-
Where would you go for Shouldice surgery?
-
I’ve sent a message Watchful.
I get all your saying… Similar to my experience.
But I also have other issues too!!!
That said think hernia is probably worst.
-
Thanks for looking up Lindsay’s case, William – this helps. It’s a good sign that he moved on – he must be happy with his repair.
I used to think that treating inguinal hernias was straightforward, so I didn’t bother researching it much all those years while watchful waiting. I thought I would just go to a good general surgeon and get it done when the time comes.
When the time finally came, I went to a general surgeon, and he told me that he himself had had an inguinal hernia which was repaired with open mesh, and he had chronic pain after that, and needed a neurectomy. Also, he told me that he routinely cuts the ilioinguinal nerve while performing the procedure. At that point, I realized that I knew nothing, and this was absolutely not a trivial thing.
I then went to a laparoscopic hernia surgeon, and he said he was 80% sure he could do it that way in my case, but there was a 20% chance that he would have to abort the procedure, and convert to open. At that point, I started being even more concerned.
The next step was to research mesh because those were mesh procedures, and this freaked me out even more. Meanwhile, my hernia symptoms kept getting worse. The next phase was researching tissue repairs, and looking into the very few places that offer it. I’m still shocked that treating this simple condition has so many pitfalls, and you need to travel far and maybe even to a different country to get it treated in the least bad way.
Anyway, I’m at the tail end of the research part, and it’s time for action. I really wish my hernia hadn’t become so symptomatic over the last year. It was minimally symptomatic for many years. That’s what aging does to you, I guess. Your existing issues get worse, and new ones pop up to make things even more interesting.
-
This reply was modified 2 years, 3 months ago by Watchful.
-
This reply was modified 2 years, 3 months ago by
-
Here’s some of what Linzee/lindsay wrote
It can bee seen it was an indirect hernia repair by Dr Kang7th January, 2019
My name is Lindsay, Australian, age in early 60’s. My contribution is for anyone with an inguinal hernia that is considering travelling for a mesh-free repair. I relate how I reviewed my options when in this position, ended choosing a Kang repair, and my experiences in following this through in Korea. My experience was very positive.
..
Background
I had an indirect inguinal hernia for >10 years, which deteriorated quickly and needed to be fixed. My quickest option was a local mesh repair, which in my case was to be larger than average in scope, entailing an open operation and general anesthetic.
..
I did some internet searches and noticed concerns with hernia mesh repairs. These included unpredictable adverse responses to mesh in some patients, and that significant pain was not uncommon after the repair. I also found reports that large hernias carry a higher than average possibility of recurrence, and higher probability of problems with mesh pain. From this, I sought only mesh-free repairs, but found only one clinic advertising this option in Australia.
..
Non-mesh inguinal hernia repair options
I found “HerniaTalk” to be a good place to learn about non-mesh inguinal hernia repairs, and where they might be available. I encountered recent information mostly on Shouldice, Desarda and Kang repairs. I found a recent presentation by Dr. Kang that provided a very useful overview to inguinal hernia repair approaches – https://www.youtube.com/watch?v=kzOyeRYysj4 . Hence, the Kang repair for indirect inguinal hernia appeared to me to be most suited to my situation. This repair is available at Gipum Hospital in Seoul.
..
The strengths I saw in a Kang Repair -
That’s weird linzee link states “no activity”.
Unless I’m doing something wrong.
-
https://herniatalk.com/members/linzee-1018/
linzee had an indirect hernia repaired by Dr Kang. It has held up for many years.
And, afaik, is still perfect.Linsay, according to Dr Kangs site, can also be contacted direct by email for further discussion.
Hope this helps Watchful
-
I posted at the same time you did, Dr. Kang, and hadn’t seen your post. This helps me understand what happened there. I certainly need to decide soon. I’m in bed right now trying to get my hernia back in!
-
Does anyone here know of anyone who had surgery for an indirect hernia with Dr. Kang? The only case I heard of is Pinto. He posted that he had an indirect sliding hernia, and his hernia recurred pretty much right away after surgery by Dr. Kang. A second operation by Dr. Kang has been successful so far. I know we have successful direct hernia experiences, but what about indirect? Those are two completely different procedures with Dr. Kang.
-
Hello Watchful,
You seem to be now at a very sensitive point in making your final decision. So, I am very careful about posting new article.
Shouldice surgery is surely a very good repair technique. And I do not intend to influence your decision in any way. I think you’ve worked very hard, and have more information than surgeons, so you’re good enough to make the best decision for yourself.
Nevertheless, I am posting this simple article because I felt the need to answer your doubt about Pinto’s case. You pointed out that Pinto’s recurrent case was omitted in my previous statistics.I have changed the surgical method dozens of times since I started non-mesh tissue repair in 2012. Just like a child growing up, Kang repair took on its present form as it grew up.
