[Jimbohen]

This brand new Comfort-Truss is a great low profile, light weight, innovative design. It’s the best one I’ve tried and I have no affiliation with the designer George Hirst who sales it from his website: https://mynaturalherniacure.com/

[Jimbohen]

quote drkang:

Looking at the active discussions, I understand that many people have deep interest in minimal laparoscopic repair. I can feel the sense of fear that people have towards existing inguinal hernia repair methods; starting from mesh repair. However, I believe more than necessary fear can result into looking at only the trees instead of the whole forest.

If it succeeds, it is definitely delightful but only 1~2% at most, I believe, of the total number of inguinal hernia patients are subject to so called minimal laparoscopic repair. Most inguinal hernia patients will not be able to undergo this surgery. Therefore it will not be of much needed help looking into this technique excessively.

The real question here is which technique is practical for the majority of inguinal hernia patients. So, in my opinion, we need to concentrate our discussion on mesh repair and non-mesh open repair. I believe there are two directions we can take. The first is developing the ideal mesh with no side effects; though I do not know if it is possible or not. The second is finding or developing a new minimal non-mesh open repair different from existing ones and then educating it. It is an issue that each and one of us have to decide on. Every doctor may have different opinions but I personally believe the second direction is the best way.

Dr. Kang,

Thanks for your advise that the discussion should focus on the ideal non-mesh open repair and hernia mesh rather than laparoscopic non-mesh repair since very few adults will ever be candidates for this. Regarding your belief that there are then two directions we should take rather than three. The first, but not the best, is developing the ideal mesh with no side effects. This recent press release from Purdue University seems to hold some real promise. Korean researchers there and in Korea have engineered a silk hybrid material that can attack bacteria when illuminated with green light could be the basis for this revolutionary new ideal mesh.

https://www.purdue.edu/newsroom/rele…al-remedy.html

Here’s a summary of some of the points from this article and another source. I don’t fully understand it all but it seems like it could lead to “the ideal mesh with no side effects” that’s so desperately needed:

These Korean researchers have found a way to fuse a far-red fluorescent protein into silk. When exposed to green light, the resulting material will release molecules that kill bacteria and other dangerous pathogens.
The new all-natural organic biomaterial offers an alternative way to sterilize pathogens. Whereas current hernia meshes are often toxic to humans.
They claim this silk hybrid has several uses including wound treatment.
Young Kim, an associate professor of biomedical engineering at Purdue, said that silk is one of the oldest and best-understood biomaterials. Harvested from the cocoons of silkworms, the material generally does not cause any ill effects in humans aside from the rare allergy.
Likewise, green light is not dangerous like ultraviolet light. Green is the strongest wavelength of the visible spectrum, but it’s still safe for humans since it’s found in natural sunlight.
To create a material that featured the benefits of these two, the Purdue-NAAS research team fused the “mKate2” gene into a silk host. A fluorescent protein in the far-red spectrum, mKate2 creates reactive oxygen species (ROS) in the presence of green light.
ROS are radical molecules that react to any organic contaminants they encounter. They attack the membrane and genetic information of bacteria and other pathogens.
The researchers tested the new silk using E. coli bacteria. When they shone a weak green light on the light-reactive biomaterial, they determined that the survival rate of bacteria on the silk hybrid plummeted to 45 percent.
In addition, the new material appeared to be very versatile. The hybrid silk could be turned into a bandage, FABRIC, FILM, and SOLUTION. (injectable)
Fluorescent silk is eco-friendly and bio-compatible with humans.
Kim’s fellow researcher Jung Woo Leem explained that they made fluorescent silk so that it could be disinfected or decontaminated with just normal light instead of UV light. Kim added that their team’s product is superior to competing plasmonic photocatalysts in terms of efficiency and ability to be scaled up.
Plasmonic photocatalysts use metal nanoparticles from semiconductor materials. While these nanoparticles can react with normal light, they may have hazardous effects on the environment, humans, and animals.
Kim pointed out that silkworms create the host material for the ROS-generating proteins of their fluorescent biomaterials. The manufacturing process of their silk photocatalysts is very easy and environment-friendly compared to industrial processes that create plasmonic photocatalysts.
He and his team are already considering other uses for the hybrid silk. Kim talked about IMPLANTABLE and INJECTABLE bandages that will NOT be REJECTED by the HUMAN BODY and will NATURALLY BREAK DOWN after the wound has healed up.
The hybrid silk was genetically engineered to accommodate the fluorescent protein, but it is an organic product and technically not a GMO. The silkworms that produced it are normal; the protein is added to the silk after harvesting.

Dr. Kang, of course this new biotechnology may take some time if it ever comes to fruition for hernia mesh. Especially here in the USA where the powers that be will bog down the process largely out of greed. Big Pharma won’t want to risk the billions they rake in for their many severely flawed and deficient patented mesh products. And their the tail that wags the doctor dog! Thus, perhaps you can help expedite the process for this ideal hernia mesh with your fellow countrymen.

Regarding your belief that the discussion should also focus on the second direction of finding or developing a new minimal non-mesh open repair different from existing ones and then educating it. Respectfully, your posts under this topic as well as the information on your website have led me to believe that you have essentially achieved that goal. Correct me if I’m wrong, but isn’t your “Kang non-mesh minimal open repair” for indirect hernias a method that you developed and refined over just the past few years? Do you not consider it the ideal method with little or no room for improvement? Therefore, please describe the specific nuances and the advantages of your method in even greater detail to the extent that this is practical. Informing and educating all of us, who are very interested, is a big step in the right direction towards having other surgeons perform it for the benefit their patients. I’m not a doctor so for what it’s worth, like you I also “personally believe (that this) the second direction is the best way.”

