[pinto]

As I mentioned, I had long followed Dr. Kang, more than anyone else. Dr. Brown, of course, is an excellent choice as well. From my view, you can’t lose with either one. I cannot say that for the other doctors, probably due to my lack of information. In my heart, I know either Dr. K or Dr. B will do right by you.

[pinto]

Bestoption, from one member to another about exercise: test the water before you take the plunge. The problem about IH is that there are too many factors to isolate what one(s) are causative. And most of all: most herniae don’t grow smaller, they grow bigger. Despite my continual caution about it, my hernia enlarged. Multiple docs told me that running would be ok for me. I did so as long as it was painless. I believe it was ok. But for weight training I’m not so sure. My training was very limited and surely did not include squats or crunches. I remember reading the lament by a women with an IH who wishes she hadn’t followed the advice that exercise could heal a hernia. Her condition greatly worsened, which especially for pure tissue repair can negatively affect surgery. I hope you are able to find an effective but safe method.

[pinto]

Many thanks for that.

[pinto]

columb.if and Bestoption, yesterday I replied to your posts but they were blocked as “unapproved.” System bug or censorship? I hope not the latter.

[pinto]

This website system sucks!! I just made thoughtful replies only to be unapproved for no reason. What goes???

[pinto]

This website system sucks!! I just made thoughtful replies only to tell me that they are unapproved for unknown reason.

[pinto]

Bestoption, you ask, why do the surgery? I was hit with a lightening bolt. Watchful waiting only buys time. IH will never go back in time. That is, it only increases in size (in most cases) and significantly, increasingly making surgery more difficult or risky. I was under false hope that I could ride out my IH a few years or more! Once I found the IH get bigger, my whole being switched into survival mode. I happened also to have a convenient time to have the surgery. It became a no-brainer: do it now!
About anaesthesia, I didn’t want general, but didn’t say so. Rather I raised the topic, and was satisfied about their explanation. Technically, it wouldn’t be general as I could breathe on my own. If in fact it was general, I’ll take it! I’ll take it! Excuse the humor, but if propofol, then I understand why Michael Jackson used it.
I had blissful sleep and a most, most pleasant dream. I had no bad after-effect, nothing. If propofol, given the risk, I praise the Lord as well as the Dr. Kang team. I have no other experience, only what I’ve read. Hearing columb.if’s conjecture makes me feel even happier I chose Dr. K.
About the bilateral issue: I’m willing to roll the dice because I have no obvious symptom yet–no pain or protrusion. Yes, it’s curtailing my life, but possibly I can gradually get most of it back.
Columb.if’s, per your request, I took a pic with my ipad but having trouble getting it out. Apple surely has hit the skids with its manufacture in Steve Jobs’ absence.

[pinto]

MMM, congratulations! I feel happy for you. Thanks for letting us know.

[pinto]

[USER=”1391″]UhOh![/USER], it seems that docs move the goal posts! I am floored when doctors tell patients in extreme pain 6 mos. post-op that the pain is expected. Or when doctors tell these patients that their pain is impossible. It is egregious particularly with docs who are blind to corporate blunder. Granted that some patient complaints may be groundless, nevertheless other complaints are real. As long as imperfect mesh is considered the ‘gold’ standard, hardly will there be much advancement in our lifetimes.

[pinto]

Sorry to hear about your circumstance. A complete sin I think how your surgeon gave you what seems is a runaround. Telling you your pain was impossible precluded any redress. Probably a ruse to cover his incompetence. I hope you get your justice.

Interestingly, Johnson & Johnson was pointed out by a general surgeon I spoke with as if I should be assured about the mesh he used for his surgeries. Scary that such doctors would apparently be so naive.

This case of J&J is just the tip of the iceberg not only because of such court cases but also negotiated settlements made by manufacturers to avoid the court, such as with C. R. Bard’s settlement of $184 million made in 2011. Given the potential long-term risks of mesh and the millions of surgeries made each year, we are sure to hear more and more of these litigations. If you haven’t sought legal counsel, you should in case you qualify for one of the many class action suits I suppose are already brewing.