The reason the last statistics were for patients 7 to 32 months after surgery was because there was an important change in our indirect hernia repair method in December 2019, 32 months ago. Before then, all indirect hernias were repaired with absorbable 2-0 Vicryl. But from December 2019, I used permanent 2-0 Prolene in some patients, because I suddenly had a thought that an absorbable suture material might be the cause of recurrence.
At the beginning, Prolene was used only in patients with sliding hernia, recurrent hernia, large incarcerated scrotal hernia, or in patients with large internal ring or severe ascites etc. And for patients with average risk, I continued to use an absorbacle Vicryl. As a result, there was no recurrence in 401 high risk patients who used Prolene, but among 1405 patients who used Vicryl, recurrence occurred intermittently, and 12 patients have relapsed so far. So, since September of last year, we have repaired all indirect hernias with permanent 2-0 Prolene.
My previous statistic of no recurrence with 738 patients 7-32 months after indirect hernia repairs, were only about those with the permanent Prolenes.Pinto, who underwent the first operation in August 2019 for left sliding hernia, was excluded from the previous statistic because he had surgery with Vicryl at the time. But Pinto’s reoperation was done using Prolene in March of this year.
Thank you all, and thank you Mike M! -
When talking about mesh you have to include the solution to the chronic pain problem if it happens. With mesh it’s mesh explantation. I have not seen anything that suggests, realistically, that the pain clinic remedies actually “cure” the problem. They cover it up and create new pharmaceutical based problems. A person could be on pain meds for life. The same with neurectomy. A new risk of new problems.
I like your summary but the discussions of risk almost always end short, in my opinion. You have to consider the long-term.
-
Full disclosure: I went to Dr. Kang and had a successful Dr. Kang repair.
#1. Dr. Kang – Scenario: You are going to war in your own town and Dr. Kang is like a GPS, laser guided, Smart Bomb with the least amount of collateral damage while still maintaining maximum effectiveness in the targeted area (as it relates to open tissue repair). Dr. Kang doesn’t cherry pick patients and he is not afraid to engage with his audience with full transparency. Dr Kang is well respected by his peers (including Dr. Yunis) and his results so far have been spectacular even if we do not have 20+ years of documented long-term results (many procedures don’t). Keep in mind after 6 months the collagen in that area of the body has healed up to “normal” strength or greater* from what was disclosed in our previous discussions? Dr. Kang also has 20+ years of experience with hernia repairs in general (thousands) and additionally he has extensive experience with intestinal issues (St. Mark’s Hospital London, Gibbium Hospital).
#2. Dr. Grischkan or Dr. Yunis – Shouldice is like carpet bombing imho. Evacuate the area and leave no stone undisturbed. I feel that these two doctors would be the least “invasive” with well documented long term results from both the doctor and their patients.
#3. David Krpata, M.D., Cleveland Clinic – “Uncorrupted” Bassini repair. Probably the closest operation to Dr. Kang’s for Direct Hernias? I believe Cleveland Clinic is currently performing this method when requested to very successful results. I did not have a chance to investigate this further before my Kang repair but some previous posters (with major mesh issues) had great success with that repair at the Cleveland Clinic. He has also been a guest on Dr. Towfigh’s webcast.
Modified vs. unmodified. – It really depends on what your ideology is on medical procedures. I feel there is strong enough evidence from multiple credible sources that diverting from the original procedure in this particular procedure most likely yields better results, specifically as it relates to chronic pain.
There is no doubt that the Shouldice Hospital and other doctors like Dr. Sbayi have had tremendous success despite cutting the Cremaster and nerves.
However, the chronic pain with shouldice has been increasing? in cases, is not well documented, and is expected to be somewhere around 5%+ from the Shouldice Hospital lead surgeon’s own admission? Keep in mind this is from well selected patients with semi-strict criteria.
If I was going to accept a procedure that cuts the cremaster and genital nerve branch I would go ahead and just get mesh.
If we’re getting to that point I feel the risk is similar or possibly even less at that point. -
That is an excellent find, thank you for that. Everybody should read it, whether they are looking at a Shouldice repair or not. Dr. Netto covers the inguinal hernia repair in whole in his remarks. With some very interesting comments about why mesh is so popular today. Save the link immediately. The battle continues. It’s like a civil war.
I would be very interested to know how, exactly, the Shouldice Hospital uses mesh. Dr. Netto seems to have fallen in to the trap of referring to all types of mesh and ways to use it as “using mesh”. It’s the great confuser of the hernia repair field.
-
Dr. Netto answered questions from a Scottish Parliament Committee in 5/2022 here:
He mentions that their post-op pain figure used to be 1%, but they need to redo their statistics now that the definition of post-op pain changed. He doesn’t mention his 5% guess in this one.
-
Thank you for that link to the Comment. It’s funny how you can find more if you look, I didn’t look hard enough.
But, the one reference that we would all like to see, #5, about chronic pain rates, is still behind a “sign up for free trial” wall, just a few lines down from the preview. Oh well. This internet world is a strange place. It might be worth a sign-up for Watchful or others.
