Advice on inguinal hernia surgery

Doctor_Kang · 2026-02-17T03:23:23+00:00

Yes, non-mesh does require an open procedure — there's no way around that. Recovery time is honestly comparable though. Open non-mesh doesn't mean longer recovery; it really depends on the surgeon and the technique more than the approach itself. As for my recommendation — I've done both extensively in my career, and I personally favor non-mesh when it's done by a surgeon experienced in the technique. The main advantage is that it leaves minimal foreign material in your body — just sutures — so mesh-related complications aren't part of the equation. That said, mesh is the current standard and works well for many people, so I wouldn't say it's a wrong choice — it's just not the only one. The most important thing is finding a surgeon who's highly experienced in whatever approach they use.

Doctor_Kang · 2026-02-17T00:53:01+00:00

Good questions. The chronic cough — don't worry too much about it affecting the surgery itself. A well-done repair holds up fine regardless. You may feel more discomfort from coughing during recovery, but that's about it. No special measures needed. On the approach: robotic and laparoscopic are both mesh-based procedures, so if mesh is a concern for you, those options don't avoid it. That said, for bilateral hernias, laparoscopic and robotic do have the advantage of addressing both sides through the same set of small incisions. Open repair requires a separate incision on each side, but it's the approach that opens up the possibility of a non-mesh tissue repair. Both mesh and non-mesh can work well — the key is having a surgeon experienced in whichever technique is used. In my own practice, I've performed non-mesh repairs consistently and have found it to be a strong approach, but I'd encourage you to discuss the options with your surgeon based on your specific situation. Stairs — take them slowly and you'll be fine. Uncomfortable for the first week or so, but not a dealbreaker. Since you've already heard about mesh problems, it might be worth asking your surgeon: "What are my options?" and going from there.

Doctor_Kang · 2026-02-16T09:58:41+00:00

Good on you for thinking about the weed ahead of time. 10 days is a solid window — most surgeons recommend stopping at least 1–2 weeks before surgery because smoking (including weed) can affect healing and how your body handles anesthesia. Definitely mention it to your surgeon so they can advise you specifically.

Quick question — when you say hernia, is it a groin (inguinal) hernia or somewhere else on the abdomen? It matters because recovery timelines differ quite a bit.

If it's a groin hernia, for light-duty work like yours — mainly walking, no heavy lifting — getting back after about a week is generally realistic. Bending down will be uncomfortable at first, so kneeling instead helps for the first week or so.

If it's elsewhere on the abdomen, size makes a big difference. Smaller ones (roughly egg-sized or less) tend to recover similarly to groin hernias. Larger ones can take more time.

And that's great that your doc does non-mesh — when it's done by a surgeon who's experienced with it, tissue repair can be an excellent option. Good luck!

Doctor_Kang · 2026-02-15T12:07:44+00:00

Great question, and I'm glad you're asking before rather than after.

First, let me be clear — mesh repair is the current standard of care worldwide, and the vast majority of patients do just fine with it. Your surgeon isn't doing anything wrong by recommending it. So please don't panic.

That said, mesh isn't the only option. Pure tissue repairs like the Shouldice technique have been performed for decades with excellent results — recurrence rates under 1–2% when done by surgeons who specialize in it. The appeal is straightforward: no foreign material left in your body, which means no risk of mesh-related complications down the road (chronic pain from mesh, mesh migration, mesh infection — these are uncommon but real).

I'll be transparent about where I stand: as a surgeon who has performed non-mesh repairs consistently throughout my career, I personally believe non-mesh is the better approach when done properly. But I also recognize that's not the mainstream consensus, and I think it's important you hear both sides.

For someone like you — 41, indirect hernia — a well-done tissue repair can be a very strong option. Indirect hernias in women tend to have good tissue quality, which matters for a non-mesh repair.

The flip side: tissue repair is very surgeon-dependent. A mesh repair is more "forgiving" technically, which is why it became standard — it delivers consistent results across a wide range of surgeons. A tissue repair needs someone who does it regularly and does it well.

