[John Fortem]

Ah yes! I got it now. Dr. Shouldice was influenced by Dr. Bassini. Here is an excerpt from a book called Textbook of Hernia, published by Springer in 2017, where Dr. Koch is a contributing author. I believe he penned the part about tailored approach and history of hernia repairs. Here we go…

quote :

“The ancient history of inguinal hernia is remarkable with many creative but mostly futile approaches to its treatment. One illustrated and informative resource for the work and workers of that era are the early chapters in Hernia Healers by Stoppa et al. [14,15].

The modern era of inguinal hernia repair began with the works of Bassini [16]. He recognized that the transversalis fascia was the Achilles tendon of the groin, the layer through which hernias develop. He proffered that to correctly repairan inguinal hernia the groin must be dissected layer by layer knowledgably and carefully from the skin into the preperitoneal space. Only then could the muscles, fascial elements, vessels, nerves and vassal structures be identified and preserved. His reconstruction began with the posterior wall opened. After checking for a femoral hernia,he dissected the peritoneal sac to its true neck and ligated it there. He then used a three-layered interrupted suture repair to reconstruct the canal’s posterior wall. His deepest suture line included the lateral edge ofthe rectus muscle, the internal oblique muscle, the tranversus abdominus muscle, and the medial edge of the transversalis fascia. He approximated that four-layer composite to the lateral edge of the transversalis fascia and the inguinal ligament. He replaced the spermatic cord in its normal position and sutured the external oblique aponeurosis to comfortably re-create the obliquity of the canal and the external inguinal ring. In his earlier operations, starting in 1844, Bassini insisted his patients be awakened enough from anaesthesiato perform straining motions to prove that his repair was sound. Bassini’s results for inguinal hernia repair was astounding compared to the poor results of other surgeons of his time. With 90 % personal follow-up of 262 casesover 4 years, his failure rate was less than 3 %. He eventually reported this in a paper entitled, Nuovo metodo operativo per la cura dell’ernia inguinale. While some have noted that Bassini never specifically wrote about the importance of opening the posterior wall, illustrations by his devoted pupil, Catterina, clearly showed that he did open it and that he had described doing so in his own paper, Bassini’s operation for the radical cure of inguinal hernia [17].

Bassini’s true repair was altered and became known as the Modified Bassini Repair/North American Bassini Repair as was its impressive results. Many North American surgeons, influenced by Andrews, did not appreciate the importance of completely reconstructing the canal’s posterior wall. Most simply ligated the peritoneal sac and pulled the transversus arch to the inguinal ligament, frequently under enough tension that a relaxing incision was needed. The short-and long-term result of the Modified Bassini repair was not good. Most failures could be traced to the inability of tissues pulled together under tension to withstand normal intraabdominal forces associated with ordinary bodily functions.

In the early part of the twentieth century severalother suturing techniques were used to approximate the internal oblique and transversus abdominus muscle, with or without the medial flap of the external oblique, to the shelving edge of the inguinal ligament. The “Darn” technique was popular in the UK, Europe and the Far East [18]. Continuous single or double strands of nylon or silk suture that bridged the canal created a mesh-like structure. This technique never gained much interest with American surgeons.

E.E. Shouldice, a Canadian surgeon, revitalized Bassini’s original principals of inguinal hernia repair [19]. Using a local anaestheticShouldice dissected the structures of the groin including opening the posterior wall into the preperitonealspace. Differing from Bassini’s interrupted suture technique, Shouldice used continuous 34-gauge stainless steelwire to reconstruct the posterior wall and repair the hernia. The results of many-thousand repairs at the Shouldice hospitalare impressive. Shouldice championed using local anaesthesiaand insisted on patients ambulating early. His detailed dissection through the double layers of transversalis fascia, along with the contributions of Rives and Stoppa of Franceand Nyhus and Condon in the USA and the earlier work of Henry and Cheatle helped set the stage for the eventuality of posterior repairs.”

