[pinto]

Thanks gentlemen @Jack2021, @Good intentions, @William Bryant.
I play Russian roulette with it finding sometimes even if timed out, window refresh reveals my post; other times nothing. 🙁 It just gets tiring having to copy the message before posting. I’ve yet to encounter the same problem at other websites. Indeed, one website I do, even if your device suddenly turns off your unfinished post still remains at the website.

William, some of your posts are of considerable length. You must have the luck of the Irish; that’s all I can say.

[pinto]

I totally agree with @ajm222
“it doesn’t do everyone else any good when exaggeration is employed. just saying we should try and be as precise and level-headed as we possibly can when sharing stories, and as detailed as possible, as we have seen that the devil is in the details. age, type of repair, type of hernia, past medical history, any other extenuating circumstances…”

Although I didn’t offer the case of a 50 year-repair, it’s quite reasonable that a 20 year old patient repaired could continue weight training thru to age 70. I don’t see how that could be hyperbolic unless well established in the hernia field, such is impossible. I don’t think that Chuck meant it literally true but his tenor I took as quite a long-lasting repair. In fact I have an uncle, though not presently a weight trainer, who had a repair decades ago under the “old regime” and never has had a problem.

I still agree with you @ajm222 on your main point while wishing to point out how mysterious hernia matters are still in the 21st century by the lack of studies.

[pinto]

Hyperbole??? Can you claim such when the science of herniae is so young? Many many questions are left unanswered due to the dearth of studies. Of course empirical studies ought to be the guiding light, but anecdotal information is mainly what we got. Nothing wrong with entertaining observations that hernia repairs last 5 years or they last 50. If a set of them were happen to be valid, it could save one’s life.
Perhaps a member expresses hyperbole about something but discussion will often clarify it. I wouldn’t be too worried about it (though it could be concerning if talk became uncivil).

[pinto]

This website IT really sucks. A message I wrote and posted evaporated.

[pinto]

Hold own, @Chuck: Didn’t you post somewhere that generally IH repairs last 5 years? Your friends’ 50-year stretch probably qualifies for Guinness.

[pinto]

Gentlemen, you’ve gone the wrong way about the cosmetics of scars. After being wheeled in from Kang surgery, I was surprised how beautiful the incision looked. More importantly, however, are two points I believe you guys missed: 1 the bigger the incision the more pain; 2 Kang’s 1 1/2 inch deserves a close look. His and Shouldice’s must be radically different surgery. How is it he manages such a small incision? (rhetorical ques.). It probably explains why his surgeries result in little pain (comparatively speaking). We know from what he says, he thinks Shouldice is a bit too invasive. His IH has been called Marcy but he believes his is considerably different. In time maybe we’ll learn more about it.

[pinto]

Everyone take a look at the blog linked by @Freeman!! Are the photos of the patient’s incision scars typical of IH operations??? I didn’t read the blog–maybe the guy had a whale of a hernia. Otherwise it looks like butchery. Just saying.
(@Freeman, excuse my post, but does your incision(s) similarly look that way, too?)

[pinto]

@Swayze, please confirm: your doctor exams solely used “laying flat abdomen palpating.” My understanding is that standard testing is done with the patient standing. I would like to have my understanding confirmed or disconfirmed about standing being standard. Anyone?

[pinto]

Thanks, Watchful, you are a gem of a member here. I appreciate you staying with me on this. HT being an information exchange, hopefully we can learn from one another. I’m just speaking aloud right now, but I feel something amiss about your hospital situation. Surely it’s recognized as the gold standard for pure tissue repair and you made a good choice. But if your descriptions are on the mark, then I see a red flag. Not that it means something untoward. Maybe you can’t answer this but I would have been left uneasy by his statements.

I just wonder if he is restricted somehow by hospital policies. As a surgeon at Hospital X using the “X-approach,” it’s pretty foregone that x-approaches will be used. There may be times an “independent” surgeon might think Y or Z approaches might even be better but unable to be performed there. Thus x-approach might be applied more often than a surgeon would if outside Hospital X. BTW, I think he is really candid the way we would like. That’s a big plus for him. He might be practicing at other hospitals or even his own clinic.