[pinto]

Thank you for sharing and even in a way representing us all. A profound way to bring humanity together. Bravo!

[pinto]

Good point about the weakness of data, but that hasn’t stopped various medical writers (often, surgeons themselves) stating that once an IH, chances rise for a subsequent one (apart from recurrence of the same side). Moreover, it is not hard to find in the medical literature a distinction made about right-left having different chances of occurrence. If the two sides were structurally equal, then chance of occurrence might be a mute point. But as Kaspa pointed out, the left side seems to be structurally advantaged. If so, then it is highly likely the two sides will differ about frequency of occurrence.

As this related data comes into question, then you must be skeptical also about most other data in the IH field. For example various authors question the rates of recurrence claimed for the IH surgical methods. Follow-up of patients post-op has said to be problematic. Immediately we have questionable data, therefore. A can of worms emerges that could turn the field upside down.

I presume that a lot of the stats found come from clinical conjecture rather than scientific study, the latter being more preferred. In its absence, clinical conjecture might be the only thing we have. Weak as it might be, it can be a helpful starting point as long as we remain flexible in its use.

[pinto]

Thanks for the info about the right side. I wonder if the sides differ appreciably about surgical complexity.

Because African Americans have genes only 70% African ( 20% European), I wonder about the IH stats for Africa as well as for Asia. Environmental factors play a part Im sure.

[pinto]

Dr. Kang,

Thank you for your considerate, thought-provoking yet still balanced commentary. If I got it straight, pure tissue repair by nature involves some amount of tension of the IH tissue; some methods more, some less. Thus it is not possible to eliminate all tension. Mesh sees to erase it all, but as Good Intentions and others, Jnomesh, Uh-oh, point out, mesh has its own tensions to deal with (or not!).

I thought it interesting that you referred to mesh as the “gold standard” as it is by virtue of its having cornered the market in the rich, developed world, but it is not yet developed itself. Various members here who have had this treatment will attest that it failed them beyond reason. World-wide are these cases, so there must be a better way.

Your own work has intrigued us and you so kindly opened a window to it for us. You appear to give the central thrust of your approach:
>we believe that the most important surgical procedure to >prevent recurrence is to seal the hernia hole directly.
Fascinating! Too bad I am a sufferer; otherwise I might pursue a medical degree. 😀 Seriously, that helps much in understanding your approach.

Now don’t all methods of pure tissue repair do that? Apparently not and this can become an important criterion for comparing the various surgical methods. Striking about Dr. Kang’s work is something else–his departure point. He begins not with prior textbook dogma, but what he found as a practitioner: failed mesh devices. That as his inspiration, he has steadily developed his pure tissue repair, much distinguished in South Korea and elsewhere.

Dr. Kang’s post leaves us much to contemplate.

[pinto]

Thank you, Good Intentions, I appreciate it and your continued valuable guidance.

Hey, everybody, we are onto something. I have not seen any challenge anywhere else about this tension-free issue. This is the central plank upon which the mesh establishment is built: Tension-free: Mesh proponents claim that 1) suture repair involves stitching to close up the IH hernia and 2) that inherent tension (stretching tissue and/or stitching) results in higher recurrence. Thus mesh, simply as a cover, sidesteps the tension from stitching/stretching, if I got it correctly. So they ask, “why risk recurrence with non-mesh?” Probably a big selling point.

If however some suture repair has overcome the stitching/ stretching drawback (and recurrence), then why go mesh? With the problems of mesh identified at this Forum and elsewhere, it seems a no-brainer.

But just like food manufacturers slapping the word “natural” on all their products as a gimmick, the proof of being “tension-free” is in the pudding. Can tension-free non-mesh methods bear scrutiny?

Thank you all, and let’s continue on together.

[pinto]

You state, >Tension-free” is meant to refer to sutures not pulling through tissue<
This seems impossible: suture is a stitch or row of stitches holding together the edges of a wound or surgical incision (OED). Penetration of the tissue by stitches ultimately must put pressure on the surrounding tissue not to mention that tissue must be pulled together to close the IH gap.

