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  • No mesh

    I will try to summarise my situation. I am based in UK and have a bilateral inguinal hernias.
    After a long long research I am still contemplating what should be my next step. It is not an easy task and it is not comparable to taking a haircut Like all the patients I want to make a right decision. I am already experiencing other long term and unresolved health issues which may or not contributed to hernia but for sure I don’t need further complications.
    NHS ( national health service) offers only mesh repair which I am definitely not going to accept.
    1st choice: BioHernia which offers non mesh repair in Germany by DR Koch and potentially I could get partial reimbursement by NHS. This is tempting as the procedures are very expensive and despite no one should save on health this isn’t realistic for some of us. I was convinced until I read this forum and especially when coming across comments such as Baris. Therefore are some concerns the way DR Koch actions his decisions and haven’t seen any recent comments about him. On the other hand he has good feedback on Google and Facebook.
    2nd choice: DR Mohan P Desarda website also very convincing but there are high medical costs involved and perhaps exaggerating but I am worried about how good is his performance at the current age.
    3rd option: Dr Kang’s repair. Sounds promising and has sincere responds. Drawback is the medical cost and travel. I can’t stop thinking about the Dr Towfigh’s comparison to Marcy’s technique and not being suitable for adults. Is Kang’s repair any different than Marcy’s ? Any suggestion is welcomed.

  • #2
    As I understand things, both Dr. Brown and Dr. Kang understand groin anatomy and the various named techniques well enough to produce appropriate variations as they see fit. They asses each situation as they go and choose the most appropriate way to solve the problem.

    Also, as I understand things, the "Marcy" technique is used for indirect hernias. So the type of your hernia will matter.

    Both Dr. Brown and Dr. Kang have seen the damage that mesh can cause and have made a conscious and informed decision to avoid using mesh if possible. Named techniques, by their nature, are self-limiting. I would choose a surgeon who knows all of the techniques, and understands the basis behind them, and uses them in the way that is best for the patient..

    Good luck.

    Comment


    • #3
      Dr Brown of Fremont, CA used the Marcy-Desarda technique on me during my May 22, 2019 operation. Good outcome, specially as it pertains to pain and inflammation and healing. You can check his website and schedule an online consultation.

      Comment


      • #4
        Originally posted by Good intentions View Post
        As I understand things, both Dr. Brown and Dr. Kang understand groin anatomy and the various named techniques well enough to produce appropriate variations as they see fit. They asses each situation as they go and choose the most appropriate way to solve the problem.

        Also, as I understand things, the "Marcy" technique is used for indirect hernias. So the type of your hernia will matter.

        Both Dr. Brown and Dr. Kang have seen the damage that mesh can cause and have made a conscious and informed decision to avoid using mesh if possible. Named techniques, by their nature, are self-limiting. I would choose a surgeon who knows all of the techniques, and understands the basis behind them, and uses them in the way that is best for the patient..

        Good luck.
        Thank you for your response and it does make sense what you’re saying. I am seeing lots of positives for Dr Kang.

        Procedure in Germany would be convenient for me
        (distance and potential reimbursement). It interests me if how comparable is Dr Koch approach and procedure to the above surgeons. Unfortunately I am not seeing many recent comments about him.

        Comment


        • #5
          Originally posted by fidel18 View Post
          Dr Brown of Fremont, CA used the Marcy-Desarda technique on me during my May 22, 2019 operation. Good outcome, specially as it pertains to pain and inflammation and healing. You can check his website and schedule an online consultation.
          He sounds also promising. Thank you will read more about.

          Comment


          • #6
            Hi Bestoption,

            Thank you for considering my surgery method as one of your options.
            And I also thank Good Intentions – you have always been so devoted to this forum.

            As I read the statements and questions posted to this forum, I have always wanted to say about a few things. I noticed the statements related to such things were posted here, so I would like to give you my opinion thereon.

            The biggest difference between most of other inguinal hernia repair surgeries and Marcy repair is: while most of other inguinal hernia repair surgeries are type-nonspecific repair method, Marcy repair is type-specific repair method for indirect inguinal hernia. In other words, Marcy repair is, as far as I know, practically the only surgery method which repairs indirect inguinal hernia in type-specific way. (Unfortunately, it is difficult to find any information as to how Dr. Marcy administered direct inguinal hernia repair surgery.)
            So, many people seem to think that any type-specific indirect inguinal hernia repair is always Marcy repair. However, what I think is that Marcy repair is just one of type-specific repair methods that can be administered for indirect inguinal hernia repair. This is the same as there being many different methods of type-nonspecific repair such as laparoscopic mesh repair, Lichtenstein, Bassini, Shouldice, Desarda and so on.
            I have been administering non-mesh repair (where indirect type and direct type hernias are repaired by different surgery methods) for the last 7 years. And there is a big difference between the indirect type-specific repair I administer and Marcy repair.

