# Femoral Hernia — GCMD Library living collection

Everything in the library about femoral hernia — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 75 cited statements

## Episodes
### In-Depth Reviews
- [Inguinal Hernia With M. Rosen](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756) — podcast · 31:05 · [machine version](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756.md)
- [Inguinal Hernia With M. Rosen](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757) — podcast · 31:05 · [machine version](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757.md)
- [Inguinal Hernia With M. Rosen](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758) — podcast · 31:05 · [machine version](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=0) Introduction and Asymptomatic Hernias (Ep 1)
- [5:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=300) High-Risk Patients and Non-Operative Management (Ep 1)
- [7:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=475) Selecting Operative Approach (Ep 1)
- [13:52](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=832) Laparoscopic Technique and Anatomy (Ep 1)
- [20:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1240) Mesh Selection and Fixation (Ep 1)
- [24:27](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1467) Open Repairs and Special Situations (Ep 1)
- [28:04](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1684) Recurrent, Bilateral, and Incarcerated Hernias (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=0) Asymptomatic hernias and observation strategy (Ep 2)
- [5:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=300) Non-operative management in high-risk patients (Ep 2)
- [7:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=475) Selecting operative approach for primary hernias (Ep 2)
- [13:52](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=832) Contraindications and limitations of laparoscopy (Ep 2)
- [17:06](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1026) Laparoscopic technique and mesh selection (Ep 2)
- [23:43](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1423) Mesh fixation and open repair technique (Ep 2)
- [25:18](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1518) Femoral hernia management (Ep 2)
- [28:04](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1684) Special scenarios: recurrent, bilateral, and incarcerated hernias (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=0) Asymptomatic Hernias and Observation Strategy (Ep 3)
- [5:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=300) Non-operative Management in High-Risk Patients (Ep 3)
- [7:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=475) Selecting Operative Approach for Primary Hernias (Ep 3)
- [13:52](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=832) Contraindications and Patient Selection for Laparoscopy (Ep 3)
- [17:06](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1026) Laparoscopic Technique and Mesh Selection (Ep 3)
- [23:43](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1423) Mesh Fixation and Open Repair Technique (Ep 3)
- [25:18](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1518) Femoral Hernia Management (Ep 3)
- [28:04](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1684) Special Scenarios: Recurrent, Bilateral, and Incarcerated Hernias (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "In VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, risk of emergency presentation requiring operation was less than 1%, specifically one-third of 1%" — Michael Rosen (clinical) [Ep 1 · 3:22](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=202)
- "In VA study over two years, almost one-third of observed patients developed symptoms and needed operation, with no worse outcomes than immediate surgery group" — Michael Rosen (clinical) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=240)
- "By five years follow-up in VA study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms" — Michael Rosen (clinical) [Ep 1 · 4:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=260)
- "Learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies" — Michael Rosen (clinical) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=540)
- "Risk of chronic pain in laparoscopic inguinal hernia repair, when done right, is lower than in open inguinal hernias because mesh is placed away from nerves" — Michael Rosen (clinical) [Ep 1 · 9:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=560)
- "Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair" — Michael Rosen (clinical) [Ep 1 · 12:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=730)
- "Most important part of laparoscopic repair is parietalization of the cord - stripping peritoneum off the cord inferiorly and posteriorly" — Michael Rosen (clinical) [Ep 1 · 18:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1100)
- "Risk of recurrence in laparoscopic repair is peritoneum coming under the mesh inferiorly and going back out to the defect" — Michael Rosen (clinical) [Ep 1 · 18:53](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1133)
