[Jack2021]

You may be correct, as that was apparently the case in the past when she treated the likes of Alan Shearer and Michael Owen, though they retired in 2006 and 2013 respectively. I believe she is well into her 70s now, so I’m not sure if she still works for the big football clubs across Europe anymore.

Whilst modifying her technique vs the traditional Shouldice, my understanding is she cuts the cremaster and genital nerves still, unlike the other well known German surgeons commonly mentioned on here in the past, before the site had the disastrous revamp that knackered it.

I don’t understand why Dr Towfigh hasn’t just scrapped it and relaunched the original. Although basic and with a regular troll latterly, it was so much better than what it’s become, hence few of the old members posting anymore. Was it done intentionally…? 🤔

[Jack2021]

Thanks for posting Good Intentions, interesting story. I’ve scoured the web and can’t find any info re who operated or where he had surgery either. Good old General Data Protection Regulation! I guess we’ll have to wait and see if he ever mentions it on his social media accounts and it makes the news.

Like you say, it’ll be interesting to see how he does for the rest of the season.

• This reply was modified 1 month, 1 week ago by  Jack2021.

[Jack2021]

Hi Oceanic,

Really sorry to hear about this. Apologies if I missed it in the thread, but have you spoken to Dr Conze about this yet and if so, what did he think?

I’m guessing he’d want to do his own ultrasound to assess you before giving a definitive opinion, which obviously isn’t particularly convenient with him being in Germany.

If you haven’t already, I’d look to email Dr Conze some of the ultrasound imaging if you can and then run through over the phone what he thinks are the possible scenarios, including potential outcomes/risks, if it definitely is a recurrence. I’d write down in advance what you think the scenarios could be, to make sure you cover everything with him.

I’d also check with Dr Conze re whether he would charge you again if the repair has failed, should you decide to go back to him for treatment.

Another option, albeit long haul, would be to contact Dr Kang. From memory, I think he’s previously said that his repair is suitable for tissue repair recurrences.

More of a long shot, but I think good to cover all options, you could also try to contact Dr Ralph Lorenz to ask if a Desarda repair could be an option.

Best of luck and please keep us posted,

Jack

[Jack2021]

Thanks for your reply @drtowfigh

It does sound like your opinion has shifted somewhat following your conversation with Dr Lorenz if you now consider the Desarda repair another tool in the toolbox.

Re you not having seen a situation among your patients yet to use Desarda vs another more vetted technique, is there a situation you can think of that would warrant it’s use from your perspective, or do you still feel that greater evidence over more time is needed?

Thanks

[Jack2021]

It’s understandable that you were worried. I think it’s no insignificant trauma going through hernia surgery, worrying about recurrence, possible mesh issues (for those who have a mesh repair) and mesh removal as in your case unfortunately. There’s clearly plenty of people on this forum who regularly have it on their minds pre and post operation and it’s an emotional burden to carry and deal with.

On the plus side, it’s great that a bit of rest and ibuprofen sorted things out for you and hopefully that was reassuring, somewhat at least. It’s also very positive that your range is still lengthening, which must indicate that your long-term perseverance with physical rehabilitation following your surgeries is paying off. Definitely something to be pleased about.

With the variation in the course of the genitofemoral nerve in different people and I guess in all likelihood, other nerves too, it’s more understandable that hernia surgery has a risk of pain resulting, regardless of the repair method, as your reference alludes to as well, where it notes in relation to the nerves which ‘…serve regions of the abdominal wall, pelvis, and perineum.’ that ‘Any clinical involvement of these nerves may result in pain, loss of sensation, or motor deficits and reduce an individual’s quality of life.’

This may also be one of the key factors why some people have pain with a hernia before surgery and others not so much, due to nerve compression from the hernia and such like, depending on individual nerve location.

I know that there can also be long term pain and numbness following caesarean surgery in women, so surgery related nerve damage is likely a risk of many operations, with potential risks vs potential benefits always the key deciders.

With all surgeries, we clearly need an excellent surgeon to improve the odds in our favour.

[Jack2021]

My hernia’s apparently an indirect inguinal hernia.

