[pinto]

@Watchnwaitin, congrats on that. I’m glad for you that you were able to avoid surgery. As you demonstrate your unconventional method was not “mental” but physical. Another feature is that yours did not cure but only lessen the symptom. Moreover, the hernia is quite small. The larger the hernia, the greater the risk.

By your own admission you still have a hernia and who knows, it could possibly get worse. Nevertheless yours is the dream scenario for someone on watch and wait. Mine progressed too quickly for that. How about elaborating more on your method so others might try it.

[pinto]

Only my opinion but I think your case needs Kang even more than my own. He has seen it all besides being excellently skilled.

[pinto]

Everything I posted about my experience is as accurate as I could make it. Let me correct your mis-statement (in my view):
“Its a little concerning that you had so much post op surgical pain”

Your statement is wrong—from my perspective. You must be referring to my first surgery. I probably am more tolerant of pain than most others but here are three “pains” to talk about: 1) unavoidable pain, immediately post-op that everyone has; 2) my getting out of bed; 3) the taxi rides. Other than those I had no pain. #1 cannot be eliminated anywhere. #2 only if I was not in a motorized bed. #3 not if I had stayed longer in the hospital.

Given I had a sliding hernia it might have required a longer stay for caution’s sake. Moreover as I posted in the thread “Sliding Hernia,” the hospital staff was a bit unaware even though I had them search locally for a rental hospital bed for my hotel room (= unnoticed red flag). As a matter of fact after a few days in my hotel room going into my shower, I thought “I really didn’t need pain meds” (while excepting the walking + taxi rides). The rest of the 99.9% time it was painless.

I surmise that generally most surgical pain comes from the incision. Stephen says Kang’s incision is the smallest in the world at an inch and a half. I’ve yet seen any smaller for pure tissue repair. My #2 and #3 pain was not due to incision (known by my second surgery); I attribute it to the hospital but I am forgiving because everything else was so fine. Anyway going by other Kang patients, my first surgery was not representative. Nevertheless afterwards I was painless and body fully intact. 😀

You say, “several folks that went to Kang have said they were is such pain they could barely walk…one patient said he had to stay another night. So the Kang repair definitely has some downsides.” Name me a surgeon anywhere in the world who could do better. If you look enough you will find the same for any top surgeon. A million and one variables involved. You will find no perfect scenario.

I cannot answer your technical questions. I think Shouldice’s reputation is great—the gold standard. But too much slicing and dicing in my view. Kang, according to his website, was once vice-president of a Korean national surgical society, a position typically elected based on excellence of reputation. Remarkable because he does pure tissue repair—a minority medical approach! I believe he is a great surgeon. The only downside is that his hospital being specialized and reputable does an immense number of surgeries. The double-edged sword for our most important requirement of a surgeon–experience. A trade-off emerges between skill and personalized attention. For you, you absolutely must have a highly skilled and experienced surgeon.

[pinto]

@Watchful, medically naive, I knew nothing about imaging etc. My CT scan was not for the purpose of the hernia but something else. I received no report. By luck I could use it for my hernia apparently. I thought it was pretty cool that the later two hernia surgeons I visited looked at their computer monitor–and I believe–applied a measure to their screen. Anyway they both made a calculation coming up with the same measurement in response to my question, how big is my hernia? It was kind of a test of their ability. 😀 (The first doctor quite familiar with CT scans could not identify a hernia, saying he would need a CT for that purpose.)

@William Bryant, you’re lucky to be on the slim side as I found out and maybe you too that being obese is a disadvantage for surgery.

[pinto]

Watchful, I don’t doubt that general hospitals have specialists. Indeed from my experience they do. Only certain staff do the hernias for example—but they also do a lot more different surgeries. Thus they likely to be much much less experienced with hernias than the specialists talked about at HT. Moreover because these are general hospitals, the hernia surgeon will likely have less latitude about approach and material. Many likely are pushed to do mesh and mesh chosen for them. Some do mesh and non-mesh true, but here again they can’t match up with the experience of the specialist surgeons we speak of here at HT.

[pinto]

Thanks Watchful. Although a good explanation and maybe quite correct, I must think that the approach to the spermatic cord is not the defining feature that separates hernia approaches from one another. All must deal with the spermatic cord. Moreover, how Dr. T applies Marcy may or may not be textbook Marcy. BTW was Marcy originally developed solely as an approach for children? I’ve always thought it was not age or gender-specific. If true, then the question remains open—-Why not men at least slim men?