- "Stoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter mesh or 6 by 6 inch mesh" — Michael Rosen (guideline) [Ep 1 · 19:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1180)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene), midweight is 40-50 grams per meter squared, lightweight (Ultrapro) is less than 30 grams per meter squared" — Michael Rosen (clinical) [Ep 1 · 21:02](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1262)
- "Lighter weight mesh has advantage of less foreign body and less contraction, but disadvantage is half the material with risk of fracturing in direct hernias where it bridges and muscles never come together" — Michael Rosen (clinical) [Ep 1 · 21:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1310)
- "No evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation" — Michael Rosen (clinical) [Ep 1 · 24:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1449)
- "If absorbable fixation is put through a nerve, it is the neuroma that causes the problem, not the tack itself" — Michael Rosen (clinical) [Ep 1 · 24:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1460)
- "Mounting evidence supports placing medium-weight polypropylene mesh in contaminated fields" — Michael Rosen (clinical) [Ep 1 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1496)
- "For recurrent hernia, should go where nobody has been before; if both spaces have been operated, go where surgeon is most skilled" — Michael Rosen (opinion) [Ep 1 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1692)
- "For bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach" — Michael Rosen (opinion) [Ep 1 · 28:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1710)
- "Surgeons learning laparoscopic technique should avoid bilateral and recurrent hernias during learning curve, though these patients may benefit most" — Michael Rosen (opinion) [Ep 1 · 28:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1720)
- "In the Fitzgibbons VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, the risk of presenting with an emergency problem (incarceration/strangulation) requiring operation was less than 1% (actually one-third of 1%) over the initial study period." — Michael Rosen (host_summary) [Ep 2 · 3:22](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=202)
- "In the Fitzgibbons study, almost one-third of observed patients developed symptoms requiring operation within two years, and by five years almost three-quarters developed symptoms." — Michael Rosen (host_summary) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=240)
- "Patients who developed symptoms during observation in the Fitzgibbons study did not do any worse with their eventual operation compared to immediate repair." — Michael Rosen (host_summary) [Ep 2 · 4:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=260)
- "For an 89-year-old with asymptomatic hernia, observation is appropriate because odds are in a couple years they might not develop symptoms, but in younger patients the odds are against them living the rest of their life without symptoms." — Michael Rosen (opinion) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=280)
- "Inguinal hernias can be repaired under local anesthesia in high-risk patients with severe comorbidities (cardiac disease, ascites, coagulopathy)." — Michael Rosen (clinical) [Ep 2 · 6:32](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=392)
- "The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200-250 cases required." — Michael Rosen (host_summary) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=540)
- "The primary advantage of laparoscopic repair is placing mesh away from nerves, resulting in lower risk of chronic pain compared to open repair when done correctly." — Michael Rosen (clinical) [Ep 2 · 9:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=560)
- "Chronic pain incidence in open inguinal hernia repair varies depending on measurement method: very high if detailed surveys are used, lower if only counting patients who present with complaints." — Michael Rosen (epidemiological) [Ep 2 · 9:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=590)
- "Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair." — Michael Rosen (clinical) [Ep 2 · 12:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=730)
- "The disadvantage of laparoscopic repair is operating near intestines with risk of intestinal injury and major blood vessel injury, though this risk should be incredibly low with proper technique." — Michael Rosen (clinical) [Ep 2 · 12:25](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=745)
- "In elderly patients or those on anticoagulation requiring quick restart, open repair is preferred to avoid dissecting the retroperitoneal space." — Michael Rosen (opinion) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=800)
- "In a 78-year-old with symptomatic hernia on one side and asymptomatic hernia discovered laparoscopically on the other side, repairing the asymptomatic side doubles anesthetic time and increases hematoma risk without clear benefit." — Michael Rosen (opinion) [Ep 2 · 14:26](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=866)
- "Previous lower abdominal surgery increases risk of enterotomy and OR time for laparoscopic repair; if patient has not had previous open inguinal hernia, open approach is preferred." — Michael Rosen (opinion) [Ep 2 · 16:26](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=986)