Re surgeon choice, like many on here I’d prefer a tissue repair but I’m still procrastinating over who to go to for surgery.

Travelling abroad for surgery is a factor for me and my preference would be to have it done in the UK, though options are extremely limited here. I’ve posted about UK options previously.

In Germany, Dr Conze followed by Dr Lorenz would currently be my preferred choices, though I’m yet to speak with Dr Lorenz. There are good reviews for both Dr Koch and Dr Wiese and Dr Koch came across well when I spoke with him and I haven’t spoken with Dr Wiese.

I’m sure there are currently lesser-known surgeons in countries such as Poland for those nearer there, as the 15-year Desarda follow up study was done there, which I’ve posted about previously, as have others. I tried to contact Dr Kryspin Mitura, who was involved with the study, for more information but didn’t hear back.

If I was in Canada, I’d do my research on the Shouldice Hospital surgeons and try to book in with one who gets great reviews and is open to not fully cutting the cremaster, preserving the nerves and using prolene.

I’d start with Dr Towfigh in the US as IMO she clearly cares about her work, comes across as very knowledgable in her Hernia Talk interviews/discussions and appears to be well-respected by her peers. She also seems open to new perspectives, such as when discussing the Desarda repair with Dr Lorenz.

There are the South Korea options we’re aware of and Dr Kang has some great reviews on here, though no published research data yet.

I’ve also read positive reviews about Gerald Young in Auckland, who’s apparently done many hundreds of successful Desarda repairs, so for any members on that side of the globe, he may be worth contacting.

As you don’t seem to currently have a hernia Chuck and you’ve likely got all the knowledge available that you can find yourself and that this forum can provide, I’d try to look for ways to focus on the present and move on from this until you really need it, i.e. should you get a recurrence. Were this to happen, if it’s an option, I’d personally opt for a tissue repair and hope that lasts, as it appears to be easier to have mesh as a follow up surgery than vice-versa usually, as I understand things, but that’s just my opinion from the research I’ve done.

Re trying to find ways to move on from all this and the significant trauma you’ve experienced, I realise that it will be difficult or perhaps impossible not to be mindful of a possible future recurrence and that this may linger over you, as is often the case for people following serious illness, such as cancer and perhaps other surgeries too. This can affect our mental health and result in an emotional burden and/or PTSD for many people (as can working in jobs associated with this kind of thing) that I think often gets overlooked and isn’t talked about enough.

While a lot of us probably get a bit of low level support via this excellent forum, perhaps reaching out for some specialist emotional support to help focus more on the here and now could be beneficial for you and other members of the forum too possibly, be it in the form of counselling, cognitive behavioural therapy (CBT) or some lower level support with an organisation/s in your country that provide it. This is commonly offered and found to be beneficial in the UK for people with cancer, following bereavement and other traumatic events, so I’m guessing there should be some great options in the US too. Perhaps other members of the forum are able to share some signposting options.

I hope this is some helpful food for thought alongside the hernia stuff.

[Jack2021]

https://www.kenhub.com/en/library/anatomy/iliohypogastric-nerve

My research ruled out the likelihood of Pudendal neuralgia from hernias, though it is linked to pelvic mesh placement following pelvic organ prolapse, most commonly with women. If you’ve been a regular cyclist over the years it may be worth investigating, as this can apparently be a cause of Pudendal neuralgia.

Anatomy, Abdomen and Pelvis: Genitofemoral Nerve –
Perhaps an indicator as to why some people may get pain while others don’t following hernia surgery and why it’s so essential for surgeons to locate and carefully preserve the nerves during hernia surgery, albeit some may argue this is why it’s better to cut the genitofemoral nerve, is that apparently,

‘In at least 50% of individuals, there is some variation in the course of the genitofemoral nerve as it travels within the retroperitoneum and ultimately entering into the inguinal canal. Variation is also found at the level of its bifurcation into genital and femoral branches.’
This is from the ‘Structure and Function’ section of this link –
https://www.ncbi.nlm.nih.gov/books/NBK430733/

[Jack2021]

I don’t recall the post you mention GI and after all you’ve unfortunately been through, I guess the cause of your irritation may just be as you’re thinking.

