Jack2021
Forum Replies Created
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Hi William,
I remember reading the post/article you mention about the two farmers whose Desarda repairs recurred. I think it may be a post somewhere here on HT. If not on here, maybe it was patient info.
It was in reference to a surgeon in New Zealand (hence the sheep farmers!) and from memory, I think the person said that the surgeon had just those two recurrences from a large number of Desarda repairs. I’m not sure of the numbers but 300+ rings a bell.
I think it was part of a thread from someone looking for tissue repair in Australia, but I’m not 100% certain.
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Hi Pinto,
I’ve read through the Kang Repair information on the Gibbeum Hospital website (http://gibbeum.com/whykr/Why-and-What-Kang-Repair.php) and in the ’Direct Closure’ section, it does actually state that ‘Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences.’
That is possibly the main source for Dr Towfigh referring to it as a modified Marcy repair, though from what he said in their Hernia Talk Live discussion on YouTube, Dr Lorenz seems to have further insight into the modifications.
With regard to a Marcy repair apparently having a higher risk of recurrence for men than for women, Dr Towfigh has previously mentioned the differences in anatomy in this area being a factor and perhaps the sentences I’ve pasted below from Dr Kang’s ‘Direct Closure’ section that follow on from what I pasted above, qualify, or at least allude to the higher risk for men.
@drtowfigh or @drkang, would need to give the expert medical perspective on this for clarity.
‘In fact, most of the internal inguinal ring is occupied by the spermatic cord which contains the testicular vessels, lymphatics and sensitive nerves. So it is very difficult to close the internal inguinal ring securely without damaging the aforementioned sensitive structures.’
I hope that the Kang repair will soon become more widespread, because if it really is as effective as the feedback on HT and explanations on the Gibbeum website, surely @drkang must urgently publish all the details of his Kang repair and share it globally as a priority, as Dr Desarda did with his repair, to encourage a reduction in the use of mesh and all its associated risks and to offer more choice to those wanting a non-mesh repair.
With @drkang’s repair apparently taking less than half the time vs other tissue repair methods, perhaps that may equate to a shorter teaching duration for other surgeons also.
If Dr Lorenz is correct in his statement about the Kang repair differing to Marcy purely in the way that the suturing is done, I like the idea of that.
I can imagine how Dr Kang would have taken significant time to work out how this would make an effective repair for adults vs the original Marcy method and to finesse his technique.Despite it perhaps sounding a simple modification to the average layman, if it has groundbreaking results then it’s a huge discovery, regardless.
Keeping things simple and straightforward is often the best way to go in life, hence the KISS acronym commonly used by skilled tradespeople in the UK – keep it simple stupid!
Hopefully for all watchful waiters and future hernia affected people, @drkang will be forthcoming with sharing his technique in the very near future, perhaps starting with an interview on Hernia Talk Live with @drtowfigh. Come on, please get it organised!
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I was disappointed that Dr Lorenz didn’t answer Dr Towfigh’s question about who did his Shouldice repair, just saying it was a friend.
It would have been helpful if Dr Towfigh had asked more about their repairs and why they chose Shouldice at the time. Did their respective bio-data dictate only Shouldice repair, as you say Pinto, or did they have their repairs before they knew much about the Desarda repair, was Dr Lorenz’s friend unable to do a Desarda repair and personally preferred the Shouldice option etc etc.
It was also very interesting to hear Dr Lorenz mention @drkang’s repair and explain how he believes it differs from its Marcy repair based origins.
@drkang, @drtowfigh mentioned the possibility of having you as a guest on Hernia Talk Live, to talk about your repair. I think that all forum members would welcome that.
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I’ve just watched it too and agree this is definitely worth watching.
It was very interesting to hear Dr Towfigh say that Dr Lorenz had got her rethinking her perspective about the Desarda repair – “I need to go and visit Dr Desarda. You’re making me rethink my thoughts about it.”
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Great, thanks Dr Towfigh.
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Hi @drtowfigh,
Hope all’s good with you.
I missed this and it doesn’t appear to be on YouTube yet. Do you know when it will be available please?
Many thanks
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Thanks for your posts Oceanic and for sharing your experience so openly, I really appreciate it.
