[kaspa]

I also postponed my surgery after joining the forum. I’m learning to live with my hernia, but perhaps some day I’ll need an operation.

Now they’re talking about surgeons who do preventive triple neurectomies included in hernia repair! This is scaring. Are patients always informed at least?

[kaspa]

Is it possible to add a link for that commercial?

Laparoscopy is a mesh-only option. IMO I don’t understand the interest for laparoscopy in minor surgery that can be done with a small incision under local anesthesia. It’s complicating something that is supposed to be easy and on top of that it must use a mesh and general anesthesia…

[kaspa]

I found an article by 3 German surgeons who did Desarda repairs in Rostock:

“Inguinal Hernia Repair According to Desarda – Implementation of a Mesh-Free Method in a German University Hospital” (2015)

The article is written in German and requires subscription. It’s a 2-page article and first page can be read as preview in Thieme’s site.

Authors are Phillip M, Förster S and Klar E. I could only locate Dr. Ernst Klar who is Director at the center where repairs took place.

I don’t know how many patients were operated and results (abstract in English at Pubmed doesn’t disclose that).

All information in center’s page in Rostock is in German, so it seems they’re not looking for foreign patients, but this can be an additional contact in Germany for people wishing to have a Desarda repair:

Prof. Dr. Ernst Klar
Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie
Universitätsmedizin Rostock

In clinic’s site there’s contact information for Prof. Dr. Klar (Secretaries Anja Meschke and Frau Stein).

If anyone can find info on the other 2 authors, please share here.

Rostock is in Northern Germany and I could find a single flight there. It’s operated by Lufthansa and travels Hamburg-Rostock in about 1 hour.

Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie
https://allgemeinchirurgie.med.uni-rostock.de
Universitätsmedizin Rostock. Spitzenmedizin für die Region. Forschung für den Menschen.

[kaspa]

Dr Kang, when I decide to have a repair, I won’t be a mesh for sure. You’re absolutely right about pure tissue repair against mesh repair: Better a relapse than mesh complications. Unfortunately, it’s hard to arrange for a surgeon who does pure tissue repairs these days.

I really appreciate pioneering work like yours and hope that you’ll publish your repair soon so that it can have wide propagation throughout the world.

Thank you very much, [USER=”2019″]drkang[/USER] .

[kaspa]

I agree with Jnomesh. Anyway, whatever the repair, I read somewhere that pain before surgery is a major risk for pain after surgery. So, if scared has pain now, that much more risky than being pain-free.

[kaspa]

Lets be frank, nothing here seems to discredit the surgery. Nothing tells the hernia isn’t cured so far and pain existed before surgery, so it’s not a surgery complication. Simply it didn’t disappear except for a few weeks post-op, which is a pity. IMO pain is a complex subject unfortunately and it won’t be easy to know what exactly must be done.

I wish ssonic99 all the best and a speedy recovery.

[kaspa]

Dr. Towfigh I think so. I was even planing my trip to Cottbus in late July.

Problem was after reading about Baris experience. That made me a lot apprehensive.

[kaspa]

That’s a very nice question.

IMO that has a lot to do with hernia sac, something one can hardly find information (in Pubmed one finds almost nothing) but that may be crucial in hernia formation and consequently hernia repair.

The only information I could find so far was from Dr. Kang’s site:

quote :

A hernia sac is formed due to the exit of peritoneum through a gap in the abdominal wall muscle. After exiting through the gap, the peritoneum inflates like a balloon; thus explaining the name, hernia sac. Generally, during indirect inguinal hernia surgery, the hernia sac is separated from the surrounding tissue then tied up where it connects to the peritoneum and then the “sac” is trimmed off. After all that, the tied up, trimmed off part is pushed back in through the muscle gap.

Through extensive surgical experience, we have found that in order to prevent hernia recurrence, it is crucial to push it deep back inside. But unfortunately, previous retroperitoneal repairs did not pay close attention to this step. Properly dealing with the hernia sac is very much important in direct inguinal hernia surgery as well.