I’m certain you’ll have thoroughly researched the following already, but just in case and for general forum info, here are some links re pain associated with hernias and hernia surgery that I’ve come across. I’ve had to split them into a couple of posts as it’s not allowing me to put them all in one reply:

Genitofemoral neuralgia – https://pubmed.ncbi.nlm.nih.gov/25377757/#:~:text=The%

Ilioinguinal neuralgia – https://www.ncbi.nlm.nih.gov/books/NBK538256/

Iliohypogastric neuralgia – https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-018-0391-6

[Jack2021]

Chuck, re your question about whether Dr Conze and Dr Lorenz fully cut the cremaster muscle, of the German surgeons those of us on this forum are generally aware of, doctors Conze, Lorenz, Koch, Muschaweck and Wiese, albeit I’m unsure re Dr Muschaweck, my understanding is that none of the others completely cut the cremaster muscle as standard.

Apparently the genital branch
of the genitofemoral nerve is rarely visible immediately during open hernia surgery and is usually more posterior, becoming visible after the cremaster is divided. Perhaps that’s one of the reasons some tissue repair specialists divide/split/trim it, while generally preserving it.

My sense, rightly or wrongly, is that it’s less of a concern unless the cremaster is completely cut and some would argue it’s fine either way. I think I’d be more concerned about nerve damage.

Dr Muschaweck is the only one of them who apparently cuts the genitofemoral nerve (sometimes referred to as the genital nerve) as standard, as per the original Shouldice repair.

I believe the others identify and preserve all the nerves in the area, such as the genitofemoral nerve, ilioinguinal nerve and Iliohypogastric nerve and I think Dr Muschaweck identifies and preserves the ilioinguinal nerve and Iliohypogastric nerve.

I’d obviously recommend that people ask for clarification on all this when contacting/having a consultation with them or other doctors.

Re ongoing pain after hernia surgery, having read various posts on here and information elsewhere, it’s probably been covered on here already at some point, but a lot of the symptoms people mention sound like they may be due to genitofemoral nerve damage. Symptoms of this apparently include ‘…groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in males, while females experience symptoms radiating to the labia majora and mons pubis.’

Here’s the link to where I read that – https://pubmed.ncbi.nlm.nih.gov/25377757/#:~:text=The%20symptoms%20include%20groin%20pain,labia%20majora%20and%20mons%20pubis.

[Jack2021]

There are two surgeons in Seoul, South Korea who claim to have very good success rates with their own differently modified Marcy tissue repairs, if you’re happy/able to travel there.

Both have posted on here – Dr Kang at the Gibbeum Hospital and Dr K. Y. Chung (posting as KC) at the Ewha Womans univsersity hospital.

Dr Kang definitely sees patients from abroad, but you’d have to check with @kuyongchung (KC) or contact the Ewha Woman’s Hospital for further information.

All the best.

[Jack2021]

Hi @kuyongchung (KC),

Many thanks for joining the forum recently to talk openly and candidly about your modified Marcy repair, it’s very much appreciated.

It’s extremely important for innovative surgeons such as yourself to be openly sharing their techniques within their field and to explain and publish all the details of their work, as you’ve begun to do, for which I applaud you, thank-you.

The sooner this happens, the sooner it can be peer reviewed and validated/learnt by other specialists around the world if justifiable to do so and here’s hoping!

@drkang has apparently operated on thousands of patients with his modified Marcy ‘Kang’ repair and claims excellent low recurrence and long term chronic pain numbers, but he still doesn’t appear to be ready to explain and share exactly what his technique is.

As @drkang’s repair apparently takes around 20 minutes to complete, which is less than half the time of other open tissue repairs, one would imagine that the modification/s he’s devised have made his repair relatively straightforward for a skilled surgeon to complete and ergo easier to teach to other surgeons than say the Shouldice repair.

