Mike M
Forum Replies Created
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Dr. Grischkan was the first doctor I met with regarding hernia repair. He has done 20k+ repairs. The outpatient facility is attached to his office. There were a lot of thank you letters (some very recent) on his wall as you walk in from some big names.
He is very popular in the body building community for repairs. He doesn’t use gore-tex 100% of the time (polyester? flexible?) and he is anti-mesh. He does a tailored open tissue “no-mesh” repair depending on the size and scope.
It is my understanding he study at Shouldice for a time.
He has repaired some pretty insane cases as demonstrated by the before / after photos I saw while I was there.
I had him as my #2 option behind Dr. Kang.
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I would call Dr. Grischkan’s office and see if he can provide recommendation?
He has served as an expert witness (hernia doctor) for plaintiffs.
https://verdictsearch.com/verdict/patient-claiming-nerve-damage-after-surgery-gets-273k/
https://www.herniasurgeries.com/hernia-specialist-with-a-reputation-for-success-without-mesh/
https://www.aboutlawsuits.com/bard-mesh-expert-reports-rulings-169498/
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The closest specialist I am aware of near the Oregon / Washington region would be the owner of these forums – Dr. Towfigh located in Bev Hills, Cali. (310) 358-5020
She has a lot of different options available and is a modern pioneer in the field.
I would be extremely careful when selecting your surgeon. There have been many not so positive stories passed on these forums of local surgeons who are willing to do the repair but are not “experts” with solid track record of positive patient experience.
A few quick searches on here will show you how bad some of the cases can get with the wrong surgeon.
Dr. Towfigh, Dr. Yunis, Dr. Sybai, and Dr. Kang (who I recommend if you are willing to travel overseas) all have positive stories on these forums from former patients.
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It will get better with time per all the doctors I spoke with prior to surgery in the United States and South Korea. I only experienced the usual “painful” hernia repair symptoms the first two or three days. Tension followed which faded over time (had to sit every 15-20mins). Tension was totally gone in about a month or so. My case was probably more difficult than the average repair because my hernia was deep, egg sized, and I was above normal BMI but not obese or anything outside the range for open tissue.
Most facilities do not consider it “chronic” now until after 6 months* but it can take up to 1 year for more serious cases.
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Dr. Kang and the repair are rock solid for no mesh open tissue repair. Would definitely recommend!
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@William Bryant
Repair is perfect! Waiting on the 6 month mark before I start lifting heavy weights again (self imposed restriction). All of the generalized symptoms of “open tissue repair, no mesh” have faded significantly and continue to fade. It is getting to the point on some occasions I am now forgetting I even had surgery which I think is the goal.
Here is a great generalized article on Collagen and sleep.
https://www.hsph.harvard.edu/nutritionsource/collagen/
From what I have researched no more than 1-2 drinks per day and 6 hours of sleep minimum.
Dr. Eric Berg has some interesting information regarding this issue on Youtube.
Collagen supplements have also been suggested to improve sleep but I would take it with a grain of salt.
https://link.springer.com/article/10.1111/j.1479-8425.2006.00193.x
Regarding lack of sleep relating to “skin” but still relevant imho.
There are countless research articles that indicate lack of sleep is detrimental to collagen production.
https://www.sciencedirect.com/science/article/pii/S030698771000246X?via%3Dihub
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Top three common things that can hurt tissues and reduce collagen production / repair.
#1. Sleep deprivation (redirects proteins used in collagen production to other functions to keep you “awake”)
#2. Alcohol (more than 2 drinks per day, also 14 drinks per week is considered *heavy drinking*) in men. Also if the alcohol is interfering with your sleep it probably isn’t doing you any favors.
#3. High carb / High Sugars / Bad diet (fish is good)
4th might be stress although I have not seen any research / studies on that specifically as it relates directly to collagen production / repair.
A drink or two on the weekend every once in awhile is probably going to have zero impact as long as you hydrate and get enough sleep.