Maybe hernia sac formation is the crucial step for hernia to develop. That could be why people with defective internal inguinal rings take decades to develop an hernia even though the defect is there since birth. Also in children it’s enough to repair hernia sac for hernia to be cured.

[kaspa]

Well, I tried to add a reply here and they flagged me as spam!

[kaspa]

Nice topic by Jnomesh and all main points are there:

1. recurrence rates again and again.

– There are hundreds of studies that demonstrate that recurrence are low whatever the repair. The problem isn’t that. Problem is all complications from hernia repair and those are less acceptable to many people if they can be attributed to mesh.

– Also, whatever the repair, too much sound tissue is cut perhaps because they don’t know for sure what they are doing. Knowing what they are doing and reducing tissue cut to the least necessary is more important than counting recurrences.

– In the past they treated peptic ulcer with surgery and now they do that with medicines. Of course this is (purposefully) an extreme example, but I don’t think a patient would take surgery just because the rate of recurrence is the same. People always want (and deserve) the most physiologic and least aggressive treatment.

2. ease of doing mesh repairs saves doctors lot of time, but doesn’t help patients.

3. patients not wishing to have mesh repairs face lots of problems.

– So far one can only have high quality tissue repairs in Canada, USA, India or Korea (one center or surgeon in each country).

– It’s useless to tell a doctor you want a tissue repair. They’ll tell you go elsewhere or call you nuts (there are people who heard that).

[kaspa]

Good news at last.

Unfortunately I can’t read the article (not open access).

Maybe mesh repairs led to an age of darkness in hernia treatment.

I hope revisionism will go ahead and lead to the renaissance in hernia treatment.

I really think there’s an enormous lack of information on inguinal hernia physiology.

[kaspa]

You’re right, hernia so common, surgery so difficult.

I think your repair is too early to try anything there.

Perhaps you should read Baris account in the forum. After failed attempts to have his hernias repaired, he eventually went to Shouldice Clinic in Canada and they told him that they only reoperate after 1 year to allow for tissue healing.

Inguinal hernia repair with absorbable stitches – Hernia Talk
https://www.herniatalk.com
Hi, everyone!

I’m supposed to have an inguinal hernia repaired in August or September, and my doctor wants to use a mesh, but I won’t allow it. I’m here because I

News Feed

[kaspa]

It’s quite worrisome and depressive reading [USER=”2468″]Baris[/USER] such bad experience in Germany.

People who search for Dr. Koch want a non-mesh repair and most of them are thinking about Desarda, but I think Desarda is the repair least done by him.

Anyway, I thought that he could tell before surgery which repair would be most suitable in his opinion, either by examination, or requesting any exams.

Deciding on the operating room for a mesh or non-mesh or Desarda or “modified” Shouldice doesn’t look nice.

After reading this I think that one can get the surgery one wants only if they go to specialized clinics like Desarda’s in India, Shouldice in Canada, or Dr. Kang in Korea.

When searching for surgeons I found one in Germany that could do some 8 repair types with training in lots of Clinics throughout the world. I discarded him right away because only a superman could be enough proficient in so many repairs… Any normal surgeon would do any of them once in a while and hardly would be that proficient.

I really hope Baris is finally in good condition with his repair in Shouldice after so many bad experiences and spending so much money with all those experiences.

All this makes me think twice as my hernia is only esthetic, everything working fine and zero pain. Even if esthetic is quite important too and makes me miss a lot the time I had my groin area in perfect condition and didn’t know I lucky I was.

[kaspa]

[USER=”2019″]drkang[/USER] it was very nice to hear from you and learning that you’re doing pioneering work in inguinal hernias with great success.

I liked very much your description on your site. I’d like very much considering surgery by you, but unfortunately I think I can’t afford it plus a long 18-hour trip (each side… and I really hate long trips).

Did you train any European surgeons you can name here? That would be great if so.