- "Previous prostate surgery creates unpredictable difficulty for laparoscopic repair, ranging from straightforward to brutal; currently managed with open repair." — Michael Rosen (opinion) [Ep 2 · 16:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1015)
- "The most important part of laparoscopic repair is parietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly), a principle promoted by Rene Stoppa in open preperitoneal repairs." — Michael Rosen (clinical) [Ep 2 · 17:58](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1078)
- "The inferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for creating peritoneal holes, and close to vessels." — Michael Rosen (clinical) [Ep 2 · 18:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1120)
- "Inadequate inferior peritoneal dissection leads to use of smaller mesh, but Stoppa's original description for unilateral inguinal hernia specified never using less than 15×15 cm (6×6 inch) mesh, which is larger than most laparoscopic meshes being placed." — Michael Rosen (host_summary) [Ep 2 · 19:05](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1145)
- "For large direct hernias, heavier weight mesh material should be used." — Michael Rosen (opinion) [Ep 2 · 20:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1230)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene), midweight is 40-50 grams per meter squared, and lightweight (Ultrapro) is less than 30 grams per meter squared." — Michael Rosen (clinical) [Ep 2 · 21:02](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1262)
- "Lightweight mesh has less foreign body and may contract less due to better ingrowth, but has half the material and is at risk for fracturing, particularly in direct hernias where it bridges and muscles never come together." — Michael Rosen (clinical) [Ep 2 · 21:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1310)
- "Heavier weight mesh rarely breaks but can cause chronic pain if wrinkles or buckles are present in the groin." — Michael Rosen (clinical) [Ep 2 · 22:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1350)
- "Surgeons commonly downsize preformed meshes; for inguinal hernia repair, never use smaller than a large preformed mesh to cover the entire myopectineal orifice." — Michael Rosen (opinion) [Ep 2 · 23:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1380)
- "If struggling with mesh placement during laparoscopic repair, the problem is inadequate dissection of the space, not oversized mesh; the solution is to remove mesh and dissect more widely." — Michael Rosen (clinical) [Ep 2 · 23:24](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1404)
- "There is no evidence that absorbable fixation causes reduction in pain, provides better fixation, or improves long-term outcomes compared to permanent fixation." — Michael Rosen (clinical) [Ep 2 · 24:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1449)
- "If absorbable tack is placed through a nerve, it is the neuroma that causes the problem, not the tack itself." — Michael Rosen (clinical) [Ep 2 · 24:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1460)
- "There is mounting evidence that medium-weight polypropylene mesh can be placed in contaminated fields, with several series in ventral hernias supporting this." — Michael Rosen (host_summary) [Ep 2 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1496)
- "Bassini or McVay tissue repairs remain appropriate operations for contaminated fields." — Michael Rosen (opinion) [Ep 2 · 25:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1510)
- "For incarcerated femoral hernia with bowel compromise, an infrainguinal vertical incision allows direct access to the hernia sac, bowel resection if needed, and reduction without dividing the inguinal ligament." — Michael Rosen (clinical) [Ep 2 · 25:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1555)
- "To facilitate reduction of incarcerated femoral hernia contents, the lacunar ligament (medial to femoral space) can be released with scissors or bovie to gain an extra centimeter, avoiding destruction of the inguinal ligament." — Michael Rosen (clinical) [Ep 2 · 26:35](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1595)
- "Reverse McVay repair for femoral hernia involves taking the inferior border of the inguinal ligament and sewing it down to Cooper's ligament from below, starting immediately lateral to the femoral vein to avoid impingement." — Michael Rosen (clinical) [Ep 2 · 27:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1640)
- "Mesh plugs in femoral hernia repair can cause DVT due to irritation of the femoral vein, particularly in thin women who typically present with femoral hernias." — Michael Rosen (clinical) [Ep 2 · 27:46](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1666)
- "For recurrent hernias, operate where no prior surgery has been performed; if both spaces have been operated, choose the approach where you have the most skill." — Michael Rosen (opinion) [Ep 2 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1692)
