[Baris]

Hi,

In all 3 of my bilateral surgeries ive had general anasthesia however at the shouldice clinic they have a rule of doing local anaesthesia for all hernias unless they have been recurrent twice. So if you’ve had surgery two times before your having to go under general. Thats how they define complicated i guess. Definitely more costly and longer recovery duration.

Baris

[Baris]

Hi all,
Ive used bio hernia to have my first surgery with Dr Koch in germany. The owner of bio hernia is a guy called Naomi who himself had surgery with dr koch and is from Netherlands. There is a lot of dutch patients going to germany for treatment. Lets say a huge market for bio hernia and Dr koch ;). In regards to Dr Muschaweck she has her own secretary and you can access her email directly in regards to contacting her ( lovely and very very honest lady who i can defiently say is not motivated just with money). Id be honest they were very helpful in sorting out the surgery and accommodation so on however after having my issues with re-surgery and the fact i was guaranteed 3 years for primary repair they still haven’t replied to my 3 emails. So yh there good when things are going good. The other thing id like to highlight is the fact that they supposedly do most techniques. I firstly ever contacted them in regards to desarda however when i got there i was told by dr koch that he will do a shouldice with absorbable sutures and that he wont perform desarda and never does as he believes its for skinny people. So yh they definently aim to firstly lure you in.
As a company its definently naomi just as an agent and the doctors dont really associate with eachother. I remember when i was in so much pain in germany dr koch said that when i get back to london he would speak with his ‘close friend’ dr muschaweck to inject me with a local anasthesia until i got comfortable.
Exactly 18 months later i had a consultation with dr muschaweck. I asked her about her ‘close friend’. She said shes only spoke to him once at the annual conference briefly. 😂
How great?

Baris

[Baris]

@good-intentions i have my surgery report for my right side to show exactly whats been done and what they have seen.

‘An oblique right skin insicion was first made avoiding the previous high almost transverse skin scar. The incision was extended through fairly heavy scarring to reach the external oblique aponerousis which was opened in line with its fibres to gain access to the inguinal canal. Scarring was very heavy. There was an opening at the internal ring which was about 2 cm accross alowing extraperitoneal fat to come through. The spermatic cord was freed with great caution because at the internal ring when trying to split theposterior wall a piece of underlay mesh material was found densely adhered to the under surface of the rectus muscle. Over the groin, near the pubic tubercile, a few firm small lympth nodes were found, removed and submitted for pathological studies. The illioinguinal nerve was found and freed and protected throughout. The posterior wall eventually opened to pubic bone through very dense scarring. The inferiror epigastric vessels were bound up in the mesh and in order to open the posteriror wall, these vessels were divided and transfixed with 2-0 Maxon. There was a shallow femoral pocket above the area was good below and left alone. Some fatty material superficial to the pubic tubercile was also exised. The repair was done without disturbing the mesh which was densely adherent to the rectus muscle. Four continous lines of #32 gauge monofilament stainless steel wire was used to close the posterior inguinal wall incorperating the lateral border of the rectus abdomonis and the inguinal ligament and leaving a loose internal inguinal ring with no compression of the spermatic cord. Cremasterics had been found, scarred, but thin and divided doubly ligitated with 4-0 polysorb. The tissues were then infiltrated with 0.23% roplvacaine hydrochloride. A single continous line of 2-0 Maxon was then used to reclose the external oblique aponeurosis and anchor the distal cremasteric stump. Subcuntaneous tissues were reclosed with interrupted 2-0 Maxon, Michel clips appiled to the skin amd this wound covered with a sterile sheet and left alone at this point.’

My question now is although the mesh is heavily scared can it still be removed?
And also from whats been stated is the mesh in contact with my intestines?

