cpk303
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I had multiple U/S performed in the U.S. confirming a fat filled hernia sac prior to departing for Seoul.
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Thank you Dr. Towfigh, that’s fascinating re: insurance companies paying less for procedures requiring more time, potentially more skill, and unique equipment. All the best care seems to be heading towards self-pay and I wouldn’t blame any physician for refusing to accept insurance.
@G, Korean nationals receive govt. healthcare coverage and my understanding is that they pay a few hundred dollars in co-pay for a hernia repair. Foreigners pay the full freight which is $2,000 for single-side repair. I don’t believe any regular U.S. health insurance companies would cover any medical care outisde the country.
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Yes, Occult hernias, sliding hernias, sliding fat hernias outside the sac, lipomas, it’s definitely complex. I found that a regular jack of all trades general surgeon may not have the necessary expertise to identify all of these variations and it’s best to seek out a hernia specialist. Here is another interesting article about cord lipomas:
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Larger hernias do not always mean more discomfort. I’ve heard of people being able to regularly push an orange sized hernia back into their groin with no pain. Dr. Kang could not identify my hernia from his initial physical exam alone. However, his two excellent U/S techs found the lipoma and smaller hernia sac. He will not move forward with surgery until he has conclusive evidence from either the exam or ultrasound.
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I’m sure a surgeon and/or anyone who works for an insurance company could weigh in and confirm, but I would almost guarantee that reimbursement for a laparoscopic or robotic procedure will be significantly higher than a 20-minute pure tissue repair.
We’re already heading in the direction of more self-pay for speciality procedures, concierge medicine etc. so I agree with G re: this being a self-pay option if it ever came to the U.S.
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Yes, propofol, similar to a colonoscopy. I confirmed it a few different times. It’s still conscious sedation as you’re breathing on your own. I personally prefer propofol vs. the typical versed/fentanyl combo as there’s no hangover and I’ve returned to being completely lucid almost instantly. They don’t want you waking up and/or moving so this would be better for the surgeon as well.
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One surgeon I met with prior to going to Seoul recommended placing a 10×15 cm piece of mesh on BOTH sides because it’s possible I had/or might get a hernia on the left side. I only had one on the right side as confirmed by multiple future U/S.
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@WilliamBryant, they don’t push the propofol until De. Kang enters the OR, says hello, and is ready.
@DavidM, Phasix.
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Just a quick update. I’m now nine days post-surgery and feeling pretty good with noticeable improvement each day. I’m back home and at work leading a relatively normal day, minus any real exercise yet. I still have pretty numb areas below the incision and inner thigh with mild burning and itching at surface level. I had a large lipoma excised from the spermatic cord so possibly had a little more trauma and nerve disruption. I’ve got some minor swelling in the scrotum which interestingly arrived 5-6 days post-surgery so I switched back to briefs. Gravity isn’t my friend right now down there, LOL! The surgical glue just fell off and you can barely even see the scar already. All-in-all I’m pleased with my recovery trajectory.
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I’ll chime in here with my two cents. Sadly, in the United States, surgery options and availability are often influenced by insurance companies and the medical device industry, powerful entities that also influence teaching methods. This is not the surgeon’s fault. U.S. surgeons have sky high costs today (i.e. malpractice premiums, facilities, staff etc.) and typically receive pennies on the dollar from insurance reimbursement. Think about what an insurance company would reimburse for a 15-minute hernia repair, local anesthesia, and a couple of prolene or PDS sutures? Certainly not enough to pay the bills unless they were able to do 10 a day like Dr. Kang, which is highly unlikely.
Dr. Kang has three operating rooms reserved just for him each day. He rotates among them in order to get through up to three repairs per hour without waiting for operating room or patient prep. I just don’t see this model being viable in the United States. I’m personally hopeful that the Kang repair spreads beyond Korea but I think it would more likely end up in a few other specialty surgery locations, and probably still outside of the United States.
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Yes, Alan is correct. Only the Korean version has been published, titled “Goodbye Hernia”. Dr. Kang gives gives all of his patients a signed copy of the book. The english version is not yet in final form for publication.
If anyone is interested in reading more about lipomas, here are a few links:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422475/
https://ls.amegroups.com/article/view/5980/html
https://www.frontiersin.org/articles/10.3389/fsurg.2020.00039/full#B42
I’ll post another update on my recovery in the next few days. I’ve got some burning and itching in the numb areas so hopefully that’s a sign the nerves are coming back to life.
One other suggestion. While I checked my suitcase in Seoul, I forgot that my additional backpack probably weighed 20+ pounds. It was very difficult to walk while wearing at Incheon airport and the distances to the departure gates can be far. I would recommend having very little and very light hand luggage for your return journey.