There is more to read. This is the book:

https://www.amazon.com/Textbook-Hern…/dp/3319430432

[John Fortem]

I’m sorry you had this bad experience Baris. I know it’s of no comfort to you, but it needs to be said that not every operation has the same outcome. We are all unique, and there are many variables that influence the outcome. I think that’s also what makes surgical studies difficult, because you have so many things to consider and measures to compare across, the results easily become diluted and incomprehensible or inconclusive.

Did you say you had triple hernias? Two indirect hernias? Scrotal even? What was the third one?

I had my surgery at the hands of Dr. Koch about 1 month ago now, and I can assure you I am 99% recovered, I have fully restored function in my groin, I have no pain or discomfort. Frankly I can’t believe it ended up being this good. If I knew I would have had it operated on years ago. But I only had one, indirect hernia on the right side. I had it for about 8 years, and if I had not repaired it I think it would have gone down to the scrotum which would have complicated things. So the lesson I learned is that as soon as you recognize that you have a hernia you need to start doing your research and making plans for repair. It should not be postponed. The trouble with postponing is that you start stacking problems one on top of the other. This is true for all ailments, not just hernias. Problems are meant to be dealt with, the sooner the better.

Dare to ask questions! I knew exactly what type of inguinal hernia I had (indirect), why I had it (congenital), and what type of repair would be done, and I even knew what type of sutures and gauge would be used. I was told all these things by Dr. Koch. But I got many of these details by simply asking him, it’s not something he will tell you unless you ask. Most people will find this level of detail boring or even frightening, and while my experience with ordinary general surgeons who don’t specialize in hernia surgery don’t even tell you what type of mesh they will use, Dr. Koch is ready to answer all your questions.

Yes, Dr. Koch uses a modified Shouldice repair. But I knew that before I even came to Germany. Because I knew what the so called “original” or genuine Shouldice entailed, because I did my research beforehand. Using steel wire for suturing? Are we still living in the 18th century? I am glad that Dr. Koch uses a combination of absorbable and non-absorbable synthetic sutures. And why would he cut the cremaster muscle unless he needs to? Just because the Shouldice clinic dictates so? Because the inventor of the technique – Dr. Earle Shouldice – who lived in the 20th century used a steel wire and used to cut the cremaster muscle? The technique used should be fluid, not a static teaching from the previous century, just so you can say that you are staying in touch with the tradition.

What I liked the most about Dr. Koch is that he is approachable, he listens and adapts to your specific needs. There is nothing worse than blindly following the teachings of an old school just for the sake of preserving the tradition. Be water! As Bruce Lee would have put it. Formless! Shapeless! Dr. Koch uses the same principle. Could it be that Dr. Koch is the Bruce Lee of hernia surgeries?

All the major and minor hernia repair techniques are improvements or modifications of one or the other. You have McVay, Desarda, Shouldice, Bassini… I don’t recall now what order these came in, but I am pretty sure the “original Shouldice” borrows from some other technique, and that’s alright, that’s how it should be. Borrow freely what you find useful. That’s the only way to a better way. How does that old saying go… all artists borrow, the best ones steal?

Losing fat prior to surgery is always a good idea, if you can manage, regardless of type of repair or even type of surgery being done. I started doing strength training and conditioning 2 months prior to my surgery.

As I recall I got 10 big wound dressings in my goodie bag. On day 2 after the surgery I could hardly get out of the bed on my own and stand up straight. I walked like a robot. I did not have much pain, but I was feeling very stiff and my abdominal muscles were tense and I even had episodes of twitching. That’s because it was sutured in. Dr. Koch told me that this is normal and that the muscle needs to remodel itself, and so it did. I estimate that for each day that went by I was feeling 9% better. So right about day 10 I was nearly 100% recovered and I was feeling like myself again. I thought to myself this is amazing… Dr. Koch has accurately assessed how many wound dressings I would need. From that point on I saw nothing but improvements.