Think of any habit, food, drink, etc that is going to prematurely “age” your body, cause wrinkles, etc you want to avoid.
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Keep in mind all the leading tissue doctors we mentioned (Dr. Kang, Dr. Grischkan, Dr. Sbayi, and Dr. Yunis) are “ok” or will “accept” BMI up to and including the low 30%.
Obviously the lower you can get your BMI the better but it can still be a very strong and viable permanent option from all the mentioned specialists+ surgeons if you are “overweight” or above “normal” BMI as long as you still fall within their required guidelines.
Unfortunately there are a lot of “overweight” patients in the United States and those patients shouldn’t be discouraged from avoiding a pure tissue repair (if so desired).
Personally I would be concerned with a repair being strong enough over the long haul if the guidelines were too strict regarding BMI because anyone could gain additional weight as they age down the road unexpectedly.
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@Watchful It sounds like the procedure (as described) in that link is a removal (in that section) and what is left is “repurposed” ?
“All cremasteric structures—muscle, vessels, and genitofemoral nerve—are taken.” 1168 E.B. Shouldice / Surg Clin N Am 83 (2003) 1163–1187
“To ensure no difficulties of this nature, the distal end of the divided cremasteric structure is secured during the closure to the newly formed external ring or subcutaneous tissue. The proximal end plays a role in the repair, being incorporated into the forming of the new internal ring.”
I still don’t understand how there wouldn’t be a high chance of cremaster function loss (as well as permanent low hanging testicle) when removing and/or repurposing a large part of that muscle. I do not see anything else in this process that would restore cremaster function to what it was prior to the surgery. Obviously with so many successful cases and reports of full cremaster function it can be done and function normally it is just not explained how?
It could be that 50-70% remaining cremaster is enough to not impact function?
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These were my personal guidelines / cutoffs when I was considering Mesh:
#1. Age – 65 or older.
#2. BMI – 40% or higher
#3. Underlying health condition – (Connective tissue disorder, Marfans, collagen production issue, etc.)
None of those applied to me.
However if any of them do apply to you there are still open tissue options to at least consider:
#1. Age 65 and older – has not been a major factor with the Kang repair or Shouldice with countless success stories in that age range.
#2. BMI – Lose weight or get down to the upper limit (Dr. Sbayi, Dr. Grischkan all maintain the low 30% range BMI as the limit.) if non-mesh is your goal. Shouldice Hospital guidelines are even lower but as MarkT said they will also assess people individually on a case by case basis.
#3. Underlying conditions – Not sure on this one. However I know Dr. Kang has worked on some very challenge cases on patients with advance illnesses.
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One very important distinction between Shouldice and Dr. Kang’s indirect hernia repair is with Shouldice there is not just “cutting”. Shouldice also includes the *removal* of a “significant” portion of the cremaster muscle (30%-50%) to get a “tight” repair around the inguinal ring. This is what I was told by several Shouldice surgeons mentioned in this thread. The only surgeon that I found doing Shouldice which avoids removing cremaster tissue is Dr. Yunis.
“Dr. Kang’s indirect repair: “?? ?? facility? ???? ???? ???? ?? ???? ??? cremaster muscle fiber? split open ?? ?? ???? ??? ? ?? ?? ?? ?? ?? ??? ????? ???.
To repair the facilities in the warehouse, you can think of it as if you had to open the warehouse door and enter it, split open the master muscle fiber, operate on the structure inside, and close the warehouse door again.”So there is some injury (which is to be expected) with that indirect hernia repair but it is superficial? which skeletal muscle can easily resolve with minimal risk to full function. No removal of cremaster muscle tissue with Dr. Kang’s indirect hernia repair.
Removing 30-50% of your cremaster muscle doesn’t appear to cause loss of function in most Shouldice patients? but I would still consider removing muscle a larger risk then carefully cutting and closing muscle back up.
