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I don’t know how helpful it would be to compare hernia surgery to other surgeries. Even if hernia mesh surgery has more chronic pain than some of these other surgeries, the mesh may not be the culprit, and if it has less, it doesn’t mean that mesh is fine.
The natural approach would be to compare various mesh techniques to various tissue repair techniques, but tissue repair is so rare these days. Also, how do you deal with surgeon variability? A very experienced, conscientious, and meticulous surgeon who takes their time to do everything right will likely have different results from another type of surgeon regardless of technique. I was told many times that the surgeon makes more difference than the technique. This doesn’t mean that the technique doesn’t make a difference, but the surgeon (and whether he/she got up on the right side the morning of the surgery) may actually be the most critical factor. You would need to compare surgeons of similarly high levels of abilities, which is difficult.
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That’s what I like about Dr. Kang. He has been focused on minimalist approaches causing as little damage as possible while repairing the hernia. Whether that comes at the price of higher recurrence rates or not, I don’t know. He says not.
Even if there is a higher risk of recurrence, it may still be acceptably low when taking into account the reduction in the risk of complications. I chose not to go with him in my case because I was afraid of recurrence of my very large indirect hernia, but I really don’t know if that was the right call or not. I still suffer from a bunch of issues two months after my Shouldice repair. Not debilitating issues – I can function, but certainly annoying.
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If post-surgery issues such as some level of chronic pain are that common, there should at least be better disclosure to the patient before surgery. Some boilerplate language buried in doctor’s notes or consent forms isn’t enough because no one reads them, and they don’t mention the incidence, so patients can’t tell if these complications are extremely rare, or common-enough to be of concern.
Also, if these complications are that common, both the patient and the surgeon need to think very carefully before deciding to operate. Most inguinal hernias are minimally symptomatic, and it’s horrible to convert by surgery a minor problem to a worse problem. Fixing the hernia while ending up in worse shape overall isn’t smart.
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Good progress – thanks for the update. It sounds like you had an indirect hernia. Is that correct?
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William,
It depends on the cause of the pain. If a nerve was damaged by the surgery, then nurectomy can be an option.
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The part that isn’t clear is the basis for the claim that Marcy has poor results for adult male hernias. I found only one study, and it showed good results. Doctors who practiced it (Kang, Brown) claimed good results. I think that’s the reason this keeps coming up. Where was the battle that you mentioned documented? There’s also the question of the stitching technique. Maybe recurrence is lower with the way some surgeons (such as Kang) stitch it when compared to some other way.
@hernia2012 (Andy Elliott) – The symptoms you mentioned after your lap mesh surgery could even be effects of the anesthesia rather than the mesh. These chemicals cause bad reactions in the brain and other parts of the nervous system with a lot of variation from person to person. Unless you have a good reason to believe it’s the mesh itself, be careful. If what you are really sensitive to is the anesthesia, going through yet another surgery will only make things worse. There really isn’t a good understanding of the effects of anesthesia, and the theory is that the chemicals used cause an inflammatory response in the nervous system which can lead to anything from brain fog and sleep issues to delirium and cognitive dysfunction. How your body reacts depends on many factors – genetics, cognitive reserve, any existing degenerative processes, etc.
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That’s exactly what he’s saying. Assuming his numbers are correct, then his Marcy variant works well even in adult males (Koreans, at least). There are others who claim that Marcy works well. There was a study in Japan that showed this. Dr. Brown claimed to have success with it, although he was all over the place in terms of techniques he was using, and his criteria were never clear.
One problem with studying this is that there is no “standard” way to do the internal ring stitching part of Marcy. Dr. Kang claims to have a particularly effective way of doing this that he refined over the years. I don’t know if that’s the key to his success, or it’s just a minor aspect that improves it a bit.
The bigger problem is that tissue repair is out of favor, and almost no one practices it. We are not likely to get better information about this topic, unfortunately.
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My internal ring was more like a hula hoop (huge defect size) than a ring, so not sure how Kang’s indirect hernia repair would have worked. I think I needed the full low-tension reconstruction of the Shouldice procedure, but I don’t know for sure.
Regardless, there’s the question of recurrence, and that takes time to study. The reports of recurrence are a concern, particularly since that’s the natural fear with these limited-scope techniques.
I’m a bit surprised by the level of post-surgery pain reported by his patients. It would be interesting to understand the nature of that as well.
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Chuck,
Yes, Dr. Conze would be my top choice for tissue repair in a case like yours.
I didn’t talk to Dr. Koch because I was concerned about what happened with Baris.
I have the flip side of your problem since I had tissue repair, and if I recur, I’ll most likely need to go with lap mesh. Would you pick Dr. Belyansky as the best surgeon for that? There are certainly more choices for that than for tissue repair, but it seems to be a minefield as well with a lot of skill and experience required.
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Most cases turn out just fine with lap mesh, robotic mesh, open mesh, and Shouldice, but it’s still a crapshoot. Assuming you did your research about your surgeon (I don’t know anything about him), you just got unlucky. Maybe you would have had better results with open mesh or Shouldice, and maybe you would have had other complications.
