Watchful or GI why not Kang?

Hernia Discussion Forums Hernia Discussion Watchful or GI why not Kang?

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    • #32670
      Chuck
      Participant

      Guys I had the plastic garbage pulled out a month ago. Still struggling. But what’s even more terrifying is how will I fix any recurrance. Nothing so far but it’s coming I am sure. Watchful you have studied this to exhaustion and you seem to be leaning towards a shouldice. To me Kang seems like the obvious choice but maybe I am missing something. Had I known how serious and dangerous hernia surgery is I would have spent another thousand hours researching it. I did not take a play off here. I studied hard. Just got confused. The tissue repairs all seemed to have decent failure rates. Long healing times. Lots of initial pain. Lap mesh seemed less destructive of tissue less painful seemed to have a lower recurrance rate I could take care of both hernias in one surgery and the technique I used left no scars. Sadly despite my study I was still destroyed by this surgery. Hernia surgery is NOT routine. All the fools that go to their primary care doc then straight to a recommended mesh surgeon are simply licking out. Dr B got all the mesh out but now I am staring at recurrance surgery. Tomas won’t see me because of the removal. But kang will. Shouldice clinic uses guitar string and trainees. Lots of reports of chronic pain. Sbayi cuts the cremaster and nerves. Yunis is a nice guy but he just doesn’t do that many tissue repairs. When I questioned him about this during a consult. He yada yadad his way through saying well I have been to shouldice twice. But he conceded he was mostly a lap guy for most of his career. Peterson was nasty to me and he has lots of bad reviews. Grishkan is 100 years old. Also very nasty. Andreas Koch gets good reviews but he has also butchered a few. That leaves kang. I can’t find anything bad about him. All great reviews and he seems very experienced caring and genuine. But it’s troubling that most of the research fanatics on this page pass him up maybe due to dustance? I know the distance is great. But I don’t want to take any more chances here. Kang seems like that hands down best choice. I only hope he sticks around until I recur.
      GI I am surprised you have not recurred how careful are you these days? I can’t believe the potential for hernia surgery to completely destroy lives.

    • #32671
      MarkT
      Participant

      You sound *so* ridiculous…I hope no one takes your irresponsible posts seriously.

      You do a huge disservice to this forum with the utter garbage that you post.

      • #32679
        notanewbeeok
        Participant

        Honestly, I have to say he does not sound so ridiculous to me. I too have had a hard time finding a top notch surgeon such that I went with watchful waiting for like 15 years. But what they don’t tell you is your hernia is likely to get worse with complications. True strangulation is pretty uncommon tho, but when it happens you better have surgery damn quick if you don’t want to carry a bag around the rest of your life. I too was really surprised at the number of complications from what is supposedly “routine” surgery. If it’s so routine why are there so MANY patients who have to have it repeated, in chronic pain, mesh migration, infection, etc, etc. Doesn’t sound “routine” to me. But you can count on one thing: their FEE collection will be routine. Also I noticed many of the surgeons will not take responsibility for their mistakes and bad outcomes. Sorry Mark, but I sympathize and agree somewhat with Chuck

      • #32680
        notanewbeeok
        Participant

        May I know where did you find reviews on Dr. Kang. Is he in Seoul? Any contact info?
        Did you happen to read the post here about the problems communicating with him and his assistant?

    • #32672
      Good intentions
      Participant

      I have not had any sign of recurring. I think that my case, overall, is not common. I think that my original direct hernia was not a result of inherently weak tissue but because I over-stressed the area as I tried to continue to play sports through a very painful strained sacroiliac joint (sore lower back). I had found that if I used the Valsalva maneuver to tighten up my abdomen during a soccer tackle or running hard that I could function with acceptable pain. I think that this created a direct hernia through otherwise good tissue that might have lasted for the rest of my life. In other words I caused my own hernia. Then, after the mesh implantation, my body had a very intense rejection reaction. Lots of inflammation and tissue thickening/tightening. This lasted for three years.

      A small piece of mesh was left in the area of the original direct hernia during mesh removal because it was too entangled with critical structures. So the original hernia was never exposed during explanation. So, overall, maybe I have ended up with what would be a correct use of mesh to repair the original direct hernia. Dr. Billing (who removed the mesh) uses TAPP for mesh implantation when he repairs a hernia. But he uses the method he learned in the 90’s, not the methods that are taught today.

      On the left side I only had a lipoma. But mesh was implanted anyway.

