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  • Question for Dr. Kang

    I was reading about the Kang method in another thread, and in particular how the goal of indirect hernia repair is to close the internal ring and reduce it to the appropriate size. This raised a (possibly dumb) question, the answer to which may be painfully obvious: Is it, theoretically, possible to make the incision right at the external ring, move any herniated tissue back up the canal, close the internal ring and then sew the incision up, all without cutting any muscle?

    Obviously I'm not a physician of any kind, and my frame of reference is diagrams on the internet, so I'm sure I'm oversimplifying at least a few things here but was curious none the less.

  • #2
    Hi UhOh!

    I understand what you mean but that kind of approach probably increases the risk of recurrence a lot.
    The internal inguinal ring is located about 2cm apart from the external inguinal ring upwardly and outwardly.
    So it would be very difficult to manage the hernia sac and to fix the internal inguinal ring correcty just through the external inguinal ring without making an incision at the overlying external oblique aponeurosis.
    And that kind of approach needs the larger incision and puts more damage to the surrounding tissue during operation, resulting in more pain after operation and longer recovery time, etc.
    I think there is no advantage at all


    So I wouldn¡¯t try that kind of approach.

    Comment


    • #3
      Thanks, I appreciate the reply and explanation! Figured I was somehow envisioning things in an oversimplified way.

      Comment


      • #4
        Dr Kang,

        Do you have any particular experience with patients who have painful hernias? And separately, do you have experience treating patients with chronic groin pain that is possibly related to a hernia, like the "hidden hernia" phenomena? And if so, has your method been effective for treating those patients to find pain relief?

        Thanks in advance, though this may be better suited for a new topic thread.

        Comment


        • #5
          Hi Chaunce1234,

          Yes, about 30% of my hernia patients complained of pain together with a hernia bulging.
          And occasionally, I have some patients who had inguinal pain for some periods before they finally got the visible inguinal hernias.
          But I don’t do the hernia repairs without the sonographic diagnosis of inguinal hernias, even if they complain of inguinal discomfort.
          Of course, the sports hernia is a different story.

          Actually I don't know exactly what the 'hidden hernia' means, I am afraid.

          Thank you!

          Comment


          • #6
            drkang ,

            What would you say are main symptoms for a sports hernia? I'm not sure if I have one. The doctors are "guessing' I have one.

            Thank you, Dr. Kang!

            Comment


            • #7
              Hi katiebarns,



              Sports hernias almost always occur in people who enjoy violent sports such as soccer or ice hockey.
              I think the most critical factors for the diagnosis of a sports hernia are the pain characteristics and the location of the pain.


              Characteristics of the sports hernia pain:
              The pain from a sports hernia always occurs during hard exercise such as running, playing soccer, etc.
              It also occurs with coughing, sneezing, and sit-up as well..
              And the pain sometimes gets worse more after exercise than during exercise,
              Some patients have the worst pain at the next day, so they hardly get up from a bed nor get off from a car
              And it usually goes away after several days’ rest and comes back easily with an exercise.

              Location of the pain:
              You feel pain in the inguinal canal without a bulging.
              Someone complains of pain around an inguinal area such as over pubic bone, rectus muscle or upper thigh, etc.
              But they are not from sports hernias, but from other sports injuries.
              So you should localize your pain just in the inguinal canal to be diagnosed as having a sports hernia.
              You could, of course, have extra pain around an inguinal area at the same time, but the inguinal pain is essential for a sports hernia diagnosis.

              Thank you!

              Comment


              • #8
                drkang ,

                Thank you for your reply!!

                My injury happened after an exercise during a workout. I don't play a sport you mentioned. It was just lifting weights.

                My pain is in the same area as my previous inguinal hernia repair (in 2015). No sharp pains. Like an achy and dull pain instead. I feel it with just walking and moving every day. I don't have pain with coughing, sneezing, sit ups though. I don't have a bulge. But I would say my pain is in the inguinal canal (as mentioned just previously, same area as my inguinal hernia repair).

                Anyways the 2 doctors think it's a sports hernia but I'm not sure because I don't have all the symptoms. Is it still possible to have a sports hernia if I don't have all the characteristics?

                Thank you so much!

                Comment


                • #9
                  Dear Dr. Kang,

                  I am a 58 year old female. I’ve had intermittent groin pain and classic hernia symptoms for 4 years but no visible or palpable bulge. There was no injury and both my parents have had inguinal hernias. Two years ago, an ultrasound revealed a small, 6mm indirect inguinal hernia. My questions for you:

                  - In your opinion, is this not what is often referred to as an occult or ‘hidden hernia’? If not, what would you call it or how might you diagnose it?

