[dave11]

I had the Shouldice 2 layer done by Dr. Yunis just over one year ago. I would classify my surgery as a total success. After a massive amount of research of various no mesh repairs and surgeons, I chose Yunis over Kang because of the travel distance and covid restrictions. I loved Kang’s minimal area and sutures surgery approach to speed the healing process, but was impressed by Yunis’ varied surgical techniques and much closer proximity. Both doctors have excellent success rates. Kang encouraged the 2 layer versus the 4 layer since he believed the latter added unnecessary material for no absolute benefit. Ardent 4 layer doctors mention the reduction of tension using a 4 layer method, but I had no tension using the 2 layer. As for wire sutures, I would never place hardware store like material in my body. Yunis did use non-absorbable sutures, but eventually they help form beneficial good scar tissue that creates a more natural barrier. Also, he does not cut the cremaster. Well, I thought after a year I would let people know how the Shouldice 2 layer held up because it seems like a lot of people on HT just get the initial info and fade. I hope this helps in deciding.

[dave11]

Ah, two of my favorite contributors start a post on the Shouldice method of repair. Thanks for your input. I had the Shouldice 2 layer done by Dr. Yunis just over one year ago. I would classify my surgery as a total success. After a massive amount of research of various no mesh repairs and surgeons, I chose Yunis over Kang because of the travel distance and covid restrictions. I loved Yang’s minimal area and sutures surgery approach to speed the healing process, but was impressed by Yunis’ varied surgical techniques and much closer proximity. Both doctors have excellent success rates. Kang encouraged the 2 layer versus the 4 layer since he believed the latter added unnecessary material for no absolute benefit. Ardent 4 layer doctors mention the reduction of tension using a 4 layer method, but I had no tension using the 2 layer. As for wire sutures, I would never place hardware store like material in my body. Yunis did use non-absorbable sutures, but eventually they help form beneficial good scar tissue that creates a more natural barrier. Also, he does not cut the cremaster. Well, I thought after a year I would let people know how the Shouldice 2 layer held up because it seems like a lot of people on HT just get the initial info and fade. However, that could never be said for Watchful and Good Intentions since you are ever present to help those in need. I certainly hope you realize how much help you provide.

• This reply was modified 1 year, 8 months ago by  dave11.

[dave11]

Watchful, the Prolene 0 is nonabsorbable, but Yunis explained that the sutures do not do the primary holding at my 6 month post hernia surgery. He went on to say the adhered tissues form healthy scar tissue barriers that do the primary support. I was a little confused because I thought the stitch work was the main barrier. However, once again I was pleased that my body was able to form the barriers. I really do wonder what happens to the Prolene 0 long term being subjected to various body internal conditions. The Internet shed no light. You really are “watching” Watchful. “Dissolves” was wrong word. I do get the feeling if I live long enough my body will diminish the Prolene 0 also. I have had no inflammation from the Prolene, and in a way, the more support it gives the better for me.

[dave11]

One more thing regarding the 4 layer Shouldice is that those 2 extra layers are mostly placed to reduce tension and do not necessarily contribute to a lesser recurrence rate. As for my 2 layer, I have absolutely NO TENSION now and I am glad I avoided all that extra Prolene 0 suture work. I always remember Dr. Kang saying the 4 layer is “unnecessarily invasive.”

[dave11]

Watchful. I have tried quite successfully in my life to keep any material sold at a hardware store out of my body. I would NEVER put wire sutures in my body. In fact, after having to get a plate and screws put in my wrist after wrist surgery, I had them removed after the radius bone healed with superior wrist function . Our bodies can be wonderful healing solutions if we nurture them. The sutures used during my Shouldice have dissolved per Yunis leaving healthy scar tissue as barriers to future hernias. The Desarda technique has a lesser reputation than Shouldice and is more destructive to body tissues. This might be a factor if recurrence surgery is needed. At least for me, the Shouldice experience has been great!

[dave11]

Sheldon and Watchful, by the way, my hernia was NOT small when I actually got the surgery. My point is body tissue progressively weakens with aging, and getting a hernia fixed earlier can prevent further worsening. My smaller indirect inguinal hernia had turned into more moderately sized BOTH indirect and direct 4 months before the surgery. After waiting 8 years, I can’t preach getting preemptive surgery, but there is a proper time to avoid a much larger hernia situation. When it comes to bodily decline, advancing age always eventually wins.