I’m also UK based and posted about Dr Conze and the other surgeons in Germany, along with the very limited surgeon options in the UK early on in my research, probably a couple of years ago now. From speaking with them all apart from Dr Wiese, Dr Conze was my preferred option.
I’ve been watchful waiting since, so it’s great to hear about a first hand experience with Dr Conze. I just wish that he wasn’t more than double the price of the other German surgeons, but having worked with Dr Muschaweck in the past, they seem to share a similar price structure.
While it’s important to interrogate the data, there seems to be a lot of unnecessary arguing and overly critical hair-splitting pickiness on the Hernia Talk website these days, which I think will be putting people off from using/posting on the site, which is a shame, as it’s such a fantastic resource. I signposted someone to HT in the hope that they’d post about their tissue repair experience, but they said all the arguing put them off and declined to, so I’m glad you’ve posted your experience and look forward to further updates.
Wishing you a speedy recovery,
Jack
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Dr Towfigh talked a bit about her thinking re tissue repairs for women in her Hernia Talk video with Dr Andreas Koch. They had similar perspectives on this, if I remember correctly.
The whole talk’s worth a watch for anyone who hasn’t seen it.
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I agree Pinto, it can be really frustrating. It times out pretty quickly. I write my posts separately now and paste them across to avoid it happening.
It doesn’t seem to like multiple web links either.
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There are currently 110 reviews on the UK Trustpilot website for Biohernia regarding Dr Andreas Koch’s and Dr Martin Wiese’s hernia repairs with patients in Europe – https://uk.trustpilot.com/review/biohernia.com?sort=recency
Two of the more recent reviews, one by a guy in GB on 10th February and the one just above that by a guy in the Netherlands on 8th March appear too similar, though who knows with any online reviews. Maybe the Dutch guy wasn’t sure what to write.
The odd review only mentions the location where the person had surgery, so FYI, Dr Koch is in Cottbus and Dr Wiese is in Frankfurt.
One of the reviews for Dr Wiese mentions that he reinforced the Shouldice repair for one patient with an absorbable mesh which cost over €1000 extra. In regard to this, I’ve also seen a video with Dr Koch talking about doing the same in some cases (where he feels reinforcement is necessary from what I remember).
It won’t allow me to post the links to the jameda reviews, but Dr Wiese has 175 reviews, Dr Conze 194 reviews and Dr Lorenz 39 reviews.
Dr Koch doesn’t appear to be listed, although there are a few doctors with the same name.
I was using my phone rather than laptop and it was trickier translating, so I only checked the first few reviews for each of them which were all positive.
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Hi Dean,
Are you visiting Seoul to see Dr Kang?
As William said, if you are, please feedback on here about your experience.
For South Korea, the NHS Fit For Travel website says to confirm primary vaccination courses and boosters are up to date as recommended for life in Britain and to consider Hepatitis A; Hepatitis B; Rabies; Tetanus; Tick-borne Encephalitis.
Re the encephalitis, it says to consider this if you’ll be spending time in forests and rural areas.
There’s lots of other useful info on there too, so here’s the link to the South Korea section for reference – https://www.fitfortravel.nhs.uk/destinations/asia-east/republic-of-korea#Vaccinations
The jabs you’ll have to pay for in the UK are Hep B and flu (if you’re under 50), plus possibly the rabies and tick-borne encephalitis vaccines.
You’ll get the tetanus, diphtheria and polio combined jab for free and probably hep A too if you have them through your GP’s. I think MMR would be free if you chose to have that too.
Travel clinics and pharmacies will likely charge for everything, but could be a good option if you struggle to get an appointment with the nurse/whoever who deals with travel jabs at your GP’s.
Re hep B, it’s usually a 3 or 4 jab course if you haven’t had it before, so you’ll need an accelerated course if you travel in a month. I’d check with your GP and local pharmacies asap if you want to have it. The nurse at your GP’s may say it’s not always recommended unless you’re a sex tourist (they’ll phrase it differently to that!), but for a family trip to Asia, we all had it as a precaution. It can survive out of the body for over a week in dried blood/body fluids that you may not be able to see, so thinking about eating out all the time when away, staying in hotels and such like, we felt it a worthwhile precaution.
I’ve seen the travelbusinessclass website before but never used it, so it’d be good to hear how you get on if you do.