[pinto]

A problem with hernia is it’s so individualized that matching up with other people is not always straightforward. I think size and comfort level will determine how much to wait. Surely if pure tissue repair, then you don’t want to go beyond M size. If your daily living is impacted very little and without pain, then watchful waiting might be just fine. If somehow a very safe mesh came along, then that would buy you a lot more time. Anything short of that, I recommend surgery; the sooner, the better.

[pinto]

@Watchful, thank you for your thoughtful and gracious reply. You obviously did all you could as a patient to make the best choice and arrangements. Let me see, I think, you once wrote about your surgeon as a surgeon seemingly favors mesh though we would expect pure tissue repair.

Do you think that his view of mesh might differ a bit by the hospital policy; if he had his own hospital, he might have been more in favor of his mesh method?

You write about the surgeon: “He said yes, it would be a good and maybe one of the top two ways to fix it.” The maybe there sticks out. He seems tentative about Shouldice being the best way for your case. My sense (and maybe wrong 😀 ) is that he practices a mesh method unavailable for him to do at your hospital. I believe you wrote somewhere that you now think mesh might have been more favorable for you.

If he thought your tissue was less strong would he have automatically done mesh–or abort for later consultation? I’m glad for you he found your tissue quite adequate but if it wasn’t, what do surgeons do in such a case? Go ahead even though recurrence is likely? Or have a B-plan in place for such time?

[pinto]

Of those people with excisions, in what proportion do you think scar tissue functions as an effective repair of the original hernia?

[pinto]

@Watchful, considering your IH was “very large, life-long hernia” and your openness to mesh use, then wouldn’t we suppose you discussed with your surgeon prior to surgery the option of using mesh? What if the surgeon judged condition warranted mesh during surgery? Did you have a prior agreement about it?

[pinto]

@Chuck and all: An important factor overlooked here when talking about post-op pain is pain prior to surgery. I understand that this is a determinant of post-op pain: prior pain tends beget post-op pain. You also may have overlooked what Mike M said about his pre-surgery condition:

“Keep in mind prior to surgery I was to the point (pain wise) where I wasn’t even sure if I would be able to make it on the plane to South Korea.” [Mike M]

Evidently he is saying he had considerable pain enough that could prevent his travel. Thus it is remarkable Mike M appears to have no or little pain post-op.

The mystery however is how a human being can distinguish scar tissue within the deep recesses of their own human body. (Surely “pain” concerns internal tissues not the exterior incision, right?) Mike M says, “I can feel maybe a slight bit of scar tissue.” Is that by finger touch or by mental sensation? If sensation, how is it you are able to pinpoint it to scar tissue and nothing else? You heard this about scar tissue, so you assume it is the case with you?

[pinto]

@Watchful, I share your concern for accurate and reliable data, however it seems you sidestepped the issue I raised. I quote you from your original post:

“You’re [Chuck] engaging in selective belief/disbelief based on your particular results with your lap mesh procedure. In the case of Kang, I don’t recall that he even provided any chronic pain and discomfort results. He provided some of his recurrence stats (without counting Pinto which raised the question of who else he may not have counted) – that’s all I remember.” [Watchful]

You appear to be making an example of Kang being “selective” with his data, which if so, would be a serious charge. Later in the same thread, he explained that

“The reason the last statistics were for patients 7 to 32 months after surgery was because there was an important change in our indirect hernia repair method…. [F]rom December 2019, I used permanent 2-0 Prolene in some patients [with untypical hernias] [but still maintained absorbable use for typical cases]. …As a result, there was no recurrence in 401 high risk patients who used Prolene, but among 1405 patients who used Vicryl, recurrence occurred intermittently, and 12 patients have relapsed so far. …My previous statistic of no recurrence with 738 patients 7-32 months after indirect hernia repairs, were only about those with the permanent Prolenes. Pinto, who underwent the first operation in August 2019 for left sliding hernia, was excluded from the previous statistic because he had surgery with Vicryl at the time.” [Kang]

My original surgery was indeed absorbable so he shouldn’t include me as a recurrence because he wanted to show how improved results came by using permanent suturing. Thus you not only misrepresented Kang but make an untoward accusation. You appear by your latest post to justify the latter by saying a Korean colleague of yours found as many as 3 recurrences on the same day at Kang’s hospital. As you said it yourself, such doesn’t prove anything. Moreover it does not justify your misrepresenting Kang’s report.