[dave11]

Hi Watchful, a lot of decision had to do with my age and toning down heavy activity. Also, Dr. Kang recommends two layer because four layer has too much suturing. The Dr. Jones’ two layer video seems to confirm it has plenty of suturing of its own. Dr. Grischkan’s extreme number of successful two layer (vice four layer) Shouldice surgeries was important input too. If I were a lot younger and very active lifting, I would consider getting a four layer for the little extra long term protection. Right now, my two layer is quite solid and the surgical area has healed extremely well. I hope this helps.

[dave11]

Hi Wes, from one Philly guy to another, I would definitely consider Dr. Yunis in Sarasota if I were contemplating mesh removal. Since I am late to respond considering your mesh removal situation, I sincerely hope that any outcome you decided has been positive. I had Yunis perform a two layer Shouldice inguinal hernia surgery in August 2021. The results have been outstanding, and the lower abdomen looks firmly toned like before I acquired the hernia. Dr. Yunis is from NY and is an exceptional surgeon who will give you the best view on your mesh removal. Reports have mentioned he removes the mesh and then, if possible with remaining tissues, will do a no mesh surgery. My input here is that I got to know Yunis the man a little, and he is a solid no nonsense guy who really cares in providing successful outcomes. It seems like you had already contacted him, or his awesome admin helper Melanie, regarding the CT scan input, so perhaps you have already followed through. My message is that Dr. Yunis would be the first doctor I would talk to about getting mesh removed. He runs a first class operation and he gets exceptional results at quite fair prices. I am living proof of such results. Wes and others, I wish you all the very best regarding mesh removal.

[dave11]

Hi Sheldon, I waited over 8 years to get a somewhat small right side inguinal hernia repaired because occasionally through exercise and heat therapy it would reduce to very small. Problem with anyone over age 50 is that our abdominal tissue is not restoring as well as when we were 20. In fact, our body loses 1% of collagen production each year from age 20 on. For me, at age 75 now, that is a 55% reduction, which really affects the quality of skin and internal body tissues. So, I decided it was only going to get worse even on my well conditioned body, and it did. Thus, I did enormous research on no mesh surgery and surgeons worldwide. Drs. Grischkan, Brown, Kang, and Yunis stood out because I prefer not to place mesh in my body. Please read new website page sportshernia.com/why-not-mesh for the most clear reasons for getting a no mesh hernia repair. My favorite initially was Kang, but his South Korea location was a big problem during pandemic. On further investigation, Dr. Yunis was chosen, especially with the very competent help of his admin assistant Melanie. She answered all questions and arranged consult one day and surgery the next quite smoothly. In early August 2021, I flew to Sarasota from Pensacola to have two layer Shouldice surgery performed, and the results have been outstanding (see my other posts for details). At 6 plus months post surgery, my lower abdominal area has returned to its previous very good form before I even acquired the hernia. Dr. Yunis runs a class operation at a very fair price, which my insurance paid, and provides exceptional skill in performing diverse surgeries. I hope this helps you a little in deciding. By the way, I can be quite critical of poor medical care, but the secret for healthy life is to avoid such doctors. Thanks for Hernia Talk!

[dave11]

Well, at the 30 day mark post surgery, I was given the okay to resume all activities. Considering I had both direct and indirect hernias on the right side, I think the surgery and recovery to date have been quite exceptional. The initial outcome of my 2 layer Shouldice is apparently similar to those thousands of very successful Dr. Grischkan surgeries that had very short recovery time frames. Feeling has returned to the surgical area except for the incision healing ridge that may take another month to smooth out. I have no pain at all. I have started biking again and mild weight training. I think I will wait until the whole, including the healing ridge, surgical area feels normal again before I proceed with more vigorous activities. I am just glad to have this surgery behind me. Actually, I won’t really know the eventual result of this surgery until much more time passes, but I feel quite pleased at this specific time.

[dave11]

One important thing I forgot to mention is that I have started walking a few miles a day on the next day right after surgery. This and a very healthy high protein diet seem to be quite beneficial to the healing process. I also used natural supplement Arnica 30x for the bruising and initial pain with somewhat uncertain results. Additionally, I have doubled my normal Vitamin C use to 1000 mg twice daily. I also started using Bromelain 850 mg twice daily to help with digestion. The main advantage in finally getting this seemingly good surgical repair is returning my body to a healthy whole once again. The constant use of a 2.5 inch wide athletic support for my groin is no longer necessary although I may wear one occasionally even after recovery. Such surgery is like getting out of the jail of living a restricted physical life.

