• 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]

  • Hi all,

    I am not sure if I could personally answer the various doubts about Kang repair. Because I am afraid that my intentions may be perverted. However, I think it will be helpful to broaden our understanding by giving answers to the various doubts raised.

    Marcy repair was developed around 1870. So it is difficult to say the exact surgical…[Read more]

  • No clinical trial has been done for that part. And I think 1% or 5% of Shouldice pain incidence is much lower than that of mesh repair. The incidence of chronic debilitating pain after mesh repair is probably around 5%, I guess.

    If Kang repair has a lower incidence of chronic pain than Shouldice, I think it may be because of the difference…[Read more]

  • Hi Watchful,

    After receiving your question and reviewing my surgical record again, I found that 12,363 non-mesh inguinal hernia repairs have been performed since 2013, and 217 patients have had reoperation due to recurrence. 1.8% of the total.
    However, since 2013, my surgical method has improved over 50 times. Therefore, these statistics cannot…[Read more]

  • The Surgical Clinics of North America (SCNA), published under the title of Hernias in April 1984, three years before mesh repair was introduced, said, “Groin pain after normal convalescence from an inguinal hernioplasty is infrequent, but when it occurs, it invariably precipitates a visit to the surgeon by the patient, who believes that the pain…[Read more]

  • @Good Intentions,

    I always appreciate your deep knowledge and accurate analysis of hernia repair. I don’t think there are any doctors out there who probably have more relevant knowledge and standards of judgment than you.
    I personally always agree that your assertions are closest to the truth.

    A low recurrence rate is the number one priority…[Read more]

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