kaspa
Forum Replies Created
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Dr. Hunkeler is skilled in Shouldice repair, but I’m not sure he’ll do it under any circumstances.
Even in Shouldice Hospital, they do a mesh sometimes, maybe 1-2%. Perhaps in your case he considered a mesh a better option.
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Dr. Hunkeler is a very nice surgeon who trained in Shouldice and who’ll do a tissue repair under general anesthesia.
He’s very competent, communicative and honest.
Only problem really are very high medical costs in Switzerland, unless you can have a good refund.
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I don’t think a mesh is a good option, but if I had to place one, I’d choose Onstep for sure. There is good experience with this mainly in Portugal and Denmark, even if on a worldwide basis that’s small yet.
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Pediatric surgeons are experts in non-mesh indirect hernia surgery. Often, they only ligate hernial sac, but sometimes they do a Marcy repair, if hole is too big. I once thought about hiring a pediatric surgeon. Their patients are mostly babies and children, but they can treat people until they’re 18, and these are physiologically and anatomically adults or near so. What do you think.
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@DrBrown can you recommend some expert surgeon in ringplasty in North America and Europe?
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The problem, Scott, is that then came industry. We have 2 types of inguinal hernias, direct and indirect. It’s my conviction that an indirect hernia could be treated just by sac ligation. You risk missing a direct hernia (10% according to Shouldice statistics) or may have a recurrence that can happen in years or decades, if ever. For direct hernia, I think you need a full tissue repair, like Shouldice, Desarda, or other (that will work for indirect, too). So most hernias could be treated in a very simple way before industry came.
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It’s quite clear that Shouldice is used either for direct or indirect hernia or both.
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Of course a mesh can be done either way, open included.
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Problem with BioHernia is that their surgeons do many types of hernia repairs, mesh and non-mesh, laparoscopic and so on, and I’m not sure you can grant you’ll have the repair you want. According to some reports here, sometimes they do a tailored repair, which may mean you’ll come from the operating table with a surprise (see Baris here in forum).
The best known surgeon is Dr. Muschaweck and she’s perhaps the best choice. But she charges 6.000-7.000€, a sum that allows you to choose a center anywhere in the world, trip included.
This is just an opinion based on reports here and elsewhere so you should check directly with Biohernia before making a decision.
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@Casimir I understand English is not your native language (neither mine) and it’s hard for me to fully understand what you really mean. I invite you to please write it in your own language and I’ll try to have it translated by Google so that I can help.
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I once considered Muschaweck, but she charges 6,000-7,000€ enough to take the repair anywhere else in the world, and as Dr. Towfigh already said her method isn’t validated outside her clinic.
Dr. Kang’s (not that expensive) isn’t validated either.
In a time of “mesh do it better” publishing tissue methods would be of utmost importance for this area to evolve.
Since Shouldice, only Dr. Desarda published a new tissue approach as far as I know.
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@Casimir If your’ hernia doesn’t bother you too much maybe it’s better to wait and see. I wouldn’t agree though that a non-reducible hernia cannot incarcerate.
Indirect hernias usually have intestinal contents, not fat…
About 10% of patients from Shouldice Hospital are doctors. So they take the full repair for direct or indirect hernia.
If treating an hernia was quite simple, something like an injection, and costed something like $100 I’d take a specific repair and see. However repairing it may cost a lot of money and you wouldn’t like to repeat that in case you get another hernia on the same side. Further, if you don’t have any complication what’s the problem to have the whole groin repaired?
IMHO Desarda and Shouldice are designed to repair both direct and indirect hernia, whatever type one may have. Why don’t these surgeons have designed a specific repair for indirect hernia is a mystery. Maybe they need to repair the whole Hasselbach triangle to have a robust indirect hernia repair.
Dr. Kang designed a modified Marcy that works in adults. That’s great but you still have a small change you need to have another repair. If you treat all area you only have to worry about the other side if you have no hernia there.
It would be highly desirable that Dr. Kang publish his repairs and results anyway. Not just to offer more confidence, but also to help non-mesh repairs evolve.
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I said “incarcerated” but should be “strangulated”.
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Dr. Kang is perhaps the only doctor doing specific repair for indirect hernia. I don’t think non-reducible hernias aren’t able to be treated by any tissue repair (perhaps you mean incarcerated?).
Treating your indirect hernia only means you have a small risk, perhaps 10%, you can have a recurrence because of a missing hernia and you’ll need to be operated again.
A small indirect hernia won’t last forever that size and will likely enlarge.
Information given here is provided between forum users with good faith to anyone requesting it.
You can also e-mail Dr. Kang and I’m sure he’ll gladly provide all personal information you need.
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Chief-surgeon explains that they use mesh to have lower recurrence than “Canadian” operation.
I don’t understand the interest and wouldn’t recommend that to informed people.
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This reply was modified 4 years, 8 months ago by kaspa.
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This reply was modified 4 years, 8 months ago by
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According to Shouldice numbers 1991-2001 secondary hernias are not as prevalent as in Obney’s article.
They repaired 72.228 hernias. Of these 60% were indirect and had 8% occult hernias, 38% were direct and had 25% occult, 1.88% femoral and 70% occult. This makes about 15% on average.
If you have no complication after hernia repair, I think having indirect-only repaired or all area repaired doesn’t make a great difference. Perhaps if you have indirect-only repaired and later need a direct repair, that’s more difficult to do (my thoughts). Missing a femoral hernia, even if quite rare, is too bad as these can be really dangerous.
Anyway, these considerations only happen with tissue repairs. For mesh repairs, one is applied blindly and there’s no discussion.
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Shouldice claims that often enough there are occult hernias and these account for a percentage of recurrence. That’s why they explore the whole area, including searching for femoral hernia (here, if present, they apply a mesh almost always). To explore the area completely they must cut a lot of structures and reconstruct them. That’s the rationale. I presume Desarda is more or less the same.
According to literature if you treat indirect hernia only, you’ll get 37% recurrence due to “missed hernias”. See: Obney N, Chan CK. Repair of multiple time recurrent inguinal hernias with reference to common causes of recurrence. Contemporary Surgery 25:25-32(1984).
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To the best of my knowledge Shouldice and Desarda work both for direct or indirect hernias, or both.
Dr. Kang is an expert in tissue hernia repair and perhaps technically speaking those repairs are more adequate for direct hernias.
Dr. Kang uses different repairs for each hernia and so he must be quite aware what’s more perfect for each case.
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This reply was modified 4 years, 8 months ago by kaspa.
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This reply was modified 4 years, 8 months ago by
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There are very good doctors that can do a tailored approach and you can discuss that in detail beforehand. However, if you’re not lucky a tailored approach may only mean that you leave operating table with a mesh, and that’s all, as I’ve heard in some [dramatic] stories.
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Hi George. I’ve already seen your videos and truss. You claim to have cured your hernia through exercises only. However you don’t prove it. Also, from your videos and your discourse it seems you still have an hernia. Of course your exercises and truss may be helpful. The problem is that you claim a cure. If it’s so, please use your videos to prove that you once had an hernia and not now. Or better still, why don’t you have a doctor confirm you’re cured? That way no one could doubt your word. But this way anybody can, me included.