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Indirect Hernia no-mesh repair by Dr. Koch

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  • Indirect Hernia no-mesh repair by Dr. Koch

    Thank you Chaunce1234 for introducing me to Bio Hernia and Dr. Koch!

    I don't know if I have mentioned this before, but my brother also had an inguinal hernia. Up until recently that is, until he met Dr. Koch. After a lot of research and many considerations we both decided to travel to meet with Dr. Koch for a consultation. My hernia is still asymptomatic, but my brother's hernia had gone down to the scrotum. So he had to do away with his hernia to avoid entanglement and ease the symptoms of pain he had been experiencing for the last two years. It also prevented him from working on his other health issues, such as following through with his physicals to improve his back problems. He had his hernia for about 10 years I think.

    It was an open surgery. The technique used was Shouldice suture repair with four absorbable and two permanent sutures. No mesh was used. The wound was closed very nicely. I have not seen a wound closure that looks that good. The scar is barely noticeable, it's as if you drew a tiny line with a pencil. So if you care for such things, there is no need to worry if you go to Dr. Koch. My brother had his appendix removed when he was younger and he still has the scars to show it. That closure looks as if a tiny tractor plowed through the skin. It's a big difference.

    It's been about one month now since the surgery and my brother is feeling very good. His hernia has not returned. The scrotal sack is a bit enlarged on the side where the intestine used to be. That's the price you pay for not fixing your problem. That's something to think about if you are reading this and you also have a scrotal hernia. He does complain about stabbing kind of pain from time to time that radiates down to his foot on the hernia side. But it's not unbearable pain and he only feels it sometimes. He also has a tiny egg like enlargement on the scrotal sack. I suspect this could be something called "hydrocele of the cord".

    We are both very grateful to Dr. Koch and his team. I can recommend Dr. Koch to anyone looking for an experienced surgeon to do a mesh free hernia repair in Europe.

    If any of you have questions about the surgery, about Dr. Koch or the clinic, feel free to ask me. I will do my best to answer your questions. We will both most likely be seeing Dr. Koch early next year where I will get my own hernia sorted out and my brother will get his checkup.

  • #2
    This is excellent feedback, thanks for sharing this experience with Dr Koch and hopefully this information will be helpful to other future patients.

    Do you know if your brother was in constant pain before the surgery, and to what degree if any?

    Please continue to keep us updated on your brothers progress, as well as your own.

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    • #3
      Hi im glad it went well..
      was the cremaster muscle cut for ypur brothers then resuspended?

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      • #4
        In regards to the stabbing pain I described earlier, he has been experiencing this for about a year before the surgery. I'm not sure what to make of it, but if it's been there before the surgery, I think it's unlikely to be caused (or worsened) by the hernia surgery itself. It may not be related to the hernia at all.

        My brother has been diagnosed with discus hernia. This diagnosis was discussed with Dr. Koch and made possible thanks to Dr. Koch because my brother has been having back problems for some time now and he was refused an MRI scan back at home. On the day of the first visit, after explaining the back problem, Dr. Koch called his colleague Dr. Boris who operates his own radiologist office at the same medical center and my brother was offered an MRI scan which later confirmed his suspicion that he did without doubt have a herniated disc.

        So if any of you are in need for an MRI scan, just know that these services are also offered at the same medical center. There are in fact a dozen of different private practitioners that all collaborate and operate under the same roof.

        If we go back to the hernia itself, my brother has had his hernia for about 10 years, and I think he said that it only became problematic (symptomatic) during the past 4 years which is when it slipped down into the scrotum. Like I said, it's difficult to say what pain symptoms were caused by his bad back and which ones were caused by his hernia. But I think it's reasonable to say that his hernia related pain was no more than 4 on a scale of 10. Judging by the number of complaints I hear from him... hehe... I would say it's likely a 2 out of 10 now, and that's only on the bad days, on good days it's closer to 0.

        It all depends on what condition you are in when you go in for the surgery, and what other health issues you have. But I would say the sooner you treat your hearnia while it is still not symptomatic, the better the chances of success are and that you will not have any chronic pain.

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        • #5
          In regards to cremaster muscle... it was "split" according to Dr. Koch. My understanding is that it was sliced but not dissected away. The cremaster muscle stands in the way, you have to get past it somehow to pull the herniated intestine back into place. The easiest way to do so would be to dissect it, which if I am not mistaken is the standard procedure in the original Shouldice technique. But with Dr. Koch everything is about preservation and conservative approach, so he makes a smaller cut in it, just enough so he can grab hold of the intestine and pull it back up. It is likely more time consuming but Dr. Koch has had hundreds of patients to practice on so he can probably do it blind-folded. I think he said he does around 300 to 400 operations per year. If memory serves me right, he has been doing hernia surgeries for the last 12 years... you do the math.
          Last edited by John Fortem; 11-22-2018, 04:38 PM.