Right around the end of week 3 I reactivated my gym membership and started doing some light cardio workouts. After week 4 I started doing some weight lifting. I could not wait to start hitting that gym again, and I am dead serious about exercising now. I have never exercised this much in my whole life. I exercise 5 times a week with 2 days off during weekend. I am nearing the end of week 7 now and I am doing squats and pull ups, something I could never do before. I have never been a fat guy. I used to compete in athletics for a local club, I did that for 7 years, I trained karate for 3 years, I gave tennis a shot, among other things. I am what you would you might call a normal guy, just a little bit over the “normal” limit if you look at the BMI or waistline. My hernia is/was mainly congenital, but having a sedentary job did not make things better for me and frankly I believe that’s largely what contributed to my hernia (loss of supportive lean muscle).

There are a lot of things to be said about the surgery, but I have nothing but only positive things to say about my experience with Dr. Koch.

I can highly recommend Dr. Koch to anyone looking for…

1. A surgeon who listens and tailors the surgery to your wishes and needs.
2. A highly skilled hernia surgeon with special training in Shouldice repair.
3. Well educated and informed surgeon who keeps in touch with the literature and the hernia field.
4. A surgeon within Europe that does mesh-free hernia repairs.

[John Fortem]

quote pinto:

Thank you. I had it backwards: Here´s an interesting quote:
“Despite statements to the contrary in several textbooks, it is not possible to distinguish a direct from an indirect inguinal hernia by clinical examination, unless the hernia extends to the scrotum (when it must be indirect).” Handbook of Clinical Skills.

I assume that an indirect does not automatically mean it reaches the scrotum but when it does, it must complicate surgery.

Another point of my confusion is that I thought two people can have the same kind of hernia but sourced by congenital cause or weakness later developed in life. In other words, one could get an indirect IH apart from congenital reason. But you seem to say indirect is only traceable to congenital cause. Could you confirm what would be most accurate? Many thanks.

Correct, indirect does not necessarily mean it reaches the scrotum. And yes, scrotal hernias are more difficult to repair.

Are indirect hernias always congenital? I don’t know that for sure, but I am told by Dr. Koch that this is the most common type of hernia in males and it is believed to be congenital in nature. Congenital meaning it’s present at birth. Me and my brother both had the indirect type. That should answer your question about the congenital aspect of it.

[John Fortem]

quote pinto:

You make a lot of sense. The essential point I want to make is that the medical community overwhelming says that IHs cannot be healed other than by surgery. And further some patients pre-surgery who have tried these hernia cure exercises have reported their herniae got worse. So there is big risk in doing physical exercise programs not medically approved (precisely because the reports of exercise failure could be accurate.) If I am mistaken, then I will be happy to learn of the rigorous research data that support these programs or claims. Otherwise, caution should be taken.

The indirect/direct distinction, so far, is most confusing in my study of IH. I might be wrong but my understanding is that apart from the congenital type, the other type can be either indirect or direct, the main difference being that the direct extends down to the scrotum. Any help in puzzling it out will be appreciated.

That’s interesting… you request “rigorous research data” for claims of hernia symptom improvement or cure of hernia through physical exercise. But you don’t put the same requirement on these anecdotal pre-surgery injuries from doing these exercises. Tell me, what rigorous research data do YOU have on patients who got worse by doing physical exercises prior to surgery? And don’t just give me anecdotal viewpoints now.

I think you have overconfidence in the medical community.

Direct hernia: intestine protrudes directly through the abdominal wall. Weakness is in the abdominal muscles.
Indirect hernia: intestine passes through the deep inguinal ring before it protrudes through the abdominal wall. Weakness is primarily in the inguinal canal and I am told that this type of hernia is the most common and is congenital.