                  - Do you believe that a 6mm defect is too small to cause pain and that my symptoms are likely caused by something else?

                  - do you believe that this hernia will inevitably grow bigger and that a bulge will eventually appear? If so, would it not be better to get it repaired while it is small - particularly as it is symptomatic?

                  - would you perform surgery on such a hernia?

                  Thank you!



                  Comment


                  • #10
                    Originally posted by drkang View Post
                    Hi Chaunce1234,

                    Yes, about 30% of my hernia patients complained of pain together with a hernia bulging.
                    And occasionally, I have some patients who had inguinal pain for some periods before they finally got the visible inguinal hernias.
                    But I don’t do the hernia repairs without the sonographic diagnosis of inguinal hernias, even if they complain of inguinal discomfort.
                    Of course, the sports hernia is a different story.

                    Actually I don't know exactly what the 'hidden hernia' means, I am afraid.

                    Thank you!
                    Thank you for the response. The "hidden hernia" I reference is a situation where a patient has groin pain but no visible or palpable hernia, though a hernia may show up on ultrasound or imaging only, and is found during a surgical procedure. This is a common topic on these forums but I understand it is controversial in the medical community perhaps because of the ambiguity.

                    Comment


                    • #11
                      Originally posted by katiebarns View Post
                      drkang ,


                      Anyways the 2 doctors think it's a sports hernia but I'm not sure because I don't have all the symptoms. Is it still possible to have a sports hernia if I don't have all the characteristics?

                      Thank you so much!
                      Hi katiebarns,

                      I read your another post to understand your situation better.
                      Well, I don’t think your symptoms come from a sports hernia.
                      Sports hernia, as far as I have experienced through the patients so far, is wear and tear of the external oblique aponeurosis, a thin and tight membrane of the inguinal canal just beneath the subcutaneous fat layer.
                      It could be injured by the repeated violent exercise such as playing soccer, and then you could get a sports hernia.
                      However. I read that you had open mesh hernia repair in 2015.
                      After mesh implantation, there is some fibrotic adhesion around the aponeurosis, so there might be little chance for you to get a sports hernia there.
                      Instead, I think your symptoms might come from the injury of the tissue around the implanted mesh.
                      The mesh is conglomerated with the surrounding tissue.
                      So after unusual physical movement, there could be some injury to the muscular structure which is attached to the mesh.
                      I have one patient with inguinal mesh who repeatedly complained of inguinal pain for some period after extreme activity once or twice a year.

                      Thank you!

                      Comment


                      • #12
                        Originally posted by Tilbis View Post
                        Dear Dr. Kang,

                        I am a 58 year old female. I’ve had intermittent groin pain and classic hernia symptoms for 4 years but no visible or palpable bulge. There was no injury and both my parents have had inguinal hernias. Two years ago, an ultrasound revealed a small, 6mm indirect inguinal hernia. My questions for you:

                        - In your opinion, is this not what is often referred to as an occult or ‘hidden hernia’? If not, what would you call it or how might you diagnose it?

                        - Do you believe that a 6mm defect is too small to cause pain and that my symptoms are likely caused by something else?

                        - do you believe that this hernia will inevitably grow bigger and that a bulge will eventually appear? If so, would it not be better to get it repaired while it is small - particularly as it is symptomatic?

                        - would you perform surgery on such a hernia?

                        Thank you!


                        Hi Tilbis,

                        I believe small hernia could cause pain and the hernia pain sometimes even more worse when a hernia is small.
                        I also believe the small hernia probably grow bigger and visible in some time.
                        And yes, I sometimes perform my tissue repair on that small hernia.

                        Thank you!

                        Comment


                        • #13
                          Hi Chaunce1234,

                          If I follow your definition of the hidden hernia, I have a lot of experiences of repairing the hidden hernias so far.
                          Among patients who come to surgery with visible hernias on the one sides, the small inguinal hernias are often found on inguinal sonography on the opposite sides.
                          If the patient wants, the hidden hernia on the opposite side is operated on at the same time.
                          However, I remember that very few of these unknown small hernias caused discomfort, including pain.
                          Of course, I think that even a very small hernia without bulging can cause pain but this does not seem to be that much.
                          Thus, I need more time to find out whether the pain will disappear after repairing a painful small inguinal hernia.

                          Comment

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