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Full disclosure: I went to Dr. Kang and had a successful Dr. Kang repair.
#1. Dr. Kang – Scenario: You are going to war in your own town and Dr. Kang is like a GPS, laser guided, Smart Bomb with the least amount of collateral damage while still maintaining maximum effectiveness in the targeted area (as it relates to open tissue repair). Dr. Kang doesn’t cherry pick patients and he is not afraid to engage with his audience with full transparency. Dr Kang is well respected by his peers (including Dr. Yunis) and his results so far have been spectacular even if we do not have 20+ years of documented long-term results (many procedures don’t). Keep in mind after 6 months the collagen in that area of the body has healed up to “normal” strength or greater* from what was disclosed in our previous discussions? Dr. Kang also has 20+ years of experience with hernia repairs in general (thousands) and additionally he has extensive experience with intestinal issues (St. Mark’s Hospital London, Gibbium Hospital).
#2. Dr. Grischkan or Dr. Yunis – Shouldice is like carpet bombing imho. Evacuate the area and leave no stone undisturbed. I feel that these two doctors would be the least “invasive” with well documented long term results from both the doctor and their patients.
#3. David Krpata, M.D., Cleveland Clinic – “Uncorrupted” Bassini repair. Probably the closest operation to Dr. Kang’s for Direct Hernias? I believe Cleveland Clinic is currently performing this method when requested to very successful results. I did not have a chance to investigate this further before my Kang repair but some previous posters (with major mesh issues) had great success with that repair at the Cleveland Clinic. He has also been a guest on Dr. Towfigh’s webcast.
Modified vs. unmodified. – It really depends on what your ideology is on medical procedures. I feel there is strong enough evidence from multiple credible sources that diverting from the original procedure in this particular procedure most likely yields better results, specifically as it relates to chronic pain.
There is no doubt that the Shouldice Hospital and other doctors like Dr. Sbayi have had tremendous success despite cutting the Cremaster and nerves.
However, the chronic pain with shouldice has been increasing? in cases, is not well documented, and is expected to be somewhere around 5%+ from the Shouldice Hospital lead surgeon’s own admission? Keep in mind this is from well selected patients with semi-strict criteria.
If I was going to accept a procedure that cuts the cremaster and genital nerve branch I would go ahead and just get mesh.
If we’re getting to that point I feel the risk is similar or possibly even less at that point. -
I would consult with David Krpata, M.D at the Cleveland Clinic- 216.445.9989
If he could not help you directly I would think he could point you into the right direction for some options.
Cleveland Clinic is one of the best hospitals in the country imho and they do some amazing things at that hospital.
It is a major institution with trials and a massive amount of knowledge base.
It is my understanding that hospital also has a lot of knowledge specifically on Bassini repairs.
That is one of the places I would start if I was in your position.
I would also think Dr. Towfigh, Dr. Yunis, Dr. Kang might be able to help too or direct you to someone that specializes in that type of repair correction maybe?
I am very sorry to hear about your issues. There has to be someone out there that can rebuild this damage and get you back to some sense of normalcy.
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@William Bryant
Dr. Kang does have you cough prior to surgery in the OR and marks the area. You are strapped down extensively so movement was never a concern of mine. I suppose some people might be awake in twilight. You are so calm and secure I don’t see how it would matter unless you have a serious pre-existing neurological condition maybe? Dr. Grischkan mentioned he uses the same method too as Dr. Kang.
I remember feeling some pressure and that is probably part of the tugging and pulling. As I mentioned I woke up during the last repair which was the umbilical. I had wondered if the the Inguinal repair was completed. That is how little I could feel. I don’t even feel like I was moving a millimeter. It took a lot of effort to even give the thumbs up when he was talking to me.