[dave11]

Well, I finally took the plunge after 8 long years waiting to get a smaller right side hernia repaired after 4 months ago it finally got larger. I studied mostly all no mesh repair methods and their hernia surgeons. I spent much time sorting through welcome Hernia Talk comments. Dr. Kang’s repairs were my favorite, but the long travel distance from North Florida during the pandemics made me choose another surgeon. Not liking foreign matter (especially mesh) placed in my body, I loved Kang’s minimal use of suture material and smaller surgical area to aid in quicker recoveries. Dr. Grischkan’s thousands of successful 2 layer Shouldice (sans the Gortex) repairs with short recovery times were interesting. Dr. Kang’s repetitive advice that the 4 layer Shouldice was “unnecessarily invasive” kept ringing in my head. And the Drs. Jones’ video showing the 2 layer seemed to have a whole lot of stitch work. After I watched Dr. Towfigh’s very informative HT interview of Dr. Yunis in July, 2020, I became more interested in him.

Dr. Yunis’ 100s of positive reviews appear at this time after surgery to have been true. One interesting question I had regarded the type of suture to use in a man who has lost over 50% (-1% per year past age 20) of his bodily collagen production as my failing groin tissues showed. I tried all the collagen supplements and they did not work for me. I take many other supplements that do work. Realize I have done 300 modified sit ups per week all during the last 8 years. My concern was getting a more permanent closure versus absorbable sutures. I would never put wire sutures in my body. I believe what I can buy at a hardware store should not be placed in my body. We agreed on using Prolene in a 2 layer Shouldice. Amazingly, Dr. Yunis just looked at my hernia area and told me I had both an indirect and direct, and the surgery proved him correct. Dr. Yunis runs a first class operation in Sarasota and his key assistant Melanie is an awesome resource in answering questions, handling insurance, providing all forms, and smoothly scheduling consult one day and surgery the next. The first night after surgery I realized why I had waited 8 years to get the surgery as the pain was intense lifting my hernia side leg getting into a high bed. I remembered that ice had been applied right after surgery. So, I used several full bags of ice (1 hour per) over a few days to reduce such pain to just mildly sore. I was amazed that ice applied directly to the surgical area was not even felt. Seemed like the area was numb. I did take 4 pain meds. At a few weeks after surgery, I have no pain, all discoloration is gone, swelling is minimal except the 3 inch no stitch incision healing ridge. Time will eventually tell if my decision was good, but I don’t plan on doing anything to acquire another hernia especially in my older groin tissues. My crazy days of my 30s in lifting 40 tons per week are long gone.

By the way, Dr. Yunis said he respected Dr. Kang and would like to meet him and enjoy some of that Korean cuisine. Hopefully, these two gentlemen will get together and share their vast accumulated knowledge and skill. Perhaps, the really diversely skilled Dr. Yunis will also acquire some Kang repair methods, and vice versa.

[dave11]

Dr. Kang, thanks for your various clarifications. I do feel that your mentioned mesh hernia surgery becoming even more entrenched has become a reality here since none of the surgeons I have contacted locally will agree to do no mesh surgery. I think they have been trained to do mesh AND there is a greater profit margin in mesh surgery. I do totally understand this because our medical service industry is one of the most expensive in the world. I was amazed at the vastly lower prices I saw for surgical procedures in Korea versus the USA. Further, given the unpublished and unshared exact nature of your Kang repair, it is understandable why our surgeons are reluctant to offer it

Your knowledge of the historical evolution of hernia surgery is amazing. It seems like the journey of someone who is looking for the ultimate best ways to perform hernia surgery today, especially in light of some tragic painful mesh surgeries. I sincerely hope your journey’s end will result in the most beneficial surgical procedures for all hernia patients. My journey as a hernia patient is made difficult by an Internet that decades ago was actually mostly informative, but now it is mostly commercially geared for marketing and sales. The problem with this is the most helpful truth becomes hard to determine. Herniatalk helps greatly in truth discovery. And your contributions are always appreciated.

[dave11]

Thunder Rose, you need to read the gibbeum.com web site describing exactly who Dr. Kang is and what he has done. And yes, that web site is so smooth and effective you would think marketing was involved, but Dr. Kang has spent some time in Great Britain where he honed his English skills. I have also had some personal communication with him through his chaplain Stephen where I got a little better idea who he is. I guesstimate that he has done about 12,000 Kang repairs going back to beginning use of the repair in 2012. He has his own hospital just for mainly hernia repair in Korea. Reports from his patients, which have all been positive, state that he is doing about 6 repairs per surgical day. He spent many years experimenting with even mesh before choosing his current no mesh method because it better favored his patients’ well being. To the best of my knowledge, he has not SOLD his procedure to anyone yet. I too am frustrated by not having a video and more specific details of his repair, but he seems focused on making sure the longer term recurrence rates stay quite low at 1/2%. On the very rare occasion he has a recurrence, he performs the surgery free of charge. He will also on occasion donate his services to those in extreme need. His direct repair only affects a 4cm X 4cm area of surgical space. His incision is a tiny 1.5 inches BECAUSE he has highly competent ultra sound techs who can determine direct or indirect BEFORE he cuts, and he completes the surgery in a remarkable 20 minutes. I heard a price of about $3000 for his repair, but that may have changed. He has dedicated his life to finding a less harmful and more efficient way to perform inguinal surgery. However, he shares the same problem as Dr. Desarda in establishing his surgery in the USA in that our surgeons work in a very expensive business in a country where the prices of everything are exploding. However, we are lucky to have a few excellent surgeons who are willing to offer no mesh procedures. You seem to have found one in Dr. Yunis.