Kind regards
Baris

[Baris]

Hi all,
i can see that this forum is getting quite intense.
firstly bio hernia hasnt replied to me after they guaranteed money back on a repair that reoccurs in 3 years time.
Secondly i am good. No reoccurrence and i can feel my muscles are strong.to continue, in the first 4 months the mesh was difficult to admit but thats now easing. i went to dr muschaweck in london just to get an update and see what she thinks. Her words were, ‘ if u came from shouldice and they cant fix it you might as-well leave now, speaking very highly of the chief surgeon. We both had a laugh. She was shocked at my story and said as a nation as german doctor i am truly sorry.
yes i did pressure dr koch but i am not the doctor i am not the surgeon my knowledge is minimal and my sole aim is to eradicate the pain. If the surgeon is the cause of the pain its very normal for me to beg for him to get rid of it right?
Dr muschaweck personally spoke to him on the phone as he was supposedly her ‘friend’ as he would not send over surgery reports.
She herself said the whole case is silly from the fact absorbable stitches in a shouldice was used which literally means its on the road to a fail. She told me after i showed my first ever open images dr koch took on the surgery table that my repair could of been done with the minimally invasive technique. Thats how small and straightforward it was. Only a slight bit of fat.
She also presumed that the mesh was used as the second surgery was done too soon and the muscle hadn’t healed up the sutures wudnt of held. When i went to shouldice they were shocked i had mesh as they said my muscle was very strong it just needed healing time. Was this my fault? That a surgeon crumbles under pressure from a patient who he has caused and inflicted pain upon? No.
this was pure greed and il tell you why.
On the second surgery I was told to take out a european health insurance card by dr koch. When i got there he told he will admit me as an emergency so they wont charge me and he wont incur costs. We had to act as if i had a strangulated hernia.
Why did i go through that stress? Wasn’t he supposed to do it free of charge anyway as he had guaranteed 3 years no reoccurrence?
ah and it costs much more than the shouldice clinic.
Theres many doctors out there that perform superb surgery. Dr brown dr kang to name a couple. Dr conze is a great mesh removal surgeon as well. But what dr koch did was solely for a few extra thousand euros.
coming to the cremester muscle. It was a procedure to cut as it reduced recurrences from 4% to the 0.5% they achieve now. This is due to the fact it can irritate/damage the repair.
The technique is a shouldice if it is done the same way as the shouldice clinic, with permanent sutures.
if you go on the newly formed shouldice instagram page you will see Dr Koch being trained by the head of the hospital.
if you go in to dr kochs office you will see a large portrait in a frame of Dr Shouldice. If he’s worshiping the guy and believes so much in it then at least follow it and if you make a mistake ( as it can happen) do your best to ensure the steps taken next are to help the patient recover and progress rather than aiding your pocket to buy yourself a new sporty audi.
Other than that speaking of me i am fine and doing well. The mesh has settled in. The side with no mesh feels as if I’ve never even had a cut before. The side withe mesh sometimes causes a nagging pain but as time goes on this is getting less and less and is not bothering me much. Dr Michael alexander told me it could take up too two years for it to fully heal on the side with mesh but keeping it in was the best course of action at the time as it could of been risky. Never needed it and no one ever needs it unless you have very bad muscle or no muscle. Im running sprinting swimming playing football and feel very strong. I have started lifting heavy since may and it doesn’t bother me at all. I just wish i went there in the first place. I have another appointment with dr muschaweck at the end of the year just for a checkup.
Lastly if you are working for bio hernia or dr koch or if they see this please respond to my email as the following month i will start legal proceedings for medical misconduct neglect and fraud.

[Baris]

quote UhOh!:

But wouldn’t all of those questions be answered in advance if imaging were done by a technician with hernia expertise? Part of the problem is how operator-dependent ultrasound imaging is and how much variance there seems to be in expertise among technicians specific to hernias.

Thats true aswell but if i had an indirect hernia and no defect in the direct area would imaging techniques show how prone the muscle is to rupture? Or would it allow the surgeon to confirm that the area is strong enough to not even need to check the fascia and just repair the ring in case of an indirect hernia? How would an ultrasound intepret this?

[Baris]