      In short, every situation has its differences. You have to evaluate your own. Calculate the odds and take a chance. When talking to the mainstream surgeons, especially the famous ones who are on the speaking circuit remember that they have years of statements and work behind them. In a way, they are tied to their past and need to keep doing what they’ve been doing, and support it as correct. It is difficult for them to change.

      You might try Dr. Wright at the University of Washington. He seems open-minded. Also remember that in general people do not want to be involved with people who insult them. It’s just human nature. Stop insulting people and maybe you’ll find a solution. Stop complaining. There are hundreds of thousands of people, probably millions actually, around the world in much worse shape than you are who have fewer resources and fewer places to get help.

    • #32675
      Chuck
      Participant

      Mark T. Piss off. I know you love your precious shouldice clinic but it def has lots of issues that you refuse to acknowledge. It’s infuriating that you can travel there pay big money then not even get to pick your surgeon. Then they sew you up with metal wire. Read the blogs and see how many are getting stuck by this wire through the years. Numerous folk claim they can feel it sticking them when they move. Now watchful tells us the docs are getting cut using it and bleeding into the hernia wounds? What’s not to like? Am I frustrated that I got butchered in criminal lap mesh surgery. Yes! But I am equally frustrated that there is so little clarity about other repair options. It’s nuts that small painless hernias are ruining lives. I really think kang is the only safe option.

      • #32683
        MarkT
        Participant

        Chuck, you just don’t have a clue…

        You are clearly incapable of doing good research…you don’t understand probability…and you read a few blog posts and you then make disparaging remarks about everyone.

        EVERY REPAIR OPTION HAS RISKS
        EVERY SURGEON HAS PATIENTS WITH CHRONIC PAIN
        EVERY SURGEON HAS PATIENTS WHO EXPERIENCE A RECURRENCE

        There is no flawless repair. You will ALWAYS find patients who have experienced negative outcomes.

        What you need to do (but are *clearly* incapable of doing) is try to understand the likelihood of various risks by evaluating the evidence that is out there (limited as it may be) and then making a decision that is best for your situation.

        What you need to STOP doing is talking crap about everyone who doesn’t mesh with your distorted, uneducated, condescending perspective. If someone were to search your post history, they would see that you have trashed almost every option at some point and been very arrogant and dismissive towards many surgeons (it’s amazing that Dr. Towfigh even bothers to try and help after what you have said about her)

        As for your “only safe option” of Dr. Kang…didn’t someone on this very forum need to go back for a 2nd surgery because he missed something and they were in terrible pain? Do you acknowledge that? OF COURSE NOT, because that would conflict with your dishonest, b.s. narrative.

        So why don’t you ‘piss off’ and come back when you have a clue and can behave like an adult.

        edit: as for my ‘precious’ Shouldice – I’ve stated in other posts what I would like to see changed or studied more…and I’ve been complimentary toward Dr. Kang, repeatedly stating that I hope his technique is better studied because it is an intriguing option. But of course you don’t acknowledge that either…

    • #32682
      Watchful
      Participant

      Chuck,

      Is it really all that likely that you will recur? What did Dr. B say about this?

      Maybe wait till it happens before picking the solution. You’ll need to see what you’re dealing with exactly.

      Some of the German surgeons are a good choice for Shouldice. A lot of experience, they use prolene, preserve the cremaster and nerve. One or two of them have a lot of experience with Desarda as well in case that’s an option for the kind of recurrence you may end up having.

      The reason I picked Shouldice over Desarda or Kang is the long track record and the many studies on different populations. If you care less about that, you may make a different choice.

      For many hernias, watchful waiting is a good option, and the “cure” can easily be worse than the disease. When continuing to wait becomes too problematic, you just have to pick your poison. None of the options is great – just different kinds of Russian Roulette with different odds for different issues (recurrence, chronic pain, etc.) These odds aren’t very clear, and a lot depends on your surgeon and how well they happen to do your specfic procedure.

    • #32684
      Chuck
      Participant

      Watchful. Thx. I have watched your detailed research and wished I had t become confused by the options. I typically research things the way you have. But I was lied to. Conned by mesh whore doctors. Todd Harris with his 20 percent tissue failure rate. Voeller with his debate full of lies then he goes to shouldice. My own physicians who said they had never seen a mesh complication in 20 years. Dr towfigh and dr yunis who presented lap mesh as the best surgery of recurrance and chronic pain. It was a real minefield. Have you selected the doc who will do your shouldice. I think if I was going shouldice I would select Andreas Koch. But I know you have studied this fanatically. I still wonder whether watchful waiting or quick repair makes the most sense. Dragging it out makes it harder to fix.