Good Intentions, I have appreciated your contributions. In reading what I have wrote, I actually seem like Dr. Kang’s PR department, but I agree with you that he does NOT seem to seek personal fame. He certainly does not need a PR department since his enormous successful body of excellent refined work speaks for itself. He just wants to help hernia patients get well as efficiently and effectively as possible. I admire his pioneer spirit and all he has accomplished.

[dave11]

Hey AJ, thanks for the reply. Yes, I realize some foreign matter will be used to repair my hernia, but I try to keep such material to a minimum. I checked out Ovitex, which is a mix of biologic and synthetic, but the synthetic part remains in the body. Also, the actual hernia sac is not processed the best way I believe as is true in many mesh repairs. Leading an active life, I have avoided the installation of a screw in part of my femur, a screw and wire in my shoulder, and had a plate removed after it was needed to heel a fracture of my wrist. My body has done a very good job of healing these problems without the hardware. My healthy lifestyle and supplements have helped a lot. Some suturing is a minor concern compared to this hardware I have avoided. The tough part, when a seeming 99% of current hernia surgeons only do mesh, is finding the best no mesh doctor and procedure. I know people who have suffered from having mesh and other hardware placed in their bodies. I wish you the very best with your recovery.

There are probably other hernia surgeons doing the two layer Shouldice, but those three I mentioned are the only ones I confirmed with and felt comfortable with the number of such surgeries they have done. Perhaps, some other people can add to this short list. That is the power of Herniatalk in that the research of many is always vastly more comprehensive than the individual. Dr. Kang does not offer a two layer Shouldice, but he does his own unique repair (seems like some version of Bassini lite to me) using just the Hesselbach triangle for the direct. I have asked him to establish a USA Kang Repair base similar to what Desarda did in Fort Myers, FL. It would be great if he was able to do so with Dr. Yunis in Sarasota, FL. Neighboring cities competing for patients would be quite interesting and offer a very welcome other choice for us no mesh believers. I believe if Kang Repair is to become the “new norm,” then he must spread his technique outside Korea. I think he is waiting on the stats to further verify his very low recurrence rate of less than 1/2% treating all types of patients (and not cherry picking them). Perhaps, Dog can use his influence once again as he did with the Desarda method.

[dave11]

Thunder Rose, thanks for prompt reply. Like you, I have been doing regular exercise while waiting on the hernia. Also, I have done a ton of research and some contact with various hernia surgeons. I respect your technical comments on the inguinal anatomy. Very busy area of the body. Other than Grischkan in OH, I think only Brown in CA and Yunis in FL perform the two layer Shouldice. Your preference for the four layer Shouldice with prolene sutures is interesting. My concern with the four layer is the extra amount of suturing placed in my body. I have to weigh my desire to keep extra foreign matter out of my body versus a lesser recurrence rate of the four layer. Grischkan is quite enthusiastic about his two layer using a very small incision. So, I kind of feel the two layer may be optimal for me. Your thoughts?

In contacting the venerable Dr. Kang, I learned that he emphasizes that he only uses about HALF the suture material of other no mesh repairs. That is all part of his desire to minimalize the total surgical field to the least area disturbed. Less area affected means less time needed for recovery usually. Plus, he uses 1.5 inch incision vice Yunis four layer about 3 inches. Big problem is he is in Korea.

I admire your choice of Yunis versus all the other surgeons you contacted. Your high technical level of inguinal hernia knowledge may have surprised a few of those surgeons. I sincerely hope your surgery is totally successful.

[dave11]

aj9000 & Thunder Rose, thanks for sharing about Dr. Yunis. I wonder if you had the two layer Shouldice and what is the length of your incision. Hope you both are still doing well. I have been nursing a smaller right side inguinal hernia for seven years, but it has gotten larger this last month. I love Dr. Kang’s prescriptive approach of repairing specifically only what is needed, but Korea is a long haul from North Florida, especially during a pandemic.