This in itself is or could be a groundbreaking leap forward in many ways, but it needs to be shared and peer reviewed, which @drkang doesn’t appear open to currently, leaving question marks against his claimed results and the method itself, regardless of whether it may be the biggest innovation in hernia repairs for a generation or two of hernia repair specialists, or not.

Perhaps yours may prove to be a long awaited groundbreaking repair KC and your openness makes that a greater possibility.

KC, how long does your modified Marcy ‘KC’ repair take you to complete and do you use permanent Prolene sutures?

What is the size of your incision too please?

Also, it’s interesting that both yourself and @drkang are based in Seoul and you’ve both devised your own modified Marcy repairs with apparent great success which is evidenced in your case, but not @drkang’s yet, although hopefully it will be soon.

Is the Marcy repair very prevalent in South Korea, thereby increasing the likelihood of surgeons such as yourself and @drkang making their own modifications, as seems to be more common with the Shouldice repair internationally, or have there been conventions or similar in South Korea focussing on modifying and simplifying hernia tissue repairs to streamline the repair so more surgeries can be completed in less time, with better long term outcomes and an improved patient experience overall? I guess what I’m getting at is what was the inspiration behind your ‘KC’ repair and the ‘Kang’ repair; is it just a major coincidence that two surgeons in the same city have devised successful modified Marcy repairs, or is there something in common that has inspired you both to create your own modified Marcy repair and could they even be very similar or exactly the same repair?

@drkang, we really need and would very much welcome your input and explanation of your ‘Kang’ repair here too please?

As Watchful mentioned, Dr Ralph Lorenz, who already has some interest and apparent knowledge of the ‘Kang’ repair and no doubt @drtowfigh and all other open-minded hernia specialists will (and should) be interested to learn more about and discuss your repair KC and the findings from your research paper, especially as you appear open to this.

Like you’ve done, we also need @drkang to be open to explaining and publishing the details of his repair, as Professor Desarda did (there are now numerous studies and many in Europe, including 15-year follow up study in Poland which evidenced excellent long-term results) and the sooner the better so it can be peer reviewed, validated and hopefully improve patient outcomes in this common, yet complicated area of surgery.

It would be good to hear your initial thoughts after reading the above posted study and posts too @drtowfigh please?

Many thanks,

Jack

[Jack2021]

A consultation with Dr Conze, including him doing a dynamic ultrasound himself, cost in the region €400 a couple of years ago I think, if you just wanted to get his opinion initially.

[Jack2021]

Hi Krisztian,

Dr Muschaweck and Dr Conze (who would be a clear preference of the two in my opinion, as I’ve covered in previous posts) are the most expensive hernia specialists in Germany from my research.

Dr Lorenz, Dr Wiese and Dr Koch, who are the other better known specialists in Germany, were all less than half the cost when I last looked into it a couple of years ago, though that may have changed.

[Jack2021]

Just to add, it’s knocking on 2 years since I was in touch with Gonzalo, so he may have moved on I guess.

[Jack2021]

Hi Gale,

Sorry to hear about your situation.

I’m also based in the UK. My suggestion would be to contact Dr Joachim Conze, who runs a clinic in Munich – 0049 89 9209010 / https://www.hernien.de/

He worked in partnership with Dr Ulrike Muschaweck for many years until, from my understanding, buying her out or coming to some agreement of sorts and taking over the clinic.

Dr Muschaweck is renowned for her sportsmen’s groin repair (the Muschaweck repair) which doesn’t involve the use of mesh. She does run a clinic in the UK once a month still I think, so you could see her also, even just for advice. A consultation will cost £400-£500 so not cheap and she’s not registered with many private medical insurance companies either, even if you have cover.

Dr Muschaweck is mid-seventies now so well beyond standard retirement age for a surgeon in Europe and is expensive too. She’s operated on the likes of Alan Shearer and Michael Owen many years ago.

To find out about UK appointments, you can contact her either through Biohernia, or more directly via her PA, Gonzalo Rojo at uk@leistenbruch.de / 0049 89 9545 338 20.