            Some think that Marcy repair is for children. In most hernia repair surgeries for children, only high ligation of hernia sac is administered. However, Marcy repair additionally closes the deep inguinal ring after administering high ligation of the hernia sac. (The high ligation of the hernia sac is a mandatory process of all existing surgery methods conducted when repairing indirect inguinal hernia.) Thus, Marcy repair is an indirect inguinal hernia repair method for adults. As far as I know, the recurrence rate of Marcy repair is very low (1~2%), once it is accurately administered. However, it is my understanding that there are not so many doctors who are used to this surgery method. Thus, when administered by inexperienced hands, the recurrence rate of Marcy repair would naturally increase.

            Another thought I had after reading the postings to this forum was that a lot of people seemed to think that mesh repair is appropriate to some and non-mesh repair is appropriate to the other, depending on the patient’s condition of herniation. Also, it seemed that there were many people who thought that even if the mesh repair is administered: there is a better mesh repair method according to a patient’s condition of herniation; or it is better to choose the most suitable surgery method among many non-mesh repair surgery methods, such as Marcy, Desarda, Bassini, Shouldice, etc, according to a patient's hernia condition.

            Such thoughts may be quite reasonable and correct. However, what I have learned from my experience and convinced of is that whether a patient’s hernia is severe or in early stage; whether a patient’s muscles in the inguinal region is strong or not; whether a patient is exercising a lot or not; or whether a patient is obese or thin, the best result can be achieved by a method in all cases, as long as a good method is administered. Thus, I believe that different hernia repair surgery methods should be administered depending only on whether the inguinal hernia is indirect type or direct type, and I have been administering more than 10,000 non-mesh inguinal hernia surgeries as I believed. Thank you.

            Comment


            • #7
              Dr Kang what method would you employ for a direct hernia

              Comment


              • #8
                scaredtodeath It is a kind of simplified Bassini or Shouldice repair. The scope of repair is just limited to Hesselbach triangle where the direct hernia occurs without the excision of the cremaster muscle. So it can be done through a smaller incision. Thank you.

                Comment


                • #9
                  Thank you dr Kang for your reply... if you have still interest in this thread of discussion would you mind giving your opinion of tissue repair success/challenges/risks of direct vs indirect hernia and also how each repair may impact flexibility

                  Comment


                  • #10
                    Also can you enlighten me what you would expect healing wise and activity wise for a patient if a MCvay vs bassini vs Shouldice was the procedure used

                    Comment


                    • #11
                      Originally posted by scaredtodeath View Post
                      Thank you dr Kang for your reply... if you have still interest in this thread of discussion would you mind giving your opinion of tissue repair success/challenges/risks of direct vs indirect hernia and also how each repair may impact flexibility
                      I am sorry that I can not catch the point of your question exactly. I have sometimes difficulty to understand English which is not my mother language. So please let me know your point again particularly about 'risks of direct vs indirect hernia' and 'how each repair may impact flexibility'.
                      And your question could not be answered briefly in several sentences, so please give me a couple of days. Thank you.

                      Comment


                      • #12
                        Big thanks to everyone and their contribution. I've been following every single response including privately. Dr Kang I am also very thankful for your participation on this forum including my topic. Platforms like this one are great so the specialists can be reached out.

                        English is not my first language therefore I apologize ahead for any nonsense and the long winded post.

                        I've been experiencing some long-term pains and aches so I cannot tell for how long I had these hernias. I struggle to distinguish which symptoms are hernia related and which not.
                        But I would like to know what has contributed to the development and what could potentially cause reoccurrence of hernias after the repair.

                        Pain relief with an osteopath. His sessions involved deep pressing onto inguinal ligament and this was extremely painful. He had good intentions and he is not a culprit of hernias (as both didn't knew at the time I even had hernia) but I am confident that he made same tears to them. After the treatments stabbing and slashing pains in the abdomen were more pronounced than before. Ironically he has temporarily reduced the pain elsewhere.


                        Eventually I managed to persuade my GP to have an ultrasound and despite I the operator that I feel pains on both sides he insisted on inguinal hernia in the right groin.
                        I wanted assurance so I booked ultrasound privately and they identified a bilateral inguinal hernias.

