked me one last time before local was administered and I decided it was in my best interest to defer to Dr. Kang’s medical opinion. Dr. Kang used 2-0 prolene non-absorbable sutures on me for inguinal and 3-0 for my umbilical hernia.

Pinto also influenced me (unknowingly lol) when I asked him what Dr. Kang used on him once he discovered his sliding hernia. Pinto was there about a week or so prior to my arrival.

I also found doctors (including Dr. Kang) switch to absorb on the portion of the repair that closes the subuc fat and the external oblique aponeurosis. Also glue to close the incision itself.

Dr. Sbayi in the video listed above calls the sutures the “rebar” support for the body (collagen).

I was worried what if I happen to gain a little weight, what if I have a bad cough, what if I lift too much, etc. etc. The permanent sutures gave me a little piece of mind it will make the repair stronger.

Dr. Grischkan went into detail with my first appointment (evaluation only) in regards to how benign and safe the sutures were especially went compared to mesh. Dr Towfigh also elaborates on the size, safety, and value of perm sutures in detail on one of her podcasts which is great.

[Wim]

Dr Kang uses local sedation, do you actually feel nothing? I once had surgery with local sedation (not hernia) and when they cut the pain was still one og the highest pain I ever experienced.

In case of hernia better to be strapped to the table because if you move your body during the surgery?

[Watchful]

I’ve been wondering about that too. There are quite a few reviews of the Shouldice Hospital where people complain about feeling significant pain and other sensations during the surgery. It seems like local anesthesia with sedation isn’t an exact science…

[Mike M]

Dr. Kang I felt zero pain during the operation with local sedation and my op lasted a little longer than normal because of the two hernias.

I did wake up the last 15mins in a twilight still nothing and this includes when I was transferred off the OR table.

I do not really remember pain until later in the day around nighttime. It came on gradual and not all at once. The pain wasnt that bad until I moved. That lasted the first 2 days maybe? then by the 3rd day I was moving around better.

[Watchful]

Seems like with this type of anesthesia some don’t wake up during the surgery, some are awake for at least part of it not feeling anything, and some are awake during the procedure feeling stuff. At least based on reports from Shouldice Hospital patients.

One confusing thing about local with sedation is if you don’t feel pain, or if you feel it but don’t remember it later. These are not the same thing…

[Mike M]

For me – I definitely remember “pain” but it just wasn’t with anything directly related to the surgery. It was with my back about 5mins after I transferred to the tiny (I’m ~6’3″) post-op bed made of bricks lol. I even remember the dream when I passed out and later woke up during surgery. It wasn’t a bad dream just weird as heck. I tried to stay awake at the start but I didn’t even make it to the number 5 when I was counting.

As far as moving – I don’t think I did but I was strapped down. Dr. Kang did ask me if I was ok when I woke up. I gave him the thumbs up. I just remember feeling pretty chill and closed my eyes. Non-eventful from my side. I hope I didn’t make Dr. Kang’s life too difficult that day. He didn’t saying anything so I think that is a good sign.

[William Bryant]

Glad this has been brought up… I always assumed with local you were fully awake, conscious, compus mentus (if that’s how it’s spelt) etc etc. Ie totally aware.

I did wonder how you stayed still enough.

If I have this wrong I’d appreciate clarification as I remember when I had surgery under general, when I came round they said, you don’t half wriggle. I wouldn’t want to do that with hernia repair.

I also recall that Dr Kang asks patients to cough during the procedure. Surely you need to be “with it” to do that.

I dont want to feel pain, nor risk accidental damage through movement. Is local ok for me?

My partner said you feel tugging and pulling etc but not pain as such. Is that right?

[Mike M]

@William Bryant

Dr. Kang does have you cough prior to surgery in the OR and marks the area. You are strapped down extensively so movement was never a concern of mine. I suppose some people might be awake in twilight. You are so calm and secure I don’t see how it would matter unless you have a serious pre-existing neurological condition maybe? Dr. Grischkan mentioned he uses the same method too as Dr. Kang.

I remember feeling some pressure and that is probably part of the tugging and pulling. As I mentioned I woke up during the last repair which was the umbilical. I had wondered if the the Inguinal repair was completed. That is how little I could feel. I don’t even feel like I was moving a millimeter. It took a lot of effort to even give the thumbs up when he was talking to me.

[Colin M.]

I’m a bit late but everything Mike said is my experience as well. I was never asked to cough during the procedure as well.

I should mention that it’s been about 20 months since my Kang Repair, and I have started weightlifting again for the last 4 months. I have had no problems exercising 5 days a week and lifting 100+ kg weight for deadlifts, bench press, and squats each week. It’s probably not recommended to do this, but I figured I’ll be the guinea pig. So far I feel great and there’s been no discomfort at all by the surgery site.

[Watchnwaitin]

Is there a detailed description anywhere of how the Dr Kang method of tissue repair is done? I’ve searched but only found details of the other methods.

[MarkT]

@cdnguy – there is some info on the hospital’s site:

http://gibbeum.com/whykr/Why-and-What-Kang-Repair.php

[Watchnwaitin]

@MarkT – Thanks for the info.

Seems like the Kang method is a modified Bassini with special stitching and no cut of cremaster muscle or more invasive steps/techniques.

Has good success from the looks of it but would be nice to have a more complete and precise explanation of what exactly is done.

[MarkT]

@cdnguy – there might be a thread on here with more detailed info, but if you tag stephen or drkang (just put the ‘@’ in front of those usernames), you will probably get a response from Stephen.

Stephen works with Dr. Kang and helps with non-Korean patients…I think he is translating Dr. Kang’s work into English too.

[Author]

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