[John Fortem]

quote Jnomesh:

Thanks. Definitely a ordeal with mesh removal on top of the two hernia surgeries on each side.
i think it is the other way around indirect hernias are easier to treat-Ive heard the analogy made the a indirect hernia so analogous to a towel preventing a door from closing. Remove the towel and the door closes. This is over simplistic but a indirect hernia is bc of a defect from birth as the small hole that allows ones testicles to drop as a infant stays open to some degree.
direct hernia a hole is manufactured within the muscle where no hole was previously.
ive also heard from most mesh proponents that a direct hernia almost always needs mesh where as a indirect hernia can be done non mesh (of course in reality mesh is used for everything . I’m sure the few non mesh experts out there would say have successs treating both types of repairs without mean.
but you are right a hernia can never be cured without surgery. I think what the author is saying is that they can be managed with some exercises and a support system (truss)
notice he seems to equate the hernia being “fixed “ with it not popping out anymore. Whether a hernia protrudes or not doesn’t really have anything to do whether a hernia is present or not .
ot just means it’s not popping out or protruding enough to be seen. The most important fact is that the hole itself in which the hernia goes through cannot be fixed without surgery.

I’m not so sure about the towel analogy, but you certainly know your hernias, that’s for sure.

Yes, indirect hernia is what I had and Dr. Koch told both me and my brother that these are usually present from birth.

Not really. Technically, you have a hernia if it pokes out. That’s what a “hernia” technically is – a protrusion of intestine through the inner layers of the abdominal wall. So if I lay flat on my back and the hernia retracts then I don’t have a hernia now, do I? Yes, you may still have a “hole” in there. But that’s not what a hernia is. It takes a hole and intestine protrusion to make a “hernia”. If hernias were defined simply as “holes” then all men would technically have hernias, as we all have holes where the testicles dropped down into the scrotum. But in healthy males those holes are not large enough for intestine to protrude through.

Why my hernia used to stay in for days, I can’t say. Was the hole becoming smaller? I can’t say, because I don’t know. But I could go on up to 5 days without being able to see or to sense a protruding intestine. Believe me, I don’t need to see it to know when I have an intestine that wants to pop out. You forgot about the sense of touch. I could literally feel the intestine pressing and pushing whenever it had been tacked in for a long time and it wanted to pop out. I have 8 years of experience dealing with this. This sensation of pressure was most severe in the early beginnings when that hole was still very small, so the intestine would have a hard time pushing out through the hole.

[John Fortem]

quote Jnomesh:

It also may depend on whether the hernia is a direct hernia or a indirect hernia since a direct hernia is due to a actual defect in the muscle itself.
i first had a indirect hernia in my right side which was bothersome but no that bad.
A year later I had what turned out to be two hernias on my left side indirect and direct and both went undiagnosed for 18 months.
before the hernias were finally diagnosed I was sent to PT 2 separate times for a month each and they had me do all sorts of stir including crunches and other at work and it absolutely aggregated my left side.
I know there are probably many variable but I really feel that the direct hernia was a different animal. It really bothered me anytime I did any an work or stomach straining and really bothered me when sitting as well-it was a nightmare

That’s a valid point about direct vs. indirect hernia.

Crunches are one of those exercises that create most abdominal pressure. I would advise against them for anyone who has a hernia that is not retractable when laying down, or anyone who recently had a hernia surgery. Crunches are difficult enough even for healthy people who don’t have a hernia. For all beginners and people who had hernia surgery I would recommend the reverse crunch rather.

[John Fortem]

quote pinto:

[USER=”2813″]GeorgeHirst[/USER], please provide us with the scientific evidence (actual empirical studies) not solely anecdotal evidence for the claim physical exercise reduces the physical gap from which IHs emerge.

You have the right to be skeptical. But you have to understand that this gentlemen is challenging all that we believe in and are taught to be true. It’s a tall order for him to come up with empirical evidence for his claims. To begin with, he would need years of scientific training and the instruments required to do for example imaging studies. It’s not something a regular Joe can fit in his backyard, nor have the expertise to operate it. What we need here is for the scientific community to take up his claims and design a study that can shed some light on the matter. Such study will cost money, and no one wants to finance it.