                        Till date I still don’t know whether I have direct, indirect or sports hernia. Neither when performing the NHS or the private ultrasound have confirm the type. Therefore I have no choice but to wait for the scheduled appointment.


                        I am not good with describing pains and don't know which ones are hernia related and which aren't. No bulges and no pains when coughing or sneezing, Occasional abdominal stabbing or slashing likely if sitting down or standing. Everything below the waist feels heavy especially legs and there is some dragging feeling in testicles. Aching pelvic, pubic bone, buttocks, thighs, lower back, hips and down the legs. Gastrointestinal system is out of control: bloated & upset stomach (belly is surprisingly large now), flatulence, constipation... Urinating is ridiculous as I need to strain to pee and the bladder never empties so I have to repeat the process multiple times. Sitting down or standing up is unpleasant. I had to stop cycling (I really enjoyed cycling). I am avoiding lifting heavy objects. I sleep mainly on my back or sideways and with the pillow under my knees or between them. Laying on my back doesn't hurt.
                        I manage pains quite well with mild massage, tiger balm, TENS machine. I take some baths with Epsom salts and magnesium flakes. Although I like the feeling of heat I am not sure if it is beneficial. I had to stop breathing technique exercises for straightening the core as it triggered the pain.

                        I will go with a non mesh repair but not decided on the procedure which will be the most suitable for me. Indeed I am perplexed. The costs are another concern.
                        Some time ago I was pretty much decided to go via Biohernia and DR Koch.
                        I became quite worried after reading the post on this forum by user Baris and his horrible experience with Dr Koch. It may be the only unsuccessful procedure done by him but it needs special observation and understanding.

                        Despite above it might be shocking to some, I haven't yet excluded DR Koch, at least until I get a better understanding.
                        Last edited by Bestoption; 06-20-2019, 02:07 PM.

                        Comment


                        • #13
                          t was today unkindly reminded about something else. I've been suffering for about 2 decades with pains below sternum combined with belching and acid reflux Originally the symptoms were mild but in the recent years pains got intensive and lead to spasms, breathing difficulties and bloated upper abdomen. I guess this often happens after overeating, greasy foods, laying down, heavy lifting or stress. I was given regular chest X ray which shown nothing. My GP never looks for any connections but happy to prescribe drugs.
                          I find symptoms very similar to hiatial hernia and hence I have gastrointestinal issues. My presumtion might be wrong, but I do wish I would listen and observe my body long time ago. I am wonder how much damage has acid already done to my esophagus.
                          Last edited by Bestoption; 06-20-2019, 02:08 PM.

                          Comment


                          • #14
                            Bestoption , perhaps you should ask that to your GP. He'll probably ask for an endoscopy, if need, or simply prescribe medication, IMO. Anyway this is not the best forum to discuss that.

                            I have discovered something interesting since my hernia appeared 4 months ago. I use to have some epigastric pain from time to time, most often after meals. It's happened a few times in the past 10 or more years. Sometimes it's quite intense and I even went to an emergency department once and they thought that was some kind of gastritis and gave me omeprazol IV without any benefit.

                            Recently that happened after breakfast and it was so intense I thought I had to go to ED again, but it disappeared after some 30 minutes.

                            Later I found that that this epigastric pain is related to my hernia and it completely disappears if I reduce my hernia.

                            It's interesting not only to see this is related to hernia, but also how meals seem to influence hernia's tension.

                            Also, it's interesting to have had that episodic pain for more than 10 years before hernia appeared. I think this can mean that something in my inguinal area was wrong long before hernia appeared.

                            By the way, this is the only symptom of my hernia so far (apart from bulging of course).

                            Comment


                            • #15
                              I always appreciate reading Dr. Kang's opinion. There aren't many experts in inguinal hernia like him, unfortunately.

                              I think the most important part in his statement above is that most doctors do a lot of repair techniques which they think it's better in each case in stead of doing a single technique, or two at most for direct and indirect. That way that's much more difficult that they are experts in any technique and thus have small rates of complications (we can add that most surgeons do a lot of surgeries and only some hernia repairs, which makes that more important).

                              When I searched for hernia surgeons in Europe I found one that could use more than 7 or 8 techniques with training in centers worldwide. Too much technocracy for me and I discarded him right away (later I even learned that training in Shouldice Clinic consists in watching a few surgeries without touching anything).

                              Also, I'm not very sure that most surgeons are aware that high ligation is mandatory in indirect hernia repair...
                              Last edited by kaspa; 06-20-2019, 03:01 PM.

                              Comment

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