- "For bilateral hernias in a skilled laparoscopic surgeon, laparoscopy is the best approach, but surgeons learning laparoscopy should avoid bilateral and recurrent hernias as these are twice as hard despite potentially offering the most benefit." — Michael Rosen (opinion) [Ep 2 · 28:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1710)
- "Large inguinoscrotal hernias are managed with open operation; if truly incarcerated and cannot be reduced in office, open approach is used." — Michael Rosen (opinion) [Ep 2 · 29:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1749)
- "For difficult-to-reduce but not truly incarcerated hernias, patient can be put to sleep for reduction under anesthesia, then TAPP repair performed; the internal ring can be cut laparoscopically at the two o'clock position (avoiding epigastric vessels) to facilitate reduction." — Michael Rosen (clinical) [Ep 2 · 29:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1770)
- "If bowel holes are made during incarcerated hernia repair, the morbidity of the operation increases unacceptably high." — Michael Rosen (clinical) [Ep 2 · 30:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1800)
- "In the Fitzgibbon VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, the risk of presenting with an emergency problem requiring operation due to incarceration or strangulation was less than 1% (actually one-third of 1%)." — Michael Rosen (host_summary) [Ep 3 · 3:22](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=202)
- "In the Fitzgibbon study over two years, almost one-third of observed patients went on to develop symptoms and need an operation, and by five years almost three-quarters developed symptoms." — Michael Rosen (host_summary) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=240)
- "For an 89-year-old with asymptomatic hernia, observation is appropriate because in a couple years they might not have symptoms, but in younger patients the odds are against them living without it becoming symptomatic." — Michael Rosen (opinion) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=270)
- "Inguinal hernia repairs can be done under local anesthesia in patients with severe comorbidities, and it is worse for them to present with an emergency problem in the middle of the night." — Michael Rosen (clinical) [Ep 3 · 6:32](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=392)
- "There is a real learning curve to laparoscopic inguinal hernia repair, with some studies showing 200 to 250 cases required." — Michael Rosen (host_summary) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=540)
- "The primary advantage of laparoscopy in skilled hands is that mesh is placed away from nerves, and the risk of chronic pain is lower than in open inguinal hernias." — Michael Rosen (clinical) [Ep 3 · 9:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=560)
- "For young, healthy, active patients with unilateral hernia who are not anesthetic risks, laparoscopic repair is preferred in experienced hands, offering about a week to 10 days earlier recovery than open repair." — Michael Rosen (opinion) [Ep 3 · 11:53](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=713)
- "Disadvantages of laparoscopic repair include operating near intestines with risk of intestinal injury and risk of injury to major blood vessels, though these risks should be incredibly low if planes are known." — Michael Rosen (clinical) [Ep 3 · 12:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=750)
- "In elderly patients or anyone on anticoagulation who needs to restart quickly, open operation is preferred to avoid dissecting the retroperitoneal space." — Michael Rosen (opinion) [Ep 3 · 13:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=780)
- "In a 78-year-old patient with symptomatic hernia on one side and asymptomatic hernia discovered laparoscopically on the other side, the asymptomatic side should not be repaired due to doubled anesthetic time and increased hematoma risk." — Michael Rosen (opinion) [Ep 3 · 14:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=849)
- "In younger active patients, an asymptomatic contralateral hernia discovered laparoscopically should be repaired because the chance of it becoming symptomatic is much higher." — Michael Rosen (opinion) [Ep 3 · 14:58](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=898)
- "Previous lower abdominal surgery increases risk of enterotomy and OR time for laparoscopic repair; if patient hasn't had open inguinal hernia, open approach is preferred." — Michael Rosen (opinion) [Ep 3 · 16:26](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=986)
- "Previous prostate surgery cases are unpredictable laparoscopically and can be brutal; in current practice these get open inguinal hernia repair." — Michael Rosen (opinion) [Ep 3 · 16:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1015)
- "The most important part of any laparoscopic repair is parietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly), a principle promoted by Rene Stoppa during open preperitoneal repairs." — Michael Rosen (clinical) [Ep 3 · 17:58](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1078)
- "The inferior dissection is the Achilles heel of any laparoscopic repair because it's awkward to view, scary to make holes, and taken very close off the vessels." — Michael Rosen (clinical) [Ep 3 · 18:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1120)