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          • #6
            Dr. Koch is a good friend with Dr. Muschaweck and he has met with Dr. Desarda at his clinic in India. He had great things to say about them both. But he was not a fan of the one-size-fits-all in regards to the Desarda method. In fact, he insisted that the majority of inguinal hernias in men are of the indirect type and are the result of bad ring closure during development.

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            • #7
              Thats probarbly correct yes but the main reason for cutting the cremester muscle is not for actually reaching the repair itself.. its due to the fact that if its not cut and resuspended in the repair it damages the repair in the future. Both dr muschaweck and and dr koch have been to the shouldice clinic to observe operations and understand the technique.
              The chief surgeon here has been operating here for 41 years on just hernias

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              • #8
                John Fortem, i just have questions for you. When the hernia or intestines of your brother slipped down to the scrotum, was he still able to bring it, meaning intestine, back by hand or when lying down or it was already permanently lodged in the scrotum? Since it started slipping down to his scrotum, how many years did he wait before surgery? I have a right inguinal hernia and I notice it is starting to go down to my scrotum. I can still press it back even if Im standing or lying down. My fear is it will get worse and get entangled with the other matters in my scrotum. Thank you.

                Comment


                • #9
                  Originally posted by Baris View Post
                  Thats probarbly correct yes but the main reason for cutting the cremester muscle is not for actually reaching the repair itself.. its due to the fact that if its not cut and resuspended in the repair it damages the repair in the future. Both dr muschaweck and and dr koch have been to the shouldice clinic to observe operations and understand the technique.
                  The chief surgeon here has been operating here for 41 years on just hernias
                  What I have read before is that the cremaster muscle is dissected in order to prevent the testicle from sliding up and sort of force opening the repair site unwillingly if you understand what I mean. But I have no date to support this.

                  But does this apply to all kinds of inguinal hernias? I mean does it even apply to scrotal hernias where the intestine has gone down to the scrotum? I think this is what Dr. Koch meant, that in this particular case he has to get past the cremaster muscle to get to the intestine and properly put it back into place. But I guess if your hernia is only superficial, i.e. it has not gone down tot he scrotum, then he may not need to do anything about your cremaster muscle. This is my own interpretation, not his words exactly.

                  I don't know about Dr. Muschaweck, I can only tell you what Dr. Koch has told me in person, that is: he himself has been to the Shouldice clinic a number of times and has even published some research papers together with some of the doctors there or are finishing up a new paper (I don't recall exactly which it was).

                  I think 41 years is a lifetime of dedication to a single topic or profession, but even 12 years of experience speaks volumes compared to maybe 1 to 2 years of experience by your general surgeon available at your local hospital. I am only speaking about what is available for me at home. And of course they all use meshes here. I rather have my cremaster muscle cut than have a mesh implant.

                  Comment


                  • #10
                    Originally posted by fidel18 View Post
                    John Fortem, i just have questions for you. When the hernia or intestines of your brother slipped down to the scrotum, was he still able to bring it, meaning intestine, back by hand or when lying down or it was already permanently lodged in the scrotum? Since it started slipping down to his scrotum, how many years did he wait before surgery? I have a right inguinal hernia and I notice it is starting to go down to my scrotum. I can still press it back even if Im standing or lying down. My fear is it will get worse and get entangled with the other matters in my scrotum. Thank you.
                    Sorry for the late reply! I haven't been to the forum in a long while. That's called a retractable hernia. No, his hernia was not retractable. Not after it had gone down into the scrotum. And he has told me that he can't recall ever being able to push it back in or that it would retract back into place on its own when laying down. So, no!

                    He had it for about 10 years in total. He had started having pain in the groin from abdominal pressure for the last 2 years, so the pain started in year 8. I would approximate that it started to slide down about 1 year before that. So the order of events would be something like this:

                    Year 0: hernia started to bulge out
                    Year 7: hernia started going down to the scrotum
                    Year 8: hernia is in the scrotum and groin pain starts to develop
                    Year 10: hernia is operated on

                    It's been nearly 4 months now and he is feeling good 90% of the time and has no symptoms of pain, but he sometimes feels some sort of discomfort. I don't know what to make of it. But the 4 absorbable sutures should all be absorbed by now and everything is held in by the 2 permanent sutures. He still has that thing that looks like a hydrocele. His discomfort might as well be coming from this area. He still doesn't know what exactly this is.

                    I myself will be visiting Dr. Koch very soon for my own surgery. I am looking forward to it and to have this done, but at the same time I am starting to feel nervous about it. I know I will have to do it sooner or later, and it's better to have ti done sooner.

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                    • #11
                      Dr Koch is an amazing surgeon and an excellent option in Europe. He’s also very in tune to tailoring to the needs of each patient.
                      #ItsNotJustAHernia
                      www.BeverlyHillsHerniaCenter.com

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                      • #12
                        Dr Koch has an excellent reputation.
                        Your brother probably had an indirect hernia. In that situation the hernia sac travels inside of the spermatic cord and
                        Dr Koch would split but not significant damage the cremasteric muscle to get to the hernia sac.
                        Regards.
                        Bill Brown MD

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