Intuitively, I don’t like lap or robotic mesh. I prefer to avoid general anesthesia, the large size of the mesh seems scary, attaching it seems risky, going through the abdomen seems dangerous, etc. Also, I don’t know how they even do it without opening you up if you have a large hernia that isn’t completely reducible. Still, I guess these techniques work well in practice in the vast majority of cases, so maybe I shouldn’t rely on my intuition with these things. If (God forbid) I get a recurrence, that’s probably what I’ll have to do.
My situation was completely different because I had more than just a hernia to contend with. It’s hard enough to get just a hernia treated well. Imagine needing two surgeons with different expertise working together. Things got messed up because I had a complex case, and surgeons mislead me saying it’s a non-issue. Well, it turned out to be an issue which led to other errors, and eventually a fix. Hopefully, not too much damage was done, and I’ll be ok with some more time healing.
I think very highly of Dr. Conze, although he didn’t see my problem coming either.
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Chuck,
A korean colleague of mine appears to deserve the money. See the thread you started before.
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Since we’re talking about reviews…
When I was researching where to go for surgery, I did ask a Korean colleague to look up reviews on Korean sites of hernia surgery at Gibbeum. He found a total of 18 reviews, and said that most of the ones he found were good.
One complained about initial pain, but this resolved later. One complained about feeling pain toward the end of the surgery, but was satisfied with the results.
There were 2 that complained about recurrence after hernia surgery there. One was on Google Maps, and one was on Kakao Maps. My colleague said that one of these reviewers (the one on Google Maps) said that 2 out of the 4 people he met at the hospital were also there for recurrence after surgery at that hospital.
We also have a recurrence on this forum (Pinto).
I didn’t actually read these reviews myself. This is what my colleague reported. My understanding is that the name of the surgeon at Gibbeum wasn’t mentioned in these reviews reporting recurrence, so I guess it could have been Dr. Kang or his son.
Take it for what it’s worth – you never know with on-line reviews.
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Dr. Kang did explain his techniques on this forum in the past. Not in every minute detail, but he said what he does.
Based on my understanding of what he wrote:
For an indirect hernia, it’s a Marcy variant. He has his own way of stitching the internal ring, and he has gone through many tweaks of that, but we know what he does in principle.
For a direct hernia, it sounds like a partial Shouldice-type repair where he reconstructs only the direct area, and leaves the internal ring area alone.
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By the way, you can check their Google reviews as well.
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The good and bad reviews you see there should be legit. It is true, however, that they have a high bar for bad reviews, so assume that you don’t see the full picture of bad reviews. Still, the good reviews tell you a lot.
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That’s strange. I talked to all 3 of them and didn’t see any indication of anything unprofessional, but my partner wasn’t there, so I wouldn’t be able to say about that type of thing…
I spent more time with Lorenz and Conze, and had very elaborate and detailed discussions with them. They were very patient and friendly, and were well-aware that this is not some minor thing. They seemed to take hernia very seriously and be well-aware of what could go wrong and how to minimize the risk of that. It was clear they like this field, and Lorenz loves training the next generation of surgeons in this field. They both do research and keep track of their results in the database. I spent less time with Wiese, but had a very good impression of his competence as well, and he has great jameda reviews. He does a very large number of Shouldice surgeries as well as other hernia surgeries.
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William,
You seem to be looking at all the wrong Germans… I already narrowed it down – check my recommendations.
I would follow the advice of your consultant and wait. Just monitor the situation. If you see it growing or it starts bothering you more, then consider pulling the trigger. As long as it’s stable, and you can easily live with it, I wouldn’t go under the knife.
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The hernia. It grew larger over time – I had it for decades.
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GI,
The other issue was known and discussed before surgery. Yes, it should have been handled differently. I don’t think it’s really relevant to others here because it’s extremely rare, so I don’t want to focus on it right now. I mentioned before the lesson that if you have a complex issue, find the best expertise for that (which may even require more than one surgeon working together). The focus shouldn’t be on relatively minor aspects such as tissue vs mesh in these cases.
I did mention a number of times that my case wasn’t run-of-the-mill. I don’t think waiting all these decades caused some kind of an adaptation issue in the groin. Shouldice is an extensive procedure – they basically reconstruct the relevant parts anyway…
What typically happens with waiting with an inguinal hernia (direct or indirect) is that the hernia grows larger. Not a good thing, particularly if you want tissue repair. There are giant scrotal hernias where there’s loss of domain in the abdomen because too much intestine came out, but I was nowhere near something like that.
For Shouldice, a bigger issue than the size of the hernia is actually the nature of your anatomy. The surgery becomes significantly more difficult when the layers are deeper in your anatomy. This is one thing that I wasn’t aware of before, and learned at the Shouldice Hospital. I don’t know what this means exactly, and I never saw it in any papers, but evidently this makes a significant difference for these types of surgeries.
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Thanks, William. I’m very familiar with spine issues as well, unfortunately.
My other issue in the groin was known, not a surprise. I may write about that ordeal at some point, but for now I want to separate it from the hernia repair itself.