For comparison, his claim is as repelling as the claim that Earth rotates around the Sun. People got hurt just for uttering those words. As Voltaire would put it: it is dangerous to be right in matters where established men are wrong.

I would love to see some scientific study on the matter. But I have yet to source one, and I am a regular visitor to PubMed (for other reasons).

quote pinto:

Some pre-surgery patients have reported that their physical exercising resulted in enlargement of their IHs. Now I realize their self-reporting are likely unscientific, but their claims are potentially valid.

If they are unscientific, what makes their claims valid?

quote pinto:

Also the medical community widely reports that IHs cannot heal naturally, only by surgery.

I have a hard time accepting a world view where the truth is only what I am told by an authority. With that said, I am not saying that a hernia can or cannot be healed naturally. We need to design a study that will try to answer that question rather than speculating about it. There are a lot of things that the medical community doesn’t have an answer to. How does the medical community explain the fact that I no longer have a hernia on my left side?

quote pinto:

Given the risk of enlargement making the IH worse, it would be foolish to do physical exercise aimed at reducing the IH physical gap–unless of course your claim has wide acceptance medically.

I believe I read somewhere that professional athletes who exercise on a regular basis are more likely to develop a hernias than people who don’t exercise at all. If you already have a hernia, and especially if it’s asymptomatic, I would say that it’s safe to do some easy to moderate exercises without the risk of enlarging the hernia.

In fact, I took up strength training and conditioning about 2 months before my hernia surgery. I saw no worsening of the hernia during this time, but it was not always comfortable to do exercises that involve a lot of lower body motion. Most uncomfortable was running on the treadmill on days when my hernia decided not to come out in the morning. It would literally come out as I was bouncing up and down on the treadmill. It would come out slowly rather than just pop out instantly, but I could feel it and it was no fun at all. Gladly it’s no longer a problem for me. I can even do squats and pull ups and I have yet not teared the repair (a little more than 1 month after surgery). And my repair was done without a mesh, so it is supposedly a weaker repair than the concrete reinforcement bars (plastic mesh) in your groin. I strongly believe that my continued physical exercise has helped me heal after the surgery. Physical exercise can do wonders to the human body, beyond comprehension of modern medicine.

quote pinto:

Aside from empirical research, at least can you name any licensed medical hospitals that offer physical exercise found to reduce IH gaps?

Just because a treatment is offered at a hospital doesn’t mean it’s a good treatment that is backed up by strong scientific evidence. There is more than one hospital in the world claiming to be able to heal any illness or disease simply by offering stem cell therapy. You go figure out if it’s true or false.

[John Fortem]

quote GeorgeHirst:

So many people say that it is impossible, while they sit and do nothing, looking for proof rather than giving it a try for themselves so they can be their own judge.

Spot on! That’s the problem with people in general, not just with people who have a hernia, they much rather talk the talk than walk the walk. Talking is easy, doing the actual work is hard.

quote GeorgeHirst:

Also, thanks for backing me up to being called a snake oil salesman. I have helped thousands of active people get on with their lives through writing my blog and designing the comfort-truss, and I pride myself on that fact. So when I see someone say that it’s very frustrating. I don’t have a blog to sell hernia belts, I sell hernia belts to hopefully help the people who read my blog and watch my videos in the same way that the truss has helped me. Am I an entrepreneur? Yes, I have been my whole life, but I have much better things to do with my time than to talk about hernias if I wasn’t truly in this to help people. I sold a very successful company that I owned for over 10 years because it wasn’t fulfilling to me.

What you are doing is something very unique. It’s what makes your blog unique and what makes you unique. It is quite possibly the first well documented attempt to heal a hernia naturally. It’s an ongoing experiment, and whatever the outcome may be in the long run you are certainly doing the public a great service, and I thank you for that.