Dr Conze treats many top athletes and sports people too and can offer the same treatments at similar prices, though you’d need to travel to Munich. He’s probably in his fifties, I’d guess and would be my preference of the two if you were to undertake surgery, because he also looks to preserve the nerves and my understanding is that Dr Muschaweck is more likely to cut them, as they’d say in basic layman’s terms, which she does with her inguinal hernia repairs as standard I believe. He would Taylor any surgery and can use mesh if it’s required.

Were you to travel to Germany, they’d provide all the details about where to stay etc, so it should be relatively straightforward, aside from having to travel for it.

They can both do open surgery repairs for a variety of hernias and would both do their own dynamic ultrasounds, rather than relying on a report from a radiologist, as they know exactly what they’re looking for.

Hope that’s helpful and please feedback on the forum regarding how you get on, as it’s always really helpful for other members to know.

All the best,

Jack

[Jack2021]

Thanks Pinto and G.

I agree Pinto, that KR could turn out to be revolutionary. In my humble opinion, that would be regardless of whether it’s a case of having changed the suturing technique/positioning, or multiple modifications.

If it’s a minimally invasive technique with low recurrence and chronic pain rates over the long term and takes less than half the time of other hernia repair surgeries, then it would surely be the biggest leap forward in hernia repair surgery in many years.

Along with that, if it turned out to be easier to teach than the Shouldice repair and perhaps the Desarda repair too, which the speed that Dr Kang does his KR surgeries may indicate, then it could be of huge benefit across the world, apart from to the mesh industry of course.

There appears to be some interest already from Dr
Lorenz and perhaps others in his circle. However, we all need @drkang to explain and publish all the details of his repair, as Professor Desarda did and the sooner the better so it can be peer reviewed and validated.

Here’s hoping this happens soon. 🤞

[Jack2021]

Hi,

Did you go ahead with Dr Drymousis for surgery (and did anyone else reading this)?

If so, or you have any further updates, it would be very helpful to hear about your experience.

Best regards, Jack

[Jack2021]

If you (and other members) haven’t watched it already, it’s worth watching De Towfigh’s interview with Ralph Lorenz on her Hernia Talk YouTube Channel. If you read this Dr Towfigh, it would be great if you could invite Dr Joachim Conze onto you YouTube channel.

I know some forum members have had video consultations with Dr Lorenz (if any of you are reading, it would be great if you could post about how you set that up and how it went), but I’ve found him difficult to get hold of. Nobody who’s been treated by De Lorenz has ever posted on the forum, which is surprising considering, though there are positive reviews on some German websites.

Germany’s a long way to go for a face to face consultation, unless you plan to have surgery while you’re there, all being well.

Re being a good fit for a Desarda repair, despite one or two surgeons suggesting it’s more suitable for younger people, from my research it appears to be an option for anyone with reasonable tissue quality, which is similar for the Shouldice repair I believe. Being slim is certainly advantageous as well. The UK surgeon (who I believe learnt the Desarda repair from Dr Lorenz) I was planning to see before he decided to have a change of career and stop practicing, didn’t put an age range on it and I’m no youngster anymore sadly!

[Jack2021]

Hi Virendra,

He’s not someone I’ve heard of before. It would be good to be able to hear from people who’d been treated by him and could verify they’d had a tissue repair etc. Did you ask Dr Drymousis to explain how he does the Desarda repair and whether he uses permanent sutures etc, as some surgeons do seem to slightly modify aspects of the original repair. It may be worth contacting his secretary to see if they have any previous patients who’d be happy to speak with you about their experience. Interestingly, one of the hospitals he works at, The Hernia Clinic at St John & St Elizabeth Hospital also has Dr Martin Kurzer on the list of consultants. Both of them are listed on the Desarda website, though I spoke to Dr Kurzer early on in my research and he advocated for mesh repairs and questioned why anyone would want a tissue repair over mesh, clearly not keen to offer any other options.

[Jack2021]

Hi Virendra,

I haven’t had surgery yet. There was a a UK surgeon who offered the Desarda repair, but unfortunately he’s no longer practising.

I haven’t done any further research for a while now, but if I find anyone else, I’ll let you know. If you happen to find anyone, please send me a message

Good luck,

Jack