- "According to Stoppa's original descriptions, for unilateral inguinal hernia repair, never use less than a 15 by 15 centimeter (6 by 6 inch) piece of mesh, which is much bigger than the vast majority of laparoscopic meshes being placed." — Michael Rosen (host_summary) [Ep 3 · 19:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1150)
- "For large direct hernias, mesh choice should change to a heavier weight material." — Michael Rosen (opinion) [Ep 3 · 20:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1240)
- "Heavyweight mesh is around 90 grams per meter squared (Marlex or Prolene), midweight is 40-50 grams per meter squared, and lightweight (Ultrapro) is less than 30 grams per meter squared." — Michael Rosen (clinical) [Ep 3 · 21:02](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1262)
- "Advantage of lighter weight mesh is less foreign body and less contraction; disadvantage is half the material with risk of fracturing, particularly in direct hernias where it's a bridge." — Michael Rosen (clinical) [Ep 3 · 21:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1310)
- "Heavier weight mesh rarely breaks but sometimes people feel it in their groin if there are wrinkles or buckles, which can cause issues." — Michael Rosen (clinical) [Ep 3 · 22:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1350)
- "For inguinal hernia repair, should never use smaller than a large preformed mesh because you need to cover the whole myopectineal orifice." — Michael Rosen (opinion) [Ep 3 · 23:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1380)
- "If struggling with mesh placement during laparoscopic repair, it's not that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space enough - you need to take out the mesh and dissect bigger." — Michael Rosen (clinical) [Ep 3 · 23:24](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1404)
- "Mesh should be fixed in place; options include Protack tacks, glue, or no fixation, though for big direct hernias everybody uses fixation." — Michael Rosen (opinion) [Ep 3 · 23:53](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1433)
- "There is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes; permanent fixation is used because if absorbable fixation goes through a nerve, it's the neuroma that causes the problem, not the tack." — Michael Rosen (clinical) [Ep 3 · 24:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1449)
- "There is mounting evidence that medium-weight polypropylene can be placed in a contaminated field, with several series in ventral hernias supporting this." — Michael Rosen (host_summary) [Ep 3 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1496)
- "For incarcerated femoral hernia with bowel compromise, make a vertical incision for vascular-type exposure, dissect onto hernia sac, bring out compromised intestine infrainguinally, resect and anastomose, then reduce." — Michael Rosen (clinical) [Ep 3 · 25:55](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1555)
- "To reduce incarcerated femoral hernia without dividing inguinal ligament, release the lacunar ligament medially (which gives off from the inguinal ligament) to gain an extra centimeter of space." — Michael Rosen (clinical) [Ep 3 · 26:32](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1592)
- "A 'reverse McVay' repair can be performed from below for femoral hernias, taking the inferior border of the inguinal ligament and sewing it down to Cooper's ligament starting immediately lateral to the femoral vein." — Michael Rosen (clinical) [Ep 3 · 27:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1630)
- "Mesh plugs are not preferred for femoral hernias because femoral hernias tend to occur in thin women and there have been DVTs due to irritation on the femoral vein." — Michael Rosen (clinical) [Ep 3 · 27:46](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1666)
- "For recurrent hernias, operate where nobody has been before; if both spaces have been operated, go where you're best." — Michael Rosen (opinion) [Ep 3 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1692)
- "For bilateral hernias in a skilled laparoscopic surgeon, laparoscopy is the best approach, but if learning, avoid bilateral and recurrent hernias laparoscopically because it makes it twice as hard despite these patients getting the most benefit." — Michael Rosen (opinion) [Ep 3 · 28:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1710)
- "For really big inguinal scrotal hernias that can't be reduced in office, open operation is preferred; when younger, these were done laparoscopically but now all done open." — Michael Rosen (opinion) [Ep 3 · 29:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1749)
- "For incarcerated hernias, TAP approach is preferred over TEP because you want the contents out of the hernia; can laparoscopically cut the internal ring at the two o'clock position relative to epigastric vessels to help reduce." — Michael Rosen (clinical) [Ep 3 · 29:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1780)

## Changelog
- Sep 7: 3 items added automatically

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