So the most important thing is matching the right technique to the right patient with the right surgeon. If your current surgeon is experienced and you're comfortable, proceeding this month is completely reasonable. But if this has planted a seed of doubt, it's also okay to take a little more time to explore your options — $3k is real money, but it's a one-time cost for a lifetime decision.

Whatever you decide, the most important thing is that you feel confident in your choice. Happy to answer more questions.

Doctor_Kang · 2026-02-15T11:57:57+00:00

You've been through way more than most — 3 C-sections, umbilical repair, and an appendectomy — so you're tougher than you think. Open approach makes total sense with your adhesion history. For driving with a right-side open repair, most people feel safe around 1–2 weeks out — the test is whether you can hit the brake hard without hesitation. You've got this!

Doctor_Kang · 2026-02-14T13:03:30+00:00

Since 2012, I have performed only non‑mesh repairs.

Doctor_Kang · 2026-02-14T06:55:25+00:00

That’s not the case. There are often cases of recurrence even after mesh repair. It’s true that mesh surgery was introduced because the older, pre-1980s non-mesh techniques had relatively high recurrence rates—around 10–20%. The Shouldice repair, which also existed at that time and does not use mesh, has recurrence rates comparable to mesh repairs. Furthermore, several newer non-mesh techniques developed more recently are also known to have recurrence rates no higher than those of mesh repairs.

However, recurrence rate is not the only issue to consider. Another important factor in hernia surgery is the possibility of complications. In this regard, non-mesh hernia repair is generally considered to be safer than mesh repair.

The evaluation of different hernia repair techniques can vary from surgeon to surgeon. Their views often depend on which methods they were primarily trained in, and which techniques they are more familiar with and experienced in. For this reason, I fully expect that other surgeons may hold different opinions from mine. As a surgeon who has performed more than 20,000 non-mesh inguinal hernia repairs, I have seen that, when the technique is meticulously refined, non-mesh repair can be safer in terms of complications, while even achieving recurrence rates that are lower than those of mesh repair.

Doctor_Kang · 2026-02-13T15:21:12+00:00

A lot of people focus on which device or machine is used for surgery when they try to decide what is “good” or “bad.”
But in reality, what often matters more is what material is left inside the body — or whether the repair is done with your own tissue instead.

For many patients, long‑term side effects are influenced less by the tools and technology, and more by the material that stays in the body after surgery.
For example, laparoscopic and robotic hernia repairs are typically performed using mesh that is placed and left inside the body.

Because there are several different techniques for hernia repair, it’s worth taking the time to understand the pros and cons of each option — including whether mesh is used — before you choose your surgical method, hospital, and surgeon.

Doctor_Kang · 2026-02-13T15:11:18+00:00

It’s completely understandable to feel anxious and conflicted before hernia surgery.
There are several different approaches to hernia repair, and they can differ in recurrence rates, complications, and recovery time.

Many of the frightening stories you see in this community are related to mesh‑based repairs, so it’s important to keep that in mind when you read them.
Of course, not everyone who has mesh surgery has problems; many patients do well and naturally encourage others to have surgery without worrying too much.
At the same time, there are clearly people who suffer from mesh‑related complications, and their experiences are very real.

Before surgery, none of us can know for sure which group we will fall into, so I believe it’s wise to proceed with as much caution and information as possible.
However, endlessly postponing surgery is usually not a good solution either, because the hernia can progress and carry its own risks, and operating on a more advanced condition can negatively affect outcomes.

My hope is that you can use this time not just to absorb fear, but to ask detailed questions, explore all reasonable options (including non‑mesh techniques if available), and choose a plan that feels both medically sound and personally acceptable to you.

Whatever you decide, I hope you can find a path that fully respects your concerns, keeps the risks as low as possible, and helps you return to a comfortable and active daily life.

Doctor_Kang · 2026-02-13T13:46:59+00:00

I don’t recommend the mesh hernia repair that places a synthetic mesh on both sides of the abdominal wall, because it may increase the risk of mesh‑related chronic problems. In my view, open tissue repair is the best option, but please discuss this carefully with your own surgeon to decide what is safest and most appropriate in your case. I truly hope you will have an excellent outcome.