    • #32685
      William Bryant
      Participant

      Mark T,

      As far as I remember, if we are referring to the same patient of Dr Kang’s, it wasn’t pain I don’t think. A recurrence which may have had symptoms as most hernia’s do.

      It would good if there was independent backing and verification of Dr Kang for the sceptical.

      • #32687
        MarkT
        Participant

        William, I had to look it up, because my memory fails…I just knew someone (Pinto) needed a 2nd surgery.

        You are correct that it was a recurrence…thank you for the clarification.

        Dr. Kang attributed it to his use of absorbable sutures for some of his repairs. His post on that case can be found here: https://herniatalk.com/forums/topic/where-would-you-go-for-shouldice-surgery/

        To be clear, my reason for bringing that case up was not at all to criticize Dr. Kang…my post history will confirm that I am intrigued by his repair method and that I hope it is studied further and becomes more widely taught/available. It was to point out that every surgeon and repair method has risks and complications…the challenge to identify why and under what circumstances, and then takes steps to mitigate those risks. As always, I preach that we need more studies and better data…

    • #32689
      Mike M
      Participant

      Pinto situation was the fact he had a very rare “sliding hernia”. It was corrected and Pinto’s follow up review was extremely favorable towards Dr. Kang.

      The best compliment I can give Dr. Kang is he is what is advertised.

      Kang procedure is minimal and extremely effective. Dr. Kang operates on all cases, old, young, low/normal/high bmi, pre-existing conditions or not. his internal data has been collected for years and yields exceptional results. I researched all options and interviewed what I considered the top three “best” open tissue repair surgeons. Having experienced it I wouldn’t go anywhere else if I did have the option and unfortunate issue of a reoccurrence.

      Also originally I was dead set against any permanent sutures but changed my mind when I inquired with Pinto the details of his second op as well as Dr. Kang for his advice.

      I think Shouldice is a solid second choice with exceptional results as well in the hands of the right surgeon. However a lot of surgeons are very strict on their patient parameters which limits this as an option to a large portion of the population in need.

      I empathize with Chuck given his circumstances. I think we can all understand why Chuck might have a very bitter disposition in regards to certain specific types of repair. However I agree we do need to keep the conversations constructive especially towards those that go out of their way to provide help and assistance including the extremely well respected Doctor and operator of these forums.

      Some of the participants here like Good Intentions research tremendous amounts of challenging articles from all different sources to help everyone reading make the best educated decision when it comes to choosing their repair.

    • #32690
      Chuck
      Participant

      Mark T. Look I know you mean well. I am sorry I am so angry. But I was completely healthy until I landed in the nest of vipers that are hernia doctors. I have found very few that are honest. All push their own methods and scoff at the others. The mesh whores are the worst. But the non mesh Guys are nasty too. When I talked to Grishkan he scoffed at Tomas saying he had to fix many desarda repairs. Yunis assistant said yunis had to fix lots of grisskan repairs. Peterson said he removed mesh regularly from towfighs patients. Towfigh indicts the desarda repair and scoffs at the kang repair calling it a Marcy which only works on kids. What are we confused and hurting patients supposed to do honestly??!? The only doc I have had a good interaction with is doctor Kang. A simple honest guy who seems to have patients best interest at heart. He really seems to want to do the best for his patients. Repairing his recurrences for free. Shouldice clinic refuses to accommodate a no guitar string repair and refuses to let you pick your surgeon. Just pay them 8 k and let their trainees get a crack at you if they like. Sorry if I am bitter but my health was destroyed by this nest of liars.

    • #32691
      Chuck
      Participant

      I should qualify my criticism of these vipers by saying Dr belyansky was amazing. Said he would get all my mesh out and did so in under two hours without cutting nerves or cathing me. Of course he says mesh is safe. But he has to.

    • #32694
      Watchful
      Participant

      Chuck,

      I have the same experience, and not just with hernia surgeons. It’s the same with spine surgeons, for example. I recognize it for what it is which is human nature, but we expect doctors to rise above that. The vast majority don’t in my experience, which is very disappointing. There are some specialists who are relatively open-minded, honest, fair, know more than just one narrow thing, and are patient-focused rather than ego-focused, but boy are they an extremely rare breed!