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For me – I definitely remember “pain” but it just wasn’t with anything directly related to the surgery. It was with my back about 5mins after I transferred to the tiny (I’m ~6’3″) post-op bed made of bricks lol. I even remember the dream when I passed out and later woke up during surgery. It wasn’t a bad dream just weird as heck. I tried to stay awake at the start but I didn’t even make it to the number 5 when I was counting.
As far as moving – I don’t think I did but I was strapped down. Dr. Kang did ask me if I was ok when I woke up. I gave him the thumbs up. I just remember feeling pretty chill and closed my eyes. Non-eventful from my side. I hope I didn’t make Dr. Kang’s life too difficult that day. He didn’t saying anything so I think that is a good sign.
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Dr. Kang I felt zero pain during the operation with local sedation and my op lasted a little longer than normal because of the two hernias.
I did wake up the last 15mins in a twilight still nothing and this includes when I was transferred off the OR table.
I do not really remember pain until later in the day around nighttime. It came on gradual and not all at once. The pain wasnt that bad until I moved. That lasted the first 2 days maybe? then by the 3rd day I was moving around better.
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I recently had a Dr. Kang repair (7 weeks ago) and was initially dead set against using permanent sutures.
However after doing a lot of research I found that using permanent sutures is probably the one main talking point that both mesh and non-mesh doctors can agree on in regards to hernia repair.
This is the only option I went back and forth on up until I was literally on the operating table. Dr. Kang asked me one last time before local was administered and I decided it was in my best interest to defer to Dr. Kang’s medical opinion. Dr. Kang used 2-0 prolene non-absorbable sutures on me for inguinal and 3-0 for my umbilical hernia.
Pinto also influenced me (unknowingly lol) when I asked him what Dr. Kang used on him once he discovered his sliding hernia. Pinto was there about a week or so prior to my arrival.
I also found doctors (including Dr. Kang) switch to absorb on the portion of the repair that closes the subuc fat and the external oblique aponeurosis. Also glue to close the incision itself.
Dr. Sbayi in the video listed above calls the sutures the “rebar” support for the body (collagen).
I was worried what if I happen to gain a little weight, what if I have a bad cough, what if I lift too much, etc. etc. The permanent sutures gave me a little piece of mind it will make the repair stronger.
Dr. Grischkan went into detail with my first appointment (evaluation only) in regards to how benign and safe the sutures were especially went compared to mesh. Dr Towfigh also elaborates on the size, safety, and value of perm sutures in detail on one of her podcasts which is great.
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The only requirement for entry when I entered from US was the COVID Vaccine (Booster if two shots were over 180 days ago).
Obviously it is still good to keep up on all the other standard ones when they are due.
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https://herniatalk.com/forums/topic/my-hernia-surgery-experience-for-kangs-repair/
Here is an old thread from 2019. Two different people with Hernia repairs from Dr. Kang one of which was a femoral repair. It is about mid-way through the thread from Kablooey.
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Hernias are unfortunately common and happen with a lot more frequency as you get older (and depending on types of abuse or activities.) I spoke to Dr. Grischkan regarding taking supplements as I had similar concerns after finding out I had multiple hernias. He was not convinced supplements would do much and just get discarded by the body / ignored. I was hoping there might be some counter arguments to this with some studies.
What I understand is there are many bad habits that can inhibit collagen production from not getting enough sleep to drinking too much. It doesn’t necessary require an underlying disease or illness. Sleep deprivation for example causes the body to redirect proteins that ordinarily would produce and support collagen to other functions such as creating stress hormones.
Hiatal Hernias are incredibly common after the age of 50 with some studies showing as high as 50%+ of the aging population having some form of one.
I am not sure when the umbilical hernia occurred on me. Mine was only 1cm in size and no mesh was used. The follow up ultrasound was “perfect” on both my hernias per Dr. Kang’s descriptions. The umbilical hernia recovery was a joke compared to the inguinal hernia. Almost non-existent in pain after the repair and completely gone after a few days.
The inguinal hernia open repair is more involved with recovery from my experience but it was pretty much exactly what I expected.