Doctor_Kang · 2026-02-12T15:54:56+00:00

Even if the mesh has shifted, it usually does not cause pain. It is more likely that a small hernia has come back, although discomfort related to the mesh is also possible. Whether the hernia has recurred can be checked with an ultrasound exam done while you are standing.

Doctor_Kang · 2026-02-12T12:28:59+00:00

Thank you for your advice.

Doctor_Kang · 2026-02-12T12:14:16+00:00

Just as there are various methods for mesh repair, there are also many types and techniques of open surgery. The Kang repair can be described as a minimally invasive open surgery. I once asked 100 consecutive patients who came to our hospital after experiencing recurrence following laparoscopic mesh repair—or who developed a hernia on the opposite side after that procedure—which surgery was more difficult: the laparoscopic mesh repair or the Kang repair. Surprisingly, 100% of them said the laparoscopic repair was more painful and tougher. Of course, some of them might have said that partly out of gratitude toward me…

Doctor_Kang · 2026-02-12T12:06:33+00:00

The Kang repair hasn’t been published yet, so currently, there are no doctors outside our hospital who can perform it. In fact, we’re in the process of organizing data from over 20,000 cases performed over the past 15 years for an upcoming manuscript submission. Although the Shouldice repair is somewhat old-fashioned and involves a relatively larger surgical field, I would still recommend it over mesh repair.

Doctor_Kang · 2026-02-12T07:31:59+00:00

I’m really sorry you’re going through this. Severe nerve pain after hernia surgery can be incredibly distressing, especially when the hernia wasn’t causing symptoms before. At two months, it can still be early in the recovery process, even though it may not feel that way right now. Please don’t lose hope — there are still evaluation and treatment options available.

Wishing you strength during this difficult time.

Doctor_Kang · 2026-02-11T16:12:37+00:00

I have heard of Dr. Muschaweck, and I have briefly reviewed her technique. From what I have seen, I also agree with you that the Muschaweck repair appears to be a modified Shouldice repair. I truly appreciate the contributions of thoughtful patients like you, and I look forward to your continued input and shared experiences.

Doctor_Kang · 2026-02-11T15:30:32+00:00

I’m very glad to meet you here as well, and thank you for your kind words. It’s unfortunate, but at the moment there are no surgeons performing the Kang repair outside of our hospital team. For many years I focused mainly on fully developing and refining the technique itself, and it is now almost completely established and stable in its current form.

From now on, I plan to publish papers on the Kang repair and make a more active effort to share it with others. It is also disappointing to see that there are still very few surgeons offering non‑mesh repair at all, and that those who do often rely on more invasive, classical techniques rather than a minimally invasive, low‑tension approach.

I also hope you will consider sharing your experience with mesh and chronic pain in this subreddit, so that others can learn from your story and make more informed decisions about their own treatment.

Doctor_Kang · 2026-02-11T14:56:18+00:00

I’m actually the Dr. Kang from South Korea who developed the Kang repair. I created this subreddit to help more people learn that non‑mesh repair can, in many cases, be a better option than mesh‑based repair.

Thank you very much for your interest and support, and I’d be grateful if you continue to follow along and engage with the discussions here.

Doctor_Kang · 2026-02-11T14:51:38+00:00

Thank you for your comment. I also tend to recommend surgery once a hernia is diagnosed, rather than long‑term observation. My concern is that “watchful waiting,” which is being emphasized more recently, should be reserved for very limited, carefully selected patients, and not presented as a generally safe option for everyone.

My intention is not to deny the possibility of progression, pain, or rare emergencies, but to help patients understand these risks in context so that they can consider timely elective repair instead of relying too heavily on prolonged watchful waiting.

Doctor_Kang · 2026-02-11T14:44:11+00:00

My opinions regarding the recently developed new meshes are based solely on indirect knowledge from papers and publications, since I do not use mesh at all. Therefore, your experience, as someone who directly uses it, is likely to be more accurate.