[pinto]

That study was not “British” but German because it was done by German surgeons in Germany I believe. That’s just a side note. I would call the results of the study biased in that it is applicable to general hospitals not specialist ones. Moreover I am unsure that the Shouldice method was done such that it truly could called that. I was glad Mike T you offered this study because it answers the question, who did the surgeries. By the authors of the paper, right? So that supports my concern made elsewhere as well about the research by these same authors. (It’s not necessarily bad but is really limited to general hospital situations not to specialist ones.)

@Chuck, I have reported various places that both my surgeries and post were painless.

[pinto]

No not large. If I recall correctly, for my first hernia two surgeons independently measured it from my CT scan as 14cm, both saying medium. Kang does not appear to measure but he also said it was medium in size.

We both agree about Watchful being a genius but ya know even Einstein couldn’t get good grades at school. I’m sure Watchful would ace hernia school and it would be good to sit next to him for the answers, but sometimes a curveball comes and then what? W’s voiced concern is data. Sure we all want that. But as I have pointed out elsewhere almost no independent data for any surgeon.

As far as Dr. T’s view about Marcy, Kang, posting here at HT, while acknowledging Dr. T’s immense status, does not agree with the Marcy characterization. As I recall he said he developed his approach organically not piggy-backing on any particular approach. Of course he was originally a mesh doc, so he didn’t begin with non-mesh at zero. He grasped the problem and figured out a way to solve it. Could he have consulted non-mesh approaches? He likely did. He may have found his was unique enough to call it the Kang Repair. It is also likely that KR, though different, has some corresponding features with Marcy.

Here’s a question for you, something that apparently Dr. T has ignored: Why can’t her Marcy approach also be used with slim or small men? Why only women? Ask Dr. T.

[pinto]

@Chuck, it seems you’re in deep torment about choice of surgeon. It is difficult I agree. I don’t agree with you punishing yourself about your previous mesh surgery. It must be true that thousands have the same operation but somehow escape into nirvana. I’m sure I would not end up well, for I never win lotteries and things like that. However in the case of my surgeon choice of Kang I lucked out. About this I don’t agree with Watchful though I applaud his great contributions here. Me, I’ve been in no pain 14 mos. out. You can go to Kang confidently. Painless according to my experiences. Recurrence chance greater? Who says? Their data is likely biased.

[pinto]

Pinto’s Account
Pinto naively accepted hospital discharge despite that he believed he needed a motorized bed by which it would assist him to get out of bed when needed. Hospital staff could not find any service locally by which he could rent a motorized bed and place it in his hotel room. Even though hospital staff later said his request for crutches for walking was the first time received, they did not have the wherewithal to consider if early hospital discharge was really appropriate. In fact some hernia hospitals, though uncommon, will have their patients stay 3-5 days before discharge. Nearly any surgeon will advice patients after surgery to protect the surgery area by bracing it with their hands or pillow when coughing etc.

Pinto believes that although his surgery was made with the best intentions, there must have been some sort of mishap considering he was the first to request crutches and he had so, so agonizing taxi rides immediately after his discharge. Apparently thousands of patients from the same hospital have relatively little trouble leaving the hospital within 48 hours and can amble away painlessly. Given that Pinto followed the surgeons guide for a safe post-op, he believes if he was able to stay in the hospital in a motorized bed for at least three days, recurrence might not have occurred. It might have even proved the surgery was done flawlessly. He subsequently had a successful operation by the same surgeon two years later without any trouble—- without need for crutches or motorized bed.

In conclusion, when making medical critiques we must do so with considered thought so as to avoid hasty claims as well as being mindful of unanalyzed assumptions by which to control bias or prejudice. Sliding hernias are neither rare nor troublesome for the experienced surgeon.

[pinto]

Sliding Hernia: Reason for Pinto’s Recurrence
As we have seen, SH is neither so rare nor troublesome for the skilled surgeon. More importantly SHs can have nearly the same prognosis as that for non-SHs. By this view Mike M made a hasty claim in attributing Pinto’s reccurence to the presumed difficulty of SH surgery.

