Jack2021
Forum Replies Created
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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
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Great links to the video and comment Good intentions, thanks.
Here’s a link to the comment – https://www.deepdyve.com/lp/springer-journal/shouldice-hospital-comments-on-shouldice-standard-2020-review-of-JkkEjJj2yQ?key=springer
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Hi Watchful,
Reassuring that the Shouldice hospital will listen to patient requests for specific surgeons, albeit without promising. I guess you’d have to be politely assertive on arrival that you’d only see whoever you’d enquired about. A longer the list of acceptable surgeons would hopefully raise the odds of getting one.
Thanks for reposting that link, I’d forgotten about that!
Also reassuring to hear about the Canada insurance study re accuracy of recurrence rates, as long as it was fully independent.
It seems to me that unless there’s an increased appetite within the sector to champion and independently monitor long-term hernia outcomes with the different tissue repairs and their modified versions and for individual surgeon results too, to account for varying degrees of skill and expertise, we’ll have to accept what’s most believably evidenced currently and hope we make the right choice.
As some of the doctors I’ve spoken to have told me, they can’t always guarantee their rates of pain and recurrence, because former patients aren’t always contactable, particularly over the long-term and if someone has a bad outcome, they may go to a different doctor, so the original surgeon never finds out that there was an issue. These unknowns may well be factored into success rates for many surgeons who keep their own records.
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Personally, I’ve found the patient.info site to be a poor resource vs this site, so echoing the points above, credit to @drtowfigh. Please do keep this site going @drtowfigh, it’s such a great resource and hopefully more surgeons with an interest in hernias will join, as I think they too would get a lot out of it that could inform their own practice.
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Re your point about not being able to select a surgeon at the Shouldice Hospital, Watchful, it would be interesting to know what the hospital’s response would be to an enquiry from a paying patient explaining that they’re travelling a long distance and would like to be treated by either a specific surgeon, or say one of a selection of two or three, if you knew all have great reviews.
Have you tried that to see what they say?
The other point to consider, as noted by one of the posters on the disappeared Mr Sea thread (apologies, I forgot who it was), is that Dr Netto from the Shouldice Hospital stated that their current stats for chronic pain may be significantly higher than stated at perhaps 5%+ and they need to look into this further, or something along those lines.
If correct, could their long term pain rates be linked to cutting the cremaster and nerves? The problem here is that we don’t have a long term study of chronic pain and recurrence of the original Shouldice vs the modified Shouldice (i.e. the version that doesn’t cut the cremaster and nerves and has 4 lines of permanent sutures) and we may never get one, certainly not in time for those of us currently watchful waiting.
I’ve not heard the actual quote from Dr Netto, but if it’s true that their pain stats aren’t accurate, why aren’t they accurate and does it therefore also raise some doubt about their stated recurrence stats too?
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I agree and hopefully @drtowfigh will be able to have it reinstated.
I checked my history as well and it also said oops, this page is no longer available.
It was such an interesting and valuable thread, so fingers crossed it reappears soon.
If it helps @drtowfigh, Mr Sea started the thread with a write up of his experience with Dr Sbayi.
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Dr Towfigh also offers a Shouldice repair, following the traditional method I believe, having recently watched her Hernia Talk with Dr Yunis from a couple of years ago, so another potential option for the US list. Please correct me if I’m wrong @drtowfigh.
If I decided to have a Shouldice repair and cost wasn’t an issue, I think I’d currently err towards Dr Joachim Conze in Germany and he uses 4 rows of permanent sutures. I thought Dr Andreas Koch came across well in the Hernia Talk with Dr Towfigh, so if he’d do 4 permanent rows instead of 2 perm/2 resorbable, then he seems a strong option too.
I’m based in the UK, so the distance may bias me somewhat, though I’d also prefer not to have the cremaster and nerves cut, ideally.
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As Wim said, hep A and B are good to get and the sooner the better, as B can be 2-3 doses spaced apart. Can’t remember re A.
If you haven’t had a BCG jab (TB), then that’s advisable also, along with being up to date with covid and flu jabs.
Check with your GP to make sure you’re up to date with MMR and tetanus and also for costs as some jabs may be free on the NHS, such as hep A, dependent on the GP practice.
I’d ring around travel clinics as well to compare prices as they do vary.