For me, the most outstanding feature is the apparent irony in that you are being “selective” (=biased) not Kang.

[pinto]

@Watchful, please confirm your claim that Kang was being “selective” (=biased) in his stats for recurrence, citing that he (by self-disclosure) excluded me from the stats. Didn’t he do that in association with reporting a change in surgical procedure, quite reasonable to do? I don’t believe he was referring to his overall, total over his long career as a surgeon. Please correct me if I am wrong but you seem to have mischaracterized Kang’s report, possibly applying a selective view yourself.

[pinto]

@PeterC, wasn’t the description about Dr. Brown highly inaccurate? I don’t believe he would be technically called a “general surgeon.” More importantly it is patently false that “He has developed his own technique called the Shouldice method.” How is it that AI would mangle such basic information?

If you don’t mind, how did you feel when AI produced his name? Isn’t he the same Dr. Brown who was your surgeon, who you attribute producing your tragic results?

[pinto]

@PeterC, what could be an interesting venture turns out contradictory because your (1) thread title (purpose) conflicts with (2) the instruction given the AI:

(1) I asked Artificial Intelligence (AI) who the best hernia surgeons were
(2) I first asked a leading Artificial Intelligence program to tell me who were some of the leading experts when it comes to hernia complications.

I don’t think (2) is the same as (1). (2) may reap candidates more scholarly inclined than surgically. (2) may be most productive in producing research reports or conceptual pieces than actual surgical skill. Thus the AI chose at least one deceased member and some already retired ones. Thank you for your attempt, but unfortunately, therefore, these AI results cannot help but hinder patient choice of surgeons.

You need to ask the AI what the criteria are for choosing the “best.” Those criteria might not be applicable for today’s patients choosing surgeons.

Finally, why not just name the AI rather than not disclosing it? It may or may not be “leading” for the purpose intended while concealing purview of its algorithm.

[pinto]

@Mike M says, “The reason I am pointing at the ‘coughing’ is I had never experienced even a hint of a hernia at any point in my life. It was the furthest thing I thought possible.”

Exactly my experience–and to boot I was the fittest I could be. I had always heard growing up “be careful picking things up.” I had never heard that it could be from sneezing or coughing. Shocking to me. But what about simply reaching for something in your car with a heavy backpack on? I don’t think any surgeon can pinpoint the cause in our cases. And further they all seem to have their own pet causes. Another dilemma is that surgeons differ about physical exercise. Despite the hundreds of years of history, hernia surgery appears still full of mysteries.

Sliding hernia–yeah, sure there’s no secret about that. But there’s research to show that with proper surgical technique, outcomes match standard ones. “A little tricker to detect”? I don’t know but one surgeon looked at my prior CT scan and could identify it as sliding. I don’t know if he was blowing smoke but he seemed well-informed and experienced about hernias, one of the most impressive ones I met.

[pinto]

I know you have made important posts here at HT and like me a patient of Dr. Kang’s. Many members know of my reviews about Kang as well as knowing I had a recurrence. About that I wanted to correct your point #3 recurrence: In my case never was it a matter of patient responsibility.

I am a former NCAA Div. II basketball player, who is not far from his former athletic state. I continued to play the game until my hernia struck. I am thin of stature and careful of diet. I was in excellent health before and after surgery.

I was careful of activity post-op and exercised only to keep body tone–no heavy lifting, no squatting, or anything to strain my pelvic area. Dr. Kang mused that maybe the absorbable suturing gave way too early. Whatever, it had nothing to do with me personally for I was quite careful in lifestyle.

As an aside, I wonder if you really can say what caused your hernia. In my case was it basketball, golf, dancing, weight training–or simply sneezing or coughing or bladder issues?? Surgeons differ about these causes. So who is to say which one? How can you really be sure it was coughing or even weight gain? You say it so confidently that it reminds of my own personal quandary as to what triggered my original hernia. Anyway, just for discussion I am posting and the wish to clarify recurrence. Otherwise, bro, take it light.