Hi dr kang,
in relation to imaging none of my hernias were present on the imaging but felt when touched. How would the surgeon know how big to make the insicion to see the whole inguinal floor? When i asked the surgeon at shouldice he very quicklly dismissed imaging techniques for hernias. In my case for instance i was shocked to find out that the surgeon cuts all the way down to the pubic tubercile. However i was glad it was done that way as on my left side i had both a direct and indirect hernia. My left side had been operated on before twice and it was totally missed. Now coming back to choosing specific types of repairs for the type of hernia, if the surgeon didnt intent to cut the whole muscle and do a one big repair (fit for both direct and indirect) how would he have found the second defect that was present on my left side. I asked about this ( to the surgeon at the shouldice clinic) and was frustrated it had been missed before. He said that they deliberately restructure the whole floor as one of the main reasons being is that in 13-14% of surgeries they perform there is a secondary hernia present which is missed by most other surgeons. I then asked what if there wasnt a secondary hernia and it was just an indirect isnt that pointless that the tissue is cut away? I was then told what if when i arrived i had an indirect but that area (where direct hernias appear) was still intact but very weak? How would i have known? How would the surgeon of known? Wouldnt it increase the likelihood of me having a reoccurence and then more surgery to then correct the direct hernia? Leading to more pain invasion and scarring? In a way thats why i believe in the shouldice technique the idea is to go in once and do the utmost to minimuze the risk to the lowest stage possible by repairing the whole area to a high standard to minimize future issues and strengthen the tissue as a whole, especially incase its still intact but prone to rupture. That is why i think the reoccurence rates are very low as every possibility is assesed and repair is done not just to fix but also to prevent.
So in a way yes its more cutting away and maybe slight more invasion but i do believe it cuts out any possibilities of being a short term resolution and rather being a long term solution, thus why they do a one repair fit for all and have amazing statistics. The only reason i say this is because i had two previous surgeries and i think everyone will agree that youd rather have one ‘supposedly invasive’ surgery rather than many little ones to correct eachother.
This is why i belive the clinic/technique does a repair which addresses both direct and indirect regardless of the type of inguinal hernia you have.

i hope i have made sense :)))
Regards
Baris

[Baris]

Hi,
the testicle being low after any inguinal hernia surgery Is common and 4 days is way too early. Usually takes a couple weeks for it to position back to its normal place and can take anywhere up untill 6 weeks.
In a usual shouldice procedure the cremester muscle is cut and resuspended into the repair. However from my own experience and hearing from others having the procedure done outside the clinic surgeons tend not to cut the muscle as they feel its unecessary (although it decreases the reoccurence rate)
Even if your cremester muscle was cut your scrotum will still raise the testicle as ive had mine cut and my testicles still raise. i was told the only time id realise ive lost the cremester muscle function is maybe if i scratched my inner thigh and the testicle hasnt retracted.
In your position its way too early however its important to ask your surgeon if he has cut the muscle and wether his resuspended it.
When i was at the shouldice clinic the surgeon told me that people wernt happy with the testicle being lower and thats why they started resuspending as this allows the testicle to return to the same position prior surgery.
So main two questions to ask the surgeon In my opinion is:
1. Has the cremestar muscle been cut
2. If cut, has it been resuspended

[Baris]

Hi jeremy
i couldnt upload the photo but il type what it states in the ‘post operative conditions’ letter from the shouldice clinic that relates to you.
’ After every operation, particularly after ventral (incisional, umbilical, epigastric) hernia repairs, fluid (blood,serum) collects in the subcutaneous space. It is always there, even though the volume must exceed a certain amount before it can be clinically detected. If it can be seen or felt as a swelling, it may become a cause of concern but is a natural occurence and should be left alone to resolve spontaneously. It is not harmful and attempts to drain it usually lead to rapid re-accumalation as well as the risk of introducing infection.’

[Baris]

Hi jeremy,
keep positive and do what you can on your side. Really and trully other than giving it time you dont have too much choice right now. If massage or packs work do that and as much as i remember it takes 8 weeks for the tissue in there to reach at least %40 healing. Dont blame yourself because travelling has nothing to do with it, the maximum damage it could do is cause you pain and not damage the repair.
I had a letter givien to me by the shouldice clinic that states that the space were the surgery is performed can swell sometimes and can take up to 6 weeks to come fully down. They advise not to drain it as it will cause more swelling and fluid in the space.
My main advice will be do not panic and have more procedures done which i did myself and deeply regretted. Remain positive and hopefully it slowy reduces.

[Baris]

Hi jeremy,
The healing rudge is usually in line with the incision and is only slightly raised feeling like a hard mass and takes months to get soft. Swelling is normal after surgery and can take time but if your specifically wanting to find out if the whole lump is the ridge then id say no. You should speak to your surgeon and see what he says about the size of the lump and why the swelling is not reducing. Does the site feel hot? Or the incision really red?

[Baris]

Hi jeremy ,
wanted to ask where did you get the surgery done??