He discounted Pinto’s pain experience in his taxi ride from the hospital apparently based solely on Mike M himself having an uneventful taxi ride after his own surgery. Because his ride was painless, by Mike M’s reasoning, therefore, Pinto couldn’t have really had any trouble. Again following Mike M’s reasoning, Pinto probably moreover was careless in his subsequent daily living—–for example the mindless lifting of heavy objects too soon before full recovery.

[pinto]

Sliding Hernia Surgery: Dangerous?
Not according to the American College of Surgeons risk calculations. Someone with a sliding hernia has only a risk of 0.8% chance for serious complications, which is below average surgical risk. https://riskcalculator.facs.org/RiskCalculator/index.jsp
If proper surgical technique is applied, SH outcomes are quite close to those for non-SH surgeries (Komorowski, Moran-Rodriguez, Kazi, & Wysocki, 2012; Piedad, Stoesser, & Wels, 1973; and Ponka & Brush 1978).
So a skilled experienced surgeon should have no trouble in the successful repair of SHs.
[strangely this website blocked my reference links]

[pinto]

@Chuck, you raise some issues but you are smart enough to know the answers already:
1 Biased sampling: complaints at FB etc. must be taken with a grain of salt. Most people happy are not as motivated to post as people having pain. The complaints could possibly be a very small proportion of all cases pro or con.

2 HT Hangers-on: Have you noticed that a lot of members here once they have a surgery and report never come back again? Apparently they had a satisfactory surgery and feel no reason to continue the topic. Some though like Good intentions is on a life-mission to destroy the mesh industry. Pinto’s reason is academic: he wants to learn more about hernia because once a hernia then always the chance (i.e., member Dog).

3 Bias against Dr. K. One or two members have an unfortunate bias in this regard. They made their minds up and so not easily changed. Their reasoning seems sound but if you at it more closely, you will see the weakness.

4 Surgeon religion. Should it matter? If so, how much?

[pinto]

The paper by the German research group struck me because it is categorized as a “clinical trial” not merely a survey or review. A question is who performed the surgeries. Without the original paper and having to guess, I’d say the surgeons are general surgeons based on the fact their affiliation is a general surgery department and the lead author is known not for hernia surgery but abdominal surgery as indicated by Medifind.

In other words, these two “German” papers concern surgery by non-specialist surgeons (generalists), probably the most likely performed surgery for hernia. The results for chronic pain must be cautioned as they most likely concern hernia surgery at general hospitals, something many HT members would avoid.

[pinto]

The paper by the German research group

[pinto]

@Anthony, an interesting find you made. His statement is actually self-contradictory: There’s “… no evidence …that mesh is ever rejected by the body.” Yet in the same breath he says next, there are though rare instances of mesh rejection. At the very least he needs some serious editing. Drugwatch.com reports mesh rejection is 5% to 30%, far from being a rare occurrence. If true, this doctor needs even more to take to heart your email.

[pinto]

Hi Anthony, you have great spirit I like that. I agree we can employ strategies so as not to worsen hernias. But I have not seen any evidence-based research to show that wishing, visualizing, or other thinking methods can eradicate them.

On the contrary I am concerned that your proposal that they can, will do people more harm than not. Why? Because once ruptured, further physical stress may make it worse. Even if we try physical therapy by ourselves, it likely will become hit-or-miss ending in futility. Then we have an enlarged hernia making repair at least a bit harder esp. for pure tissue repair.

Anthony, it’s not my job to do the research—-it’s yours. It’s your claim, your proposal. As you enjoy quotes, 🙂 let me leave you with one: “I got a bridge in Brooklyn….”

[pinto]

That’s useful info. It’s great as you point out radiation can be avoided. I got disks routinely for my CT scans but not ultrasounds. It’s good to know that operators make them available.

[pinto]

@Watchful, you’re really balling here man. Thanks for your reply back there. Much appreciated.

[pinto]

Chuck, you were once in such miserable pain that you were on the verge of suicide. Not once did I question your pain. That is what Mike M did to me by at least implication. Immediately after my surgery I asked for crutches because I could not walk unassisted. A week later when I returned the crutches, Stephen and Kang said it was the first time for the use of crutches. I was never in pain until getting out of bed or walking. The vibrations in my taxi rides seemed to rip right through my guts. I will not let anyone—-esp. a wishful thinker about his own condition—-to imply my pain was nothing and my recurrence was a function of patient irresponsibility.