Do I think you will be able to completely heal your hernia? Judging by my own experience with migrating hernia, I would say it’s plausible. And judging by the anecdotal evidence you present on the website, it seems like you are making progress.

quote GeorgeHirst:

I would rather help people, and make A LOT less money, than to make a bunch of money doing something that means nothing to me.

I feel the same way. I wish more surgeons and medical device/product manufacturers saw things this way. As I wrote in another thread of mine, “there are needs to be filled and things to be improved upon in the operating room that are not necessarily bad or damaging to the patient, and there is money to be made on these products by the manufacturers and by the surgeons who use them. You just need to use common sense, and stop looking at things solely through the dollar glasses. Don’t be greedy, don’t be evil.”

I made this statement because I have learned that Ethicon makes not only surgical meshes but also surgical glues. I had my hernia surgically repaired by Dr. Koch and he used the surgical glue by Ethicon to seal up the wound. The result is quite impressive! The incision has healed up so nicely, it’s almost invisible. I strongly believe that it is small innovations like this that can have most impact and add up to a bigger whole and benefit the patient the most. Instead of just looking through the dollar glasses and thinking that one size can fit all.

I think that the tailored approach is what sets Dr. Koch and others like him apart from other hernia surgeons. And sadly I must say, they are a minority in the medical field. A lot of the medical world is about numbers and industrialization, treating everyone equally like on a conveyor belt, without much consideration for the unique needs and anatomical variance in each patient. I get the sense that people are becoming more and more like robots, both the patients who are treated as if they are the same model and surgeons who lack the human touch with the world.

quote GeorgeHirst:

Like I say anytime I mention the comfort-truss in my videos: You don’t have to buy the belt I designed. It works for me, but everyone has to find one that works for them and fits their lifestyle. I couldn’t find one that fit my lifestyle, so I had to make it for myself, and now I get to help people by offering it to them.

I can confirm that. I have seen the videos.

[John Fortem]

quote drtowfigh:

I don’t agree that for the watchful waiting patient that can be risky. Quite the opposite. That is exactly what I would recommend for the watchful waiting patient.

I agree with this statement. I would just add that in case of a patient on watchful waiting I would make sure that the exercise regime is easy and conservative, working only with the patient’s own body weight.

[John Fortem]

Hello everyone!

Sorry for the long absence. I am writing here today to let you know that I no longer have the hernia. I had it repaired by Dr. Koch of course, and I feel great! It’s amazing… I didn’t expect the outcome to be this good. I mean I had my fears and I was a bit skeptic about the procedure. It’s been a little over a month now since I had the operation. I am like 99% recovered and it’s almost as if I never had a hernia in the first place. I have fully restored function in the groin, I have no pain or discomfort, and the incision is almost invisible which is something I found particularly interesting! For you see, Dr. Koch used a surgical glue to seal the wound, and believe it or not… it’s made by Ethicon! The same Ethicon that makes meshes that people so often complain about (and often rightfully so). So what this tells me is that there are needs to be filled and things to be improved upon in the operating room that are not necessarily bad or damaging to the patient, and there is money to be made on these products by the manufacturers and by the surgeons who use them. You just need to use common sense, and stop looking at things solely through the dollar glasses. Don’t be greedy, don’t be evil.

There are a lot of things to be said about the operation. I might have to come back here more than once to fill you guys in on all the details. I want to keep this come-back post short. And of course, if any of you are considering traveling to Germany for the operation, or you just have general questions about my hernia surgery, feel free to send me a private message and I will try to reply promptly.

I can highly recommend Dr. Koch to anyone looking for…

1. A surgeon who listens and tailors the surgery to your wishes and needs.
2. A highly skilled hernia surgeon with special training in Shouldice repair.
3. Well educated and informed surgeon who keeps in touch with the literature and the hernia field.
4. A surgeon within Europe that does mesh-free hernia repairs.