[kaspa]

[USER=”2804″]pinto[/USER] , that’s a good question. I think most surgeons add some personal details to any technique. They often (but not always) even call it “modified” something.

Training is sometimes quite deceptive as it can be just just watching, reading descriptions or watching videos. The only real training is doing something under supervision.

A great problem in surgery as already talked here in the forum is that doctors consider each one’s method the best and work back to back instead of exchanging ideas, but I think this won’t improve in the next 500 years…

For [USER=”2329″]Jeremy B[/USER] , I hope everything goes fine and that we have some updates here soon.

[kaspa]

I appreciate the comments.

I understand Desarda and Kugel are two extremes. What I like in Kugel is minimal incisions, non dissection of spermatic cord and using preperitoneal space to obliterate hernia. Anyway, there were quite serious complications with that mesh, so I wouldn’t take it.

The center in Munich is new to me, so I’ll explore it better.

Dr. Andreas Koch is the best known non-mesh surgeon in Europe and he trained with Prof. Desarda in India and Shouldice Clinic in Canada. He’ll be perhaps my choice.

From Dr. Koch’s poster “The Role of Pure Tissue Repairs in a tailored Concept for Inguinal Hernia Repair”,covering 2006-2013, it seems clear that he prefers tissue repair for small hernias (<1.5cm in EHS classification). Otherwise he prefers mesh, especially for hernias >3cm. Also, from statistics shown, he prefers Shouldice in 2/3 cases against Desarda in 1/3 (no criteria disclosed) for non-mesh repairs.

As there are some surgeons here, I’d like to ask if there’s any way to know hernia’s defect size out of operating room (I guess not…).

[kaspa]

This makes me recall Implant Files by International Consortium of Investigative Journalists.

Examples include Replacement hips and vaginal mesh products sold to hospitals without any clinical trials, Complications with hernia mesh that ruled one of Britain’s top athletes out of competing for years, Regulators approving spinal disc replacements that later disintegrated and migrated in patients.

This includes regulators throughout the world, US, Europe, UK, Australia and so on.

Implant Files – ICIJ
https://www.icij.org
Health authorities across the globe have failed to protect millions of patients from poorly tested implants, the first-ever global examination of the medical device industry reveals.

[kaspa]

Nice topic here. Of course, Dr Towfigh must be right as an inside trader and surgeon’s wouldn’t rush for a repair. But when they do, I think they’ll use same surgery they do. If they do a mesh, they’ll prefer so. If they’re non-mesh, they’ll prefer tissue repair.

But there must be lots of variation here. If I was a surgeon who does mesh repair because that’s what they taught me and anyone thinking otherwise is crazy inside institution, anyway I think I’d take a non-mesh repair elsewhere…

[kaspa]

Taking out 25-30 meshes is enough to be experienced, but of course 250-300 would be much better for dealing with any possible complications during and after procedure (like airplane pilots, the more hours you have the better).

Hard to help here but I’d take mesh out. Also I doubt those hernias that escaped physical examination, CT and US be real. Those hernias seen by laparoscopy only might be false positives IMO.

Then I’d check if I really had a hernia. If so I’d prefer a non-mesh repair. Also many people here have groin hernias and they agree with me for sure that they are painless unless there’s a complication (generally requiring urgent surgery).

Sportsmen sometimes have groin pain related to anatomical structures involved in hernia that must be diagnosed by experienced people and special imaging studies.There’s never any visible hernia anyway IMO.

All this started with testicle pain. Did you have an examination by Urologist? Also I presume pain was severe and long-lasting enough for you to take exploratory laparoscopy. Is this correct? And after surgery you never felt testicle pain again?

[kaspa]

What a case. Maybe removing mesh would be best option.

I wouldn’t take any neurotomy especially just to see what happens.

Are you sure there was a femoral hernia? That’s quite unusual (yet dangerous) particularly in a man.

Can you check an approval for that mesh? I can’t find any. Is this normal for a medical device? Also their site http://www.gallinimedical.com doesn’t exist.