[Jimbohen]

quote Jeremy B:

Dr. Ponsky would like the following communicated:
“I DO NOT yet recommend this to adults because we dont have enough data yet. We are conducting a prospective trial in Norway and have not had a recurrence yet (about 20 patients so far) but I make it very clear to my older patients that they must understand that we dont know yet who this will fail in”

Please relay the following to Dr. Todd Ponsky:

Many doctors highly recommend mesh although they don’t know who it will fail in and this seems to be many. So don’t let that hold you back!

You’re an American doctor but you’re only involved in a trial in Norway? Are the mesh pushing doctors and big pharma opposing an American trial?

Would you agree that the deep inguinal ring isn’t genetically programmed to grow as a child grows into adulthood? But instead it normally shrinks and tightens or closes around the spermatic cord? However, even when it abnormally fails to do that and an open gap remains resulting in a patent process vaginalis defect. Which sets the stage for a loop of the intestine to herniate through it and create a visible palpable bulge. Even when this occurs, isn’t the diameter of the deep inguinal ring quite often small enough for successful high ligation? Assuming this is done early enough before it may have expanded and stretched through decades of movement of the spermatic cord? Doesn’t the fact that you’ve had no recurrence with 20 adult patients bare this out?

[Jimbohen]

quote drkang:

Hi Jeremy B,

I reviewed my inguinal hernia repair cases of the past 2 years, 2016 and 2017.
The percentages of the male direct inguinal hernias are as below;

20s: 0% (0 out of 160 total inguinal hernia repairs)
30s: 8.4% (17 out of 202)
40s: 18.1% (67 out of 370)
50s: 32.8% (183 out of 558)
60s: 30.1% (209 out of 695)
70s and plus: 25.5% (170 out of 667)

It is not common that the indirect inguinal hernias have the concomitant weakness in the Hesselbach triangles(direct area).

I am very sorry, but let me say something. I don’t really want to discourage you and also hope I’m not being misunderstood for trying to disparage and criticize other doctors’ methods. All that I wish is to give the correct advice based on my knowledge to everyone on this forum.

Dr. Todd Ponsky introduces himself as a Pediatric General Surgeon and it is mentioned under his video (link above) that “it is the technique for laparoscopic high ligation of an indirect inguinal hernia”. The open high ligation is the well-known technique that has been used only for the pediatric inguinal hernias for last 120 years. Laparoscopic high ligation and open high ligation share the same concept. And if you search Dr. Patkowski’s repair which this technique was based on, you can see that they performed this technique mainly on pediatric inguinal hernias.

Recently one hospital in Seoul performed the similar non-mesh laparoscopic inguinal hernia repairs on adults for a couple of years. But now they abandoned this procedure and returned to using mesh.

To my knowledge, for this technique to be successful on adults as well, the size of the deep inguinal ring has to be as small as that of a child. It means this technique is seldom applicable for the average adults. As you know, it is not applicable for direct inguinal hernia. and can only be performed for small indirect inguinal hernia. At the end of the video, the Dr says that this will work well in young adults that have a small indirect inguinal hernia that is essentially a patent processus vaginalis. This means that it is not adequate to perform if there is gross inguinal bulging in adult patient.

5 years have passed since this video was uploaded in 2013. So I think you’d better ask him the total number of the repairs on adults so far and the surgical outcome before making a final decision.

Hi Dr. Kang,

Apparently, based on your patient records direct hernias increase with age. And, apparently more strenuous, activity since the incidence of these decreases around 60 when most become more sedentary. That would be expected since they’re often the direct result of a strain and or injury. However, your percentages seem somewhat higher than I’ve heard before. Could that be due to some other doctors misdiagnosing direct as indirect hernias?

Since the deep inguinal ring normally shrinks and closes rather than remains open. Even when it abnormally does, isn’t it more likely to just remain the size of a child’s since it shouldn’t normally grow as the body grows regardless? If the deep inguinal ring abnormally doesn’t shrink and close the result is a patent process vaginalis defect. Thus, a loop of the intestine may herniate through it and create a gross (visible) bulge in BOTH a child and an adult. Hence, why would only the adult, and not the child, be a bad candidate for laparoscopic high ligation simply on that basis alone?

Of course, I’m not a doctor so I’m certainly not trying to challenge your theory. Rather, I’m just seeking clarification for a better understanding. Thanks for sharing your insightful wealth of knowledge.

[Jimbohen]

Hello Dr. Kang,

I’ve been reading your posted comments and you’re arguments are very persuasive. I would come to Korea to have you repair my indirect inguinal hernia if I could afford to but I can’t. Do you perform the repairs yourself or just other surgeons under your supervision? Who the best and most talented surgeon on your staff aside from yourself. Since you may now have to devote most of your time operating your clinic rather than on patients.

You seem very sincere in your desire to help hernia sufferers regardless of their country and that’s very commendable. Since my health insurance will cover most of the cost. I can afford to see Dr. William H. Brown mentioned above as the doctor that’s now doing the Marcy repair in Fremont, California, USA. Since we can all learn something from each other and you’re both performing the non-mesh Marcy repair. I implore you to contact him without delay and discuss the nuances of your modified Marcy repair for indirect hernias and your modified Shouldice/Desarda repair for direct hernias. You could put your heads together and exchange thoughts and ideas and thereby sharpen each others swords or scalpels. Doing so for the very noble and compassionate cause of advancing hernia repair to greatly improve patient outcomes and thereby save many lives.

I assure you he didn’t put me up to this but I think he would be very receptive to it. Because, like yourself and a few others, he’s a rare breed who’s dedicated to making his patients well rather than making big pharma wealthy by implanting their often devastatingly harmful mesh time bombs.