    • #32699
      Chuck
      Participant

      Thx watchful. So what surgeon will you select for shouldice. I still don’t know why you are selecting that method. Many docs say it’s invasive. And some say it feels unduly tight for several years. Big surgery field. Big scar in many cases. Why don’t you prefer kang. At one time you seemed to.

    • #32703
      Watchful
      Participant

      Chuck,

      I’ll most likely go with one of the German surgeons.

      I don’t like the Shouldice procedure, but I like mesh even less. My hernia is a medium-size indirect hernia. For such hernias, I feel that Shouldice is overkill. It’s a shame to dissect and reconstruct a good posterior wall. Your groin gets carved out like sushi, and then rebuilt into a rainbow roll. At the Shouldice Hospital, you get the chef’s special Picasso Shouldice roll where the cremaster, genital nerve, and vessels are chopped off.

      The thing is that this butchery is (amazingly) proven to work, at least from a recurrence perspective. Chronic pain or discomfort terrifies me, but it appears to be rare-enough with the Germans. Not sure about the Shouldice Hospital – I would wait for the results of the pain study mentioned by their chief surgeon.

      I think it would be perfectly reasonable to pick Desarda instead, but there just isn’t nearly as much data about it, and I would need to find a surgeon that I trust who is really good and experienced at it.

      The Kang method for indirect hernias has much less data than even Desarda. I believe Kang has been practicing his current version of it for less than two years, and it went through 50 iterations before that. It’s not documented, so I don’t know the details. Maybe just tightening the inner ring with some clever stitching works well even in fairly large adult caucasian male indirect hernias. I have a very open mind about that, but I would need to understand the technique better and see more data. I don’t want to be a guinea pig, and I want “one and done”. I don’t want to need another surgery.

      In summary, as I mentioned before, my decision is driven mostly by data and by access to top surgeons performing the procedure. I don’t dismiss any of these options. Shouldice just fits my personal criteria better, but I’m far from enamored with it.

    • #32704
      Chuck
      Participant

      Watchful Thanks so much for your detailed analysis. Have you consulted with the German surgeons? Do they cut cut nerves and the cremaster? It amazes me how complicated and dangerous hernia surgery is. I chose lap mesh because I was concerned about the tissue trauma associated with open repairs. I spoke to many who had had desarda or Shouldice repairs. All of them told me that the healing time was exceptionally long with some still feeling the repair over a year later. And others saying they would feel the repair forever during specific activities. Like their dog pulling hard or lifting weights in the gym. They would always feel pain after these activities even years later. Never mind that with open tissue repairs nearly everyone that I spoke to had some kind of numbness dead spots nerve damage. Also many experienced hematomas from the surgery as well as healing ridges that took a long time to resolve. Lap mesh seemed to avoid all of those complications but of course as I know now the big beach blankets they stuffed in me cause their own problems. Had I known how problematic hernias were I would have been exceptionally careful to avoid them throughout my life. Do you know if the German surgeons will repair recurrent hernias after mesh removal? Again thanks so much for all your great research and for being willing to share it. Would love to chat with you by phone sometime if that works. I am still leaning towards Kang Simply because of his massive experience and because hernia surgery seems to be his passion and he is always looking for ways to improve his technique. Not sure that is true for these other surgeons. I hope that he will weigh in here on your concerns

    • #32705
      Good intentions
      Participant

      Chuck, did the mesh removal cure your prostatitis? The original reason to have the mesh removed.

    • #32708
      Watchful
      Participant

      Chuck,

      Yes, I consulted with some of them, and they don’t fully resect the cremaster or cut any nerves unless necessary. I wasn’t inquiring about repair after removal since that’s not my case, but some of them do remove mesh, and then repair with tissue.

      I think it is well-established that recovery from open hernia surgey (mesh or tissue repair) is more difficult on average than lap TEP. Among the open procedures, Shouldice probably requires the largest incision, so not great on that front.

      As to the incidence and severity of long-term pain and/or discomfort… This seems to be a problem with all adult inguinal hernia repair techniques that have been studied. Not sure how the different techniques compare in incidence and severity of that. It’s hard to draw any conclusions from the studies. I think that having a groin that has some issues and doesn’t feel completely normal is pretty common with all of them, but having severe issues is rare (which doesn’t mean it won’t happen to a particular person, of course).

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