[John Fortem]

quote fidel18:

[USER=”2662″]John Fortem[/USER], i just have questions for you. When the hernia or intestines of your brother slipped down to the scrotum, was he still able to bring it, meaning intestine, back by hand or when lying down or it was already permanently lodged in the scrotum? Since it started slipping down to his scrotum, how many years did he wait before surgery? I have a right inguinal hernia and I notice it is starting to go down to my scrotum. I can still press it back even if Im standing or lying down. My fear is it will get worse and get entangled with the other matters in my scrotum. Thank you.

Sorry for the late reply! I haven’t been to the forum in a long while. That’s called a retractable hernia. No, his hernia was not retractable. Not after it had gone down into the scrotum. And he has told me that he can’t recall ever being able to push it back in or that it would retract back into place on its own when laying down. So, no!

He had it for about 10 years in total. He had started having pain in the groin from abdominal pressure for the last 2 years, so the pain started in year 8. I would approximate that it started to slide down about 1 year before that. So the order of events would be something like this:

Year 0: hernia started to bulge out
Year 7: hernia started going down to the scrotum
Year 8: hernia is in the scrotum and groin pain starts to develop
Year 10: hernia is operated on

It’s been nearly 4 months now and he is feeling good 90% of the time and has no symptoms of pain, but he sometimes feels some sort of discomfort. I don’t know what to make of it. But the 4 absorbable sutures should all be absorbed by now and everything is held in by the 2 permanent sutures. He still has that thing that looks like a hydrocele. His discomfort might as well be coming from this area. He still doesn’t know what exactly this is.

I myself will be visiting Dr. Koch very soon for my own surgery. I am looking forward to it and to have this done, but at the same time I am starting to feel nervous about it. I know I will have to do it sooner or later, and it’s better to have it done sooner.

[John Fortem]

quote Baris:

Thats probarbly correct yes but the main reason for cutting the cremester muscle is not for actually reaching the repair itself.. its due to the fact that if its not cut and resuspended in the repair it damages the repair in the future. Both dr muschaweck and and dr koch have been to the shouldice clinic to observe operations and understand the technique.
The chief surgeon here has been operating here for 41 years on just hernias

What I have read before is that the cremaster muscle is dissected in order to prevent the testicle from sliding up and sort of force opening the repair site unwillingly if you understand what I mean. But I have no date to support this.

But does this apply to all kinds of inguinal hernias? I mean does it even apply to scrotal hernias where the intestine has gone down to the scrotum? I think this is what Dr. Koch meant, that in this particular case he has to get past the cremaster muscle to get to the intestine and properly put it back into place. But I guess if your hernia is only superficial, i.e. it has not gone down tot he scrotum, then he may not need to do anything about your cremaster muscle. This is my own interpretation, not his words exactly.

I don’t know about Dr. Muschaweck, I can only tell you what Dr. Koch has told me in person, that is: he himself has been to the Shouldice clinic a number of times and has even published some research papers together with some of the doctors there or are finishing up a new paper (I don’t recall exactly which it was).

I think 41 years is a lifetime of dedication to a single topic or profession, but even 12 years of experience speaks volumes compared to maybe 1 to 2 years of experience by your general surgeon available at your local hospital. I am only speaking about what is available for me at home. And of course they all use meshes here. I rather have my cremaster muscle cut than have a mesh implant.

[John Fortem]

Dr. Koch is a good friend with Dr. Muschaweck and he has met with Dr. Desarda at his clinic in India. He had great things to say about them both. But he was not a fan of the one-size-fits-all in regards to the Desarda method. In fact, he insisted that the majority of inguinal hernias in men are of the indirect type and are the result of bad ring closure during development.

