• drkang replied to the topic Question for Dr Kang in the forum Hernia Discussion 1 week ago

    Hello Chuck,

    I do not cut the cremaster muscle during hernia surgery. The genitofemoral nerve, the ilioinguinal nerve, and the iliohypogastric nerve are also preserved as much as possible.
    There is no difficulty in Kang repair after removing the mesh.
    Thank you, but unfortunately, my English skills are still not good enough for a Zoom…[Read more]

  • Hello, Chuck.

    First of all, thank you very much for always giving us undeserved support and encouragement.

    Many people claim that various hernia surgery methods are needed to provide optimal surgery for patients with various conditions.

    At first glance, it sounds very reasonable.
    My experience, however, suggests that it’s only a plausible…[Read more]

  • @Watchful,
    A BMI under 25 seems too strict.
    I’ve just noticed my BMI is 26.1. I never thought I’d be rejected by Shouldice.
    I haven’t paid attention before, but I think at least 10-20% of my patients probably crossed this threshold.
    I wonder if these very strict requirement are for patients or to manage their own statistics.

    Some patients have e…[Read more]

  • Since 2012, there has been only one patient with acute leukemia for whom I have refused surgery. The reason was the fear of infection after surgery.
    To be honest, Koreans have relatively few obesity problems compared to Westerners.
    But I would like to point out that Shouldice performs mesh repair on some high risk patients.
    Unfortunately, their…[Read more]

  • I think some people are curious about the long-term result of Kang repair, so I recently reviewed the data after 2012. Since 2012, when I started the non-mesh repair, I have been managing detailed data of all surgical patients with Excel. Of course, the recurrence is also recorded.
    During that time, there were about 50 changes in the surgical…[Read more]

  • Dear Chuck,

    It would be better for you to get robotic mesh removal from Dr Belyansky.
    And I will do Kang repair happily for you if your hernia recurs.
    There is a chance that a recurrent hernia will not occur even after mesh removal.

    The reason I remove laparoscopically implanted mesh through an open approach is because of our special situation.…[Read more]

  • 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…[Read more]

  • Yes.
    We do an ultrasound of both groin areas to confirm the presence of all possible hernias before surgery.

  • Hi Monika,

    McVay or Shouldice method for a femoral hernia takes a transinguinal approach. Therefore, to repair the loose femoral canal through which the femoral hernia passes, the external oblique aponeurosis is opened, the spermatic cord is mobilized, and the transversalis fascia is opened before repairing a defect. This process is complex and…[Read more]

  • Hi Monika,

    After infrainguinal skin incision, find and treat hernia sac, and simple closure of hernia defect with non-absorbable 3-0 Prolene. It is performed under sedative local anesthesia, and the skin incision is about 4 cm, and the operation time is usually about 15 minutes.

  • Thank you, Mark T.

    Thanks to you, I become to know how to operate on a femoral hernia in Shouldice hospital.

    The reason that McVay repair, which is a representative tissue repair method for femoral hernia, is not an easy operation for the average surgeon, is that it requires suture to the Cooper’s ligament. Because the Cooper’s ligament is…[Read more]

  • Hi Monika,
    I am sorry to hear you have multiple hernias.

    Shouldice or Desarda or Bassini methods for inguinal hernia repair cannot be used to repair a femoral hernia. I don’t know if Shoudice hospital has a special tissue repair method for a femoral hernia.

    Among the well-known tissue repair methods, the one that can be used for femoral hernia…[Read more]

  • I also don’t think an open approach is the best way to remove the lap installed mesh. However, I think that an open approach can be a good option for those who would choose pure tissue repair in case of hernia recurrence after laparoscopic/robotic mesh removal.

  • Dear Chuck,

    In order to remove the lap installed mesh by an open approach, surgery is performed in the same way as you said. However, this method is already being implemented in case of Shouldice or Bassini repair. So I don’t think it might cause serious extra problems like you’re worried about. Of course, there will be general risks with the r…[Read more]

  • Hi William Bryant,

    I haven’t thought of a specific retirement schedule yet. I think I will probably be working for at least 10 more years. As Mike M said, in our hospital, surgery is performed under local anesthesia with sedation, so many elderly people come to receive hernia surgery. So far, there have been over 100 patients over the age of 90,…[Read more]

  • Hi Chuck,

    1. Although observations have not been made for a sufficient period of time, no one has complained of any particular discomfort. I also initially thought that the lap installed mesh should be removed laparoscopically. As I said, there is no hospital that does this kind of surgery in Korea, so after much consideration, I tried open…[Read more]

  • Hi all,

    I happened to visit today and found out that herniatalk is reconnecting.
    Chuck, thanks for your compliment. I don’t deserve that anyway.

    I have removed about 100 meshes in the meantime, all of them are open meshes.
    Unfortunately, there is no hospital in Korea that provide the laparoscopic mesh removal. So, several months ago, I began to…[Read more]

  • Also, the aponeurosis flap is not as tough as the mesh, and sometimes it may die due to insufficient blood circulation. So it may have a higher risk of recurrence.

  • Hi Watchful,

    Many people think that doctors understand and are familiar with all surgical techniques, but unfortunately, this is not the case. The surgical methods taught in most teaching hospitals are not diverse, and it is common to teach a particular surgical method. Also, the greatest goal of most surgeons is to properly implement the…[Read more]

  • Hi William,

    The genitofemoral nerve, the ilioinguinal nerve, and the iliohypogastric nerve are preserved uncut. In direct, the cremaster muscle is not injured at all, and in indirect, after split open along the muscle fiber plane, the sac is processed and the deep inguinal ring is repaired, so there is minor injury but no intentional…[Read more]

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