[Baris]

[USER=”1916″]Chaunce1234[/USER]
i requested way before arriving at the hospital as id known he was the chief surgeon. I was told that it will be put on my file but will not be guranteed.
When i got there he sat me in his office and we spoke a whole load of things and i specifically asked him who would of done my surgery if i didnt request him. He answered back and said that he would of took on the file. Usually most days he does 4-5 surgeries but on my surgery day he only done one complex case before myself.
Funny enough he said when repairing my left side he broke a record globally by doing 32,001 operations.
With all the people i spoke to there none specifically requested a surgeon so i do believe if youd request him you will have a high chance of him being the surgeon. I went from london so i paid all out of pocket so im not sure wether this had any influence and how the system in canada works in terms of what rights the insurance give you. Top quality guy though never met a surgeon of that level to be that humble.
In terms of recovery im doing well, im off all kinds of pain meds and just resting. The insicion is healing well. Bowels slowly returning to normal just a lot of gas but i was told it will take a minimum of 5 days for bowels to function properly especially after general anasthesia. A lot of brusing and discolouration but this is expected and usually fully clears within 3-4 weeks.
Also to make people aware.. the videos on youtube that state they are from the shouldice clinic is a fake and is not the actual way the technique should be used.
So far all seems good and il update in the next week or so on progress 🙂

[Baris]

No side affects at all. And this suggestion of testicles hanging down is nonsence aswell. The surgeon says that most men lose the function of their cremastic muscle after puberty and its only a quite a few that have it. To be honest ive noticed no difference in terms of my testicles yet but its still early to say.

[Baris]

Thats probarbly correct yes but the main reason for cutting the cremester muscle is not for actually reaching the repair itself.. its due to the fact that if its not cut and resuspended in the repair it damages the repair in the future. Both dr muschaweck and and dr koch have been to the shouldice clinic to observe operations and understand the technique.
The chief surgeon here has been operating here for 41 years on just hernias

[Baris]

They dont do mesh removal unless the hernia has reoccured. If it has then when repairing they remove it.

[Baris]

Hi im glad it went well..
was the cremaster muscle cut for ypur brothers then resuspended?

[Baris]

The shouldice clinic only removes mesh if there is a reoccurence of the hernia. They will not remove it if there is no hernia present.

[Baris]

A few weeks before my surgery i am advised to take vitamin c every time i have a meal as they say at the shouldice clinic it enables a better repair and recovery. Ive had surgery before for a dental procedure and i was put on an IV of vitamin C and ive never recovered that quickly. Felt like i was never on the chair. Whenever i have an injury i take vitamin c and it definently helps my recovery. I ruptured my hamstring ( about 19cms) i quickly went on an iv and took dosages of vitamin C and my physio was amazed at the recovery time and how soon i was able to return to competitive sports. I denfinently think vitamin c is needed prior to any surgery but ensure a lot of fluid is taken in as it can cause constipation and thats not ideal especially if your having hernia surgery.
Also i have heard of many doctors that smoking can cause collagen issues.
in regards to exercise although it can be painful i have started strengthening my abdominal muscles for the surgery. Is this a good idea? Would it be beneficial?

[Baris]

I certainly think so. The shouldice surgeon stated that preparation was as important as on the day of the surgery. A whole load of diatery changes were given to ensure your prepared for surgery in the best way possible. I had a shouldice procedure (absorbable sutures) before and i went in their weighing 107kg. When i requested surgery at the shouldice clinic after reoccurence they told me to come in at a maximum of 89kg or theres a big chance id be sent back home. When i asked them why and that i had the surgery weighing 107kg, they said that it allows them to complete a better repair as fat around muscle tissue contributes to a weaker outcome and finish. It also ensures a less painful and better recovery i was told.
So when thinking about it even a simple change in a pre surgical procedure contributes to a better outcome.

[Baris]

Hi chaunce,

i believe the reason they use it is like you said, its biocompatible and strong. When i requested surgery they also said that i had to wait one year after previous surgery as this is the time it takes for the muscle to fully repair from being cut and sewn together and therefore i believe this may be another reason for using these sutures. It keeps the repair in its strongest form up until ffull recovery/ healing.

in terms of the desarda repair, is it still suitable for patients that are big in size? And how succesful is it? Just curious as my previous surgeon said he wouldnt opt to use it as its designed for ‘small framed skinny people’.