Summary of research-forum experts? Watchful-JF -NFG- GI- Mike M- Bryant

[Herniated]

The recurring issue of Kang recurrence. Dr. Kang claims the very low recurrence rate of <0.5%, corresponding to less than 5 recurrences per 1000 patients. Yet the anecdotal reports in this thread indicate that recurrent patients have been seen in clusters, which is hard to reconcile unless for some reason recurrent patients are scheduled together, or some of the various claims/observations are misleading. No way to know without an audit.

[pinto]

roger555, thank you, an apt way to put it. A million ways things could have turned south. A surprising thing I found having become a hernia statistic is once in, you’re in for life. Once an IH, then we have a high chance of having one on the other side. So I became a lifer. Who knows when my other side will pop.

@Watchful, you’re comment is disingenuous and shirking of responsibility. Quite unbecoming of you.

[roger555]

One very positive thing about Pinto’s recurrence is that it was repaired (I don’t know how many years ago) without any further recurrence and pain so far. You get a recurrence anywhere else and you will probably get meshed up whether you like it or not. So one good way to look at it is you get two chances to get a tissue repair by Dr Kang without any chronic pain or severed nerves and cremaster. For the initial cost of the first surgery plus travel and hotel expenses. What other hernia surgeon/hospital can match that?

[Watchful]

Pinto doth protest too much, methinks.

[pinto]

Watchful, good of you to clarify my reference to you. However, I wish to point out you were really not faithful to your original report (numbered #33613 here). At the start of reporting your colleague, you stated that “most of the [reviews] he found were good.” Today, you started off negatively by saying two reported recurrences. Positive note only came at the very end. Perhaps merely accidental but there is a serious flaw how Chuck has used your reporting, some of which is your responsibility.

More importantly however you neglected today to include an insightful comment you made previously: surgeon names were unreported in the reviews. Thus these recurrences might not have been Kang’s at all. Moreover you were entirely wrong in your original report in falsely claiming that the recurrences were likely Kang’s or his son’s implying that there are only two surgeons at the hospital. I myself had contact with two others neither of whom were Kang.

Conclusion: Claims for the negative Korean reviews for thee Dr. Kang are groundless. Chuck, please retract your false claims made.

[Watchful]

To avoid confusion, here’s what my colleague reported. He looked at 18 reviews specifically about hernia surgery at Gibbeum.

Out of these, two mentioned that their hernia recurred after their surgery at Gibbeum. One of these two mentioned that two of the four people he met at the hospital were also there for a second operation after their hernia recurred, and these people he met also had their previous hernia surgery (which failed) at Gibbeum.

Two reviews mentioned issues with pain which resolved eventually.

The remaining 14 reviews were good.

By the way, it’s extremely hard to find any reviews for the Shouldice Hospital complaining about recurrence. It’s not hard to find reviews complaining about pain, but not recurrence.

• This reply was modified 1 year, 5 months ago by  Watchful.

[pinto]

Corrections needed about Chuck’s misdirected comments about Kang:
1 Chuck as I have shown in a recent, related post and many of us know, Chuck is prone to exaggerate and be highly emotional. He is also easily swayed by anecdotes without considering their contexts. He has been called by some Members for misrepresenting medical complaints he finds at social network websites, in which case it applied to Shouldice.

2 He continues to highly mischaracterize my report about an “unusual sensation” (neither pain nor pleasure) hardly ever experienced into something weird or unsettling. I now believe he hopes that my surgery fails as he can’t believe I have had no pain post-op—not with just one but two Kang surgeries. That’s why he has twisted my words into barb wire.

3 He falsely claims there is “decent risk of recurrance” for Kang. Really? And how does Chuck arrive at the notion the surgeon has a considerable number of recurrence cases? Apparently he went through HT pages and found 7 patients of which included me. Besides 7 might be rather conservative, yes, I had a recurrence but is there a surgeon anywhere who has no recurrences?

4 Next he notes Watchful’s acquaintance, an ethnic Korean, reported he was in a room in Kang’s hospital with a number of recurrence patients. Yeah? Well, what? Wow, a hospital with a room of recurrence patients–imagine that! Really, esp. so that this is a hospital dedicated to hernias, doing thousands of operations a year, headed by a highly nationally regarded surgeon? Maybe Chuck failed Stat 101 or didn’t go to class.

I understand it’s terribly painful to suffer as Chuck has reported to the extent he threatened suicide. I was among those who supported him and was so happy he received further medical attention, lessening his troubles. Apparently not because he appears unstable and I fear that some great surgeons might be hit with false allegations hurting both them and patients who might otherwise choose them. He threatens the viability of this website for offering unvarnished views and reliable information.

• This reply was modified 1 year, 5 months ago by  pinto.

[Herniated]

A few corrections regarding your Shouldice Hospital option:

– “you may not be able to [choose] the surgeon if you knew” – If you contact the hospital and specify a preferred surgeon they will attempt to accommodate.

– “shouldice is reported to cut the cremaster and some nerves” – this varies with the surgeon. Some will cut only a portion of the cremaster and attempt to preserve nerves. Discuss with your preferred surgeon.

– “they also use stainless steel” – this is their preference due to reduced inflammatory response to stainless steel in comparison to Prolene, but if you ask for Prolene they will accommodate.

John’s Hopkins has a hernia clinic. You might want to investigate their options as well, if you have not already done so.

[MarkT]

From the wording, I think the multi-year data (from 2296 patients) only concerns recurrences, while the pain data (from 302 patients) is limited to patients at 1yr post-op?

Yes, I think they would justifiably be called chronic pain sufferers after 1yr. While the study defines chronic pain as “pain persisting for more than 3 months, affecting everyday activities”, I’ve seen timeframes of up to 6 months suggested elsewhere. The 1yr mark seems suitably liberal to avoid most cases of ‘slow healing’ or things like that?

I agree with Watchful that the concluding statement of ‘1.7% chronic pain’ is accurate by the study’s definition of chronic pain, but it seems problematic from a patient point of view (again, as Watchful highlights, this criticism has nothing to do with Dr. Kang…it has to do with the chronic pain definition).

When a patient thinks about chronic pain, I’m sure that means they would like to know the likelihood of experiencing *any* degree of long-term non-ignorable pain following a surgery. Of course it is highly relevant to distinguish between pain that would and would not interfere with daily activities, and treatment options may vary between them, but it seems inappropriate to simply exclude ‘non-interfering’ pain from the definition of chronic pain. It’s still pain and it’s still chronic.

I agree that we need longer-term data though. While it is plausible that some small % of patients’ pain may fade or resolve even beyond that 1yr mark, there is apparently a significant likelihood for new cases of pain to manifest beyond that time frame (and beyond the 3-4yr mark for recurrences), according to other research. It would therefore be likely that the chronic pain and recurrence rates are understated with these follow-up times, so hopefully more data will follow. Dr. Kang indeed deserves praise for collecting this data as it is extremely helpful.

Capturing this nuance in measuring chronic pain is important. We can imagine a situation where an overall pain rate is in line with what other studies are finding, but that the degree (severity) of that pain differs. E.g., if a surgeon or repair type was associated with the rate of enduring pain, but that pain was mostly of a much lower severity, then that would still be a very good accomplishment.