All the best,
Jack -
With Dr Towfigh having talked about not rating the Desarda repair and Dr Kang seemingly not rating it either, it would be really interesting to hear what your opinions are @drtowfigh and @drkang regarding a couple of the studies published that appear to evidence that the Desarda repair is worth considering for low rates of recurrence and chronic pain and quality of life post repair.
I realise that other members have previously posted these studies, the first of which is the 15-year follow-up study in Poland where from 198 patients tracked down who answered all the questions:
‘After 15 years of follow-up, three recurrences were found (1.5%). Recurrences occurred 2, 3, and 5 years after the surgery. All patients expressed their satisfaction with the treatment. Twenty-eight patients (14.4%) reported a rare occurrence of mild pain while performing certain activities. Three patients reported persistent chronic pain (1.5%). Conclusion: Surgical repair of primary inguinal hernia using the Desarda technique is a simple, feasible, repeatable procedure, using the patient’s own tissues, and with a low learning curve.’
17 patients who were contacted didn’t answer all the questions and there’s no further detail or explanation about this. It would obviously have been helpful to know if their repairs had resulted in chronic pain/recurrence or not.
The other study is very recent and I believe posted by Good Intentions (apologies if it was someone else). Dr Ralph Lorenz, one of the hernia surgeons in Germany who specialises in the Desarda repair and a modified Shouldice repair, was involved with this study:
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From my research, I understand that Dr Light in the UK performs the Desarda repair under local anaesthetic without sedation.
I’ve not heard of any issues with this, though I’ve not managed to find reviews.
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Prof Sheen offers a modified Shouldice, but rarely to people over 30. He’s a lap mesh specialist.
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I’ve had a quick look at the video and it’s not Prof Sheen. I didn’t watch enough to ascertain if it was in the UK or not.
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No offence taken Good intentions and apologies that I forgot to post the link you had to search for!
I tend to be very sceptical about supplements and there’s no replacing a healthy diet IMO.
As you say, if trials were to evidence successful results, that would certainly be interesting.
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If you don’t have any luck with Dr Towfigh’s suggestion of Dr Radu, you can access Dr Koch, Dr Wiese and Dr Muschaweck through Biohernia – https://biohernia.com/.
You could call/send them the details you posted above and see if Biohernia are able to check if any of those three surgeons may be able to help, or recommend other surgeons alternatively.
Two other German hernia specialists you could also try:
– Dr Joachim Conze, who runs the Munich Hernia Centre – https://www.hernien.de/
– Dr Ralph Lorenz at https://www.3chirurgen.de/
Good luck!
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Hi William,
I’ve previously contacted both Prof Lloyd’s office and Prof Sheen.
My understanding is that Prof Lloyd specialises only in mesh repairs for hernias and his ‘Lloyd release procedure’ for sports hernias. I’m pretty sure this was discussed and rejected as a good procedure during Dr Towfigh’s excellent recent discussion on Hernia Talk with Dr Ulrike Muschaweck.
Prof Aali Sheen specialises in lap mesh repairs, namely his ‘Manchester Groin Repair’, though he does offer a suture repair (I’m not sure which method) for certain patients in the 18-29 age group only.
There’s a Hernia Talk on Dr Towfigh’s YouTube channel with Prof Sheen around a year or so ago.
Hope that’s helpful.
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I’d never heard of cord lipoma before.
It would be interesting to hear @drtowfigh’s thoughts on this.
This study states:
‘ A spermatic cord lipoma is found in 20–70% of all inguinal hernia repairs.
Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI.’
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Hi Dr Towfigh,
Hope all’s good with you.
I’m very interested to see your Hernia Talk Q&A with Dr Ulrike Muschaweck.
I won’t be able to watch live though I’ll definitely watch the recording when you post it on YouTube.
Would it be possible to ask Dr Muschaweck about the following please:
– How she performs the Shouldice repair, including whether she cuts the cremaster muscle and the genital nerves, does she do a 4-layer suture repair, does she use permanent or absorbable sutures and does she prefer local anaesthetic (if so, is that with or without sedation) or general etc?
– What her thoughts are about the Desarda repair and does she perform this repair?
– What her thoughts are about long term pain after hernia tissue repairs, how likely it is and the causes?
– Is she aware of the Kang repair and if so, what are her thoughts about it?
– Does she still run clinics in both Germany and the UK?
Many thanks!
Jack