You falsely claim (by implication) that I “want to criticize Dr. Kang’s claims.” Do I?? Has he made such claim that his suture repair is tension-free in the sense used by proponents of mesh repair? Please point to his own direct statement about it. I have not seen such, so I am careful not attribute possibly false claims to someone.

Simply because I criticized your previous post must mean that my original inquiry is meritless? That seems your point. I admit you are knowledgeable and a great contributor: I have already applauded you both privately and publicly at this forum. I am simply trying to sort out a very complicated medical matter that is IH. Nothing more, nothing less.

Your first sentence of your first reply to my inquiry: “I can’t argue the use of “tension-free” as a term, but mesh actually is full of tension.” Then please dont argue it but it turns out you do. Second you side-track us by taking aim at the mesh approach. This present thread is not focused on mesh; rather it inquires if suture repair actually can say it is tension-free.

Presumably this term was not in parlance prior to the advent of mesh repair. If I am not mistaken this is a key difference between the approaches–at least from the view of mesh proponents. Thus a worthwhile question this present thread asks.

[pinto]

Seems you both are barking up the wrong tree. ‘Tension‘ here is neither shrinkage nor tissue rejection. By definition suture repair involves tension because it stretches the IH membrane together to patch the IH gap or hole. Because mesh repair instead ‘covers‘ not stretches the membrane, mesh repair is hailed as tension-free. If suture repair also can do that then its the biggest story ever–and begs to be told.

[pinto]

If I recall my readings correctly, explanations of mesh surgery typically consider suture-repair as the same as tension. That and the claimed lower recurrence rate, as I recall, are main arguments for mesh repair. If suture-repair can be made tension-free (seemingly paradoxical by definition), then please anyone edify me about this. Good Intentions graciously responded and made a well reasoned response. If so, it begs the question why suture-repair and tension are so closely associated, at least from what I have seen.

[pinto]

Let me iterate: there is no scientific evidence that physical exercise heals an IH; that is, the “hole” or gap–which is what a hernia is–remains open. It is not sealed by exercise. What is scientific evidence? For example, a cogent definition: “Results when a theory or hypothesis is tested objectively by other individuals such as in an experiment or in a controlled environment.”
http://www.businessdictionary.com/definition/scientific-evidence.html

I have merely asked this Forum, if you´ve got it, then please show us. Anecdotes, though helpful, are not scientific evidence. They may serve as precursors or illustrations but they in themselves are not scientific by an absence of rigor. At the very least, you should be able to provide licensed medical centers that offer pre-surgery IH patients exercise programs that heal–close the IH hernia. So far, no information as such has been forthcoming.

Finally I never said nor implied that patients who have reported negatively about exercise are scientific. However because only surgery can turn the clock back for herniae, it would be prudent to be cautious about the contrary claims you make.

[pinto]

PeterC, you greatly misread my post. Please, where do I say what the medical community says is “irrefutable truth”? Nowhere do I say nor imply that. Obviously if you go to a doc for your IH and he/she says, “we´re gonna do some blood letting and fix you right up,” you gonna high tail it out of there. That practice went out ages ago. Your very well-being depends on standard practices followed by a whole society; if not, then our way of life as we know it comes to a standstill. It would be foolish of you to disregard standards simply because you might read some pulp fiction accounts of a miracle drug that “cures” all forms of cancer. Hell, in that case forget the standards and roll the dice.

Further, I greatly detest your twisting my post to demean roger555´s account. Who “automatically pointed at a misdiagnosis for roger555“? Hello, PeterC. Did you know that yearly there are scores of medical errors made by dedicated doctors throughout the world? Never, never did I say his case was a misdiagnosis. We are all here to discuss matters and he presented his case for our consideration. I sinned in your book by merely suggesting the possibility of misdiagnosis? Well, if you cannot fathom the positive role of critical thought, then I guess you are left with going to your acupuncturist for all your needs. I caution you though that he/she might not be up to standards.