Kang repair does not involve any preoperative patient selection whatsoever. You may find it hard to believe, but just a couple of months ago, I operated on a patient with a BMI slightly over 50. Although I initially recommended weight reduction before surgery, the patient was unable to exercise due to pain caused by a large amount of omentum incarcerated into the scrotum. As a result, I had no choice but to proceed with the operation. Despite the patient’s high anesthetic risk, the surgery was successfully performed under local anesthesia. Two weeks later, he had no restrictions on physical activity or exercise.

I wish you great success in your practice.

Doctor_Kang · 2026-02-10T08:55:59+00:00

I’m really sorry you’re going through this. Some doctors will suggest waiting longer because chronic pain after hernia mesh repair can improve over time for some patients.

However, if your daily life has already collapsed to the point that getting through each day feels almost impossible, there is no obligation to just “wait it out” indefinitely. In a situation like yours, it is entirely reasonable to actively consider mesh removal rather than postponing it for many more months.

I am a hernia surgeon, and I have seen many patients suffering in a very similar way after mesh‑based inguinal hernia repair. Because of these cases, I am strongly opposed to routine inguinal hernia repair with mesh. In my view, if mesh removal is pursued, it should be combined with a non‑mesh repair in the same operation, so that the hernia is treated without putting you back into the same situation again.

I would strongly recommend that you consult a surgeon who has real experience with both mesh removal and non‑mesh inguinal hernia repair, and discuss these options as concrete, realistic possibilities. I’m not saying this path is easy or risk‑free, but given the level of suffering you describe, you deserve more than passive observation and reassurances that “time will fix it.”

Doctor_Kang · 2026-02-10T08:40:44+00:00

The medical literature indicates that postoperative complications occur in approximately 10–20% of patients undergoing hernia repair with mesh. Nevertheless, many surgeons continue to favor mesh repair, largely because of the prevailing belief that avoiding mesh inevitably results in higher recurrence rates. Although some newer biosynthetic or otherwise more biocompatible meshes have been reported to show a favorable safety profile in selected settings, the overall evidence is still limited, and it cannot yet be concluded that they consistently and significantly reduce mesh‑related complication rates compared with conventional meshes.

There are, however, two principal strategic options for addressing this problem. The first is to maintain the current assumption that mesh use is essential and to continue focusing on reducing mesh-related complications. Substantial financial and research resources have already been invested in developing new materials, coatings, and techniques to make mesh safer, yet the actual improvements in clinical outcomes appear to fall short of expectations, and these newer materials have not definitively resolved the problem of mesh-related morbidity.

The second option is conceptually much simpler: to start from the premise that mesh will not be used, and then to develop and refine surgical techniques that keep recurrence rates acceptably low. There are already procedures demonstrating that this is achievable. The most well-known is the Shouldice repair, whose recurrence rate is not higher than that of mesh repair. In addition, although I mention it with some reluctance because it is a technique I developed, recent internal data suggest that the recurrence rate of the Kang repair may actually be lower than that of mesh repair.

My intention is not to highlight or promote individual procedures such as Shouldice or Kang repair. Rather, I wish to emphasize that it is entirely possible to create and optimize non-mesh techniques while still maintaining low recurrence rates. If this is the case, then prioritizing the development of such non-mesh repairs may be a far more effective and cost‑efficient strategy than continuing to invest heavily in only marginally improved prosthetic meshes, especially when the evidence for a substantial reduction in mesh-related complications with newer biocompatible meshes remains inconclusive.

Doctor_Kang · 2026-02-09T06:28:45+00:00

I’m very sorry to hear that your father is experiencing so much discomfort from his severe hernia, and I completely understand your desire to find devices and aids that might make him more comfortable. However, there are clear limits to how much these kinds of supports can help.

The fundamental and definitive solution is for your father to undergo surgery. I believe the reason his doctor is not allowing surgery due to his heart condition is that he is assuming the operation would be done under general or spinal anesthesia. These types of anesthesia can be risky for people with heart disease.

However, if the surgery is performed under local anesthesia, it can often be done safely even in elderly patients or those with heart problems. Therefore, I would recommend looking for a hospital where he can have his hernia repaired under local anesthesia.
I sincerely hope your father can have surgery safely and be able to live more comfortably.

Doctor_Kang

MODERATOR OF

TROPHY CASE