“lower post-operative complications (including chronic pain) [5]”
In addition though, another useful item in the Comment article is the email addresses of both Dr. Netto and Dr. Szasz. Maybe somebody could invite them on to the forum, for their views. Or they might respond to a well-written query about chronic pain or other details of the Shouldice procedure.
-
Great links to the video and comment Good intentions, thanks.
Here’s a link to the comment – https://www.deepdyve.com/lp/springer-journal/shouldice-hospital-comments-on-shouldice-standard-2020-review-of-JkkEjJj2yQ?key=springer
-
Hi Watchful,
Reassuring that the Shouldice hospital will listen to patient requests for specific surgeons, albeit without promising. I guess you’d have to be politely assertive on arrival that you’d only see whoever you’d enquired about. A longer the list of acceptable surgeons would hopefully raise the odds of getting one.
Thanks for reposting that link, I’d forgotten about that!
Also reassuring to hear about the Canada insurance study re accuracy of recurrence rates, as long as it was fully independent.
It seems to me that unless there’s an increased appetite within the sector to champion and independently monitor long-term hernia outcomes with the different tissue repairs and their modified versions and for individual surgeon results too, to account for varying degrees of skill and expertise, we’ll have to accept what’s most believably evidenced currently and hope we make the right choice.
As some of the doctors I’ve spoken to have told me, they can’t always guarantee their rates of pain and recurrence, because former patients aren’t always contactable, particularly over the long-term and if someone has a bad outcome, they may go to a different doctor, so the original surgeon never finds out that there was an issue. These unknowns may well be factored into success rates for many surgeons who keep their own records.
-
Dr. Netto and Dr. Szasz also had some comments about the Lorenz et al paper that was referenced in the missing Dr. Sea thread. It doesn’t look he has published anything since his Towfigh interview.
It is pay-per-view and a comment so there is no abstract.
https://link.springer.com/article/10.1007/s10029-021-02455-z
-
I found the video with Dr. Netto discussing chronic pain. I think that you have to listen to everything he says about it to understand what he means. He said that they did not know and guesses at “maybe 5″%”. He also talks about the type of pain, describing it as pain that does not require pain meds. Overall, he seems to be just saying that chronic pain from the Shouldice procedure deserves more study. He has an accent so you have to listen carefully, plus his microphone was cutting out.
It’s at about 19:00. I timestamped the Share so it should start there.
-
Jack2021,
Yes, I tried it. I was told that I could request specific surgeons, but they couldn’t promise anything.
On the nuked thread, I posted a link to a 1991 paper from Germany that said that there’s a lower recurrence rate when cutting the cremaster, but higher pain. Still, it concluded that cutting the cremaster is an essential part of the Shouldice repair:
There was an independent source of information about recurrence at the Shouldice Hospital. There was a study from insurance in Canada, and it was consistent with the results claimed by the hospital. I don’t have the link readily available, but I can find it.
I don’t really doubt their historic recurrence numbers. Assuming they’ve been keeping up the level of quality work there, their repairs should be solid on that front (at least if you get one of their best surgeons). Chronic pain is a bit of an unknown, but not sure what it really is for other Shouldice surgeons either.
-
Re your point about not being able to select a surgeon at the Shouldice Hospital, Watchful, it would be interesting to know what the hospital’s response would be to an enquiry from a paying patient explaining that they’re travelling a long distance and would like to be treated by either a specific surgeon, or say one of a selection of two or three, if you knew all have great reviews.
Have you tried that to see what they say?
The other point to consider, as noted by one of the posters on the disappeared Mr Sea thread (apologies, I forgot who it was), is that Dr Netto from the Shouldice Hospital stated that their current stats for chronic pain may be significantly higher than stated at perhaps 5%+ and they need to look into this further, or something along those lines.
If correct, could their long term pain rates be linked to cutting the cremaster and nerves? The problem here is that we don’t have a long term study of chronic pain and recurrence of the original Shouldice vs the modified Shouldice (i.e. the version that doesn’t cut the cremaster and nerves and has 4 lines of permanent sutures) and we may never get one, certainly not in time for those of us currently watchful waiting.
I’ve not heard the actual quote from Dr Netto, but if it’s true that their pain stats aren’t accurate, why aren’t they accurate and does it therefore also raise some doubt about their stated recurrence stats too?
-
Good Intentions,
Yes, it was very disturbing that the thread was nuked. There were very good contributions from a number of participants here, including illuminating posts from Dr. Kang as you mentioned.
I have a medium size indirect hernia. I’m not overweight or old. The Kang repair sounds best in theory, but I’m reluctant to do that because of the lack of a long-term track record – I’m concerned about recurrence. Desarda is another option, but I don’t have the time to research it and think about it too much. I really need to have my hernia fixed ASAP. This leaves Shouldice. Unfortunately, the Shouldice Hospital has its quirks, and there are multiple flavors of Shouldice, so even narrowing things down to the Shouldice procedure still leaves you with some difficult decision making…
Log in to reply.