[John Fortem]

In regards to cremaster muscle… it was “split” according to Dr. Koch. My understanding is that it was sliced but not dissected away. The cremaster muscle stands in the way, you have to get past it somehow to pull the herniated intestine back into place. The easiest way to do so would be to dissect it, which if I am not mistaken is the standard procedure in the original Shouldice technique. But with Dr. Koch everything is about preservation and conservative approach, so he makes a smaller cut in it, just enough so he can grab hold of the intestine and pull it back up. It is likely more time consuming but Dr. Koch has had hundreds of patients to practice on so he can probably do it blind-folded. I think he said he does around 300 to 400 operations per year. If memory serves me right, he has been doing hernia surgeries for the last 12 years… you do the math.

[John Fortem]

In regards to the stabbing pain I described earlier, he has been experiencing this for about a year before the surgery. I’m not sure what to make of it, but if it’s been there before the surgery, I think it’s unlikely to be caused (or worsened) by the hernia surgery itself. It may not be related to the hernia at all.

My brother has been diagnosed with discus hernia. This diagnosis was discussed with Dr. Koch and made possible thanks to Dr. Koch because my brother has been having back problems for some time now and he was refused an MRI scan back at home. On the day of the first visit, after explaining the back problem, Dr. Koch called his colleague Dr. Boris who operates his own radiologist office at the same medical center and my brother was offered an MRI scan which later confirmed his suspicion that he did without doubt have a herniated disc.

So if any of you are in need for an MRI scan, just know that these services are also offered at the same medical center. There are in fact a dozen of different private practitioners that all collaborate and operate under the same roof.

If we go back to the hernia itself, my brother has had his hernia for about 10 years, and I think he said that it only became problematic (symptomatic) during the past 4 years which is when it slipped down into the scrotum. Like I said, it’s difficult to say what pain symptoms were caused by his bad back and which ones were caused by his hernia. But I think it’s reasonable to say that his hernia related pain was no more than 4 on a scale of 10. Judging by the number of complaints I hear from him… hehe… I would say it’s likely a 2 out of 10 now, and that’s only on the bad days, on good days it’s closer to 0.

It all depends on what condition you are in when you go in for the surgery, and what other health issues you have. But I would say the sooner you treat your hearnia while it is still not symptomatic, the better the chances of success are and that you will not have any chronic pain.

[John Fortem]

quote Chaunce1234:

Dr Andreas Koch in Germany (unsure of location)

He is based in Cottbus, east Germany.

[John Fortem]

What happened? What did it feel like? Did you feel like something snapped? Do you have a visible bulge now? What are the issues you have since? What did the doctors you met tell you?

[John Fortem]

After meeting Dr. Koch in person and after he successfully treated my brother’s hernia, I can warmly recommend him.

Feel free to ask me any questions you may have.

[John Fortem]

quote UhOh!:

Isn’t it premature to discuss repair types without knowing for certain the hernia type (direct vs. indirect)? Based on what Drs. Kang and Brown say about repair types, it sounds as though the majority of non-mesh techniques are best suited to direct hernias. At the same time, I’ve seen multiple sources suggest that the majority of hernias reaching the scrotum are indirect…

Certainly! The more you know, the better! I had the opportunity to talk about the Desarda technique with Dr. Koch and he basically confirmed what people here on the forum are saying about Desarda technique in regards to hernia type, that is: it is not a one-size-fits-all technique, and it certainly is not a very good option for indirect hernias. So if you have indirect hernia, then the Desarda technique may not be your best option.

If you ask Dr. Desarda himself, he will tell you that it does work for both types of hernias. It may work for both types of hernias, but you may not have the best possible outcome if you have one or the other type of hernia. You also have to take into consideration many factors. It may be very successful technique for both types of hernias, but only if performed by the hands of its creator, Dr. Desarda himself.

1. Hernias reaching the scrotum, otherwise known as scrotal hernias, are indirect hernias.
2. Desarda technique is best suited for direct hernias.
3. My brother had his indirect (scrotal) hernia repaired without a mesh by Dr. Koch.

[John Fortem]

Like with any new invention, it will take time to perfect it. This is all the more reason to be cautious about robot assisted surgery.

“Things that are complex are not useful, things that are useful are simple.”
~ Mikhail Kalashnikov