# Inguinal Hernia — GCMD Library living collection

Also covered as: patent processus vaginalis · direct hernia · indirect hernia · femoral hernia · incarcerated hernia · incarceration · prematurity · apnea

Experts: Dr. Todd Ponsky, Dr. Michael Rosen, Dr. Jeffrey Ponsky, Dr. Lizzie Lee

Updated: n/a · 28 episodes · 463 cited statements

## Episodes
### Foundations
- [Inguinal Hernias: Diagnosis and Management](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891) — podcast · 16:29 · [machine version](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891.md)
- [Pediatric Inguinal Hernia in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457) — video · [machine version](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457.md)
- [#115: Must Know Urology for The General Surgeon w/ Dr. Ponsky and Dr. Cherullo](https://library.globalcastmd.com/watch/115-must-know-urology-for-the-general-surgeon-w-dr-ponsky-and-dr-cherullo-13657) — podcast · [machine version](https://library.globalcastmd.com/watch/115-must-know-urology-for-the-general-surgeon-w-dr-ponsky-and-dr-cherullo-13657.md)

### Surgical Management
- [Laparoscopic Pediatric Hernia Repair: Online Course 2017](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414) — video · 102:10 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414.md)
- [Focus on Technique- Laparoscopic Pediatric Hernia Repair 2015](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046) — video · 140:52 · [machine version](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046.md)
- [Female Neonatal Inguinal Hernia Repair Dr. Tamer Ashraf Wafa](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354) — video · 4:42 · [machine version](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354.md)
- [Pediatric Open Herniotomy in boys 15 Minutes Unedited Dr. Tamer Ashraf Wafa](https://library.globalcastmd.com/watch/pediatric-open-herniotomy-in-boys-15-minutes-unedited-dr-tamer-ashraf-wafa-4393) — video · 16:29 · [machine version](https://library.globalcastmd.com/watch/pediatric-open-herniotomy-in-boys-15-minutes-unedited-dr-tamer-ashraf-wafa-4393.md)
- [Herniotomy in a Neonate 1 month old boy By Dr. Tamer Ashraf Wafa](https://library.globalcastmd.com/watch/herniotomy-in-a-neonate-1-month-old-boy-by-dr-tamer-ashraf-wafa-4412) — video · 9:59 · [machine version](https://library.globalcastmd.com/watch/herniotomy-in-a-neonate-1-month-old-boy-by-dr-tamer-ashraf-wafa-4412.md)

### Evidence & Research
- [Pediatric inguinal hernias: should repair be open versus laparoscopic?](https://library.globalcastmd.com/watch/pediatric-inguinal-hernias-should-repair-be-open-versus-laparoscopic-2356) — video · [machine version](https://library.globalcastmd.com/watch/pediatric-inguinal-hernias-should-repair-be-open-versus-laparoscopic-2356.md)
- [PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424) — video · 11:59 · [machine version](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424.md)
- [Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864) — video · 11:00 · [machine version](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864.md)
- [BOB Ped Surg 2023 - Wendy Song, CAPS  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352.md)
- [Delayed versus early repair of inguinal hernia in preterm infants](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705) — video · 0:43 · [machine version](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705.md)
- [Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401) — video · 1:35 · [machine version](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401.md)
- [The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030) — video · 0:49 · [machine version](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030.md)
- [Effect of a Pediatric Surgeon's Primarily Performed Technique on Inguinal Hernia Recurrence Rates: A Multicenter Retrospective Cohort Study](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386.md)
- [A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460.md)
- [A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527.md)
- [Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554) — video · 0:54 · [machine version](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554.md)
- [Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894) — video · 0:43 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894.md)

### Case-Based Learning
- [Groin Controversies: Update Course 2016](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437) — video · 28:58 · [machine version](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437.md)
- [Groin Controversies - Todd Ponsky: Update Course 2014](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661) — video · 28:58 · [machine version](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661.md)
- [Case-Based Journal Review: Inguinal Hernia 2025](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168) — podcast · 19:13 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168.md)

### In-Depth Reviews
- [Inguinal Hernia: Adult](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441) — podcast · 31:02 · [machine version](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441.md)
- [2026 Laparoscopic Pediatric Hernia Repair](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251) — video · 123:40 · [machine version](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251.md)
- [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/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=0) Laparoscopic vs Open Inguinal Hernia Repair in Children (Ep 20)
- [0:00](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=0) Laparoscopic vs Open Inguinal Hernia Repair in Children (Ep 21)
- [0:00](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=0) Surgeon Volume and Inguinal Hernia Recurrence (Ep 22)
- [0:00](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=0) Modified PIRS for Adult Inguinal Hernia: Study Overview (Ep 23)
- [2:27](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=147) Introduction and Controversies in Hernia Management (Ep 24)
- [15:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=900) Arguments for Laparoscopic vs Open Repair (Ep 24)
- [30:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1800) Incarcerated Hernias and Technical Considerations (Ep 24)
- [60:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=3600) PIRS Technique Demonstration and Modifications (Ep 24)
- [90:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5400) Age Considerations and Adolescent Hernias (Ep 24)
- [110:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=6600) Direct Hernia Repair - Guest Presentation (Ep 24)
- [0:00](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=0) Early vs Late Inguinal Hernia Repair in Preterm Infants (Ep 16)
- [0:00](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=0) Surgeon Technique Preference and Hernia Recurrence (Ep 19)
- [0:00](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=0) Introduction and Asymptomatic Hernias (Ep 6)
- [3:12](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=192) Evidence for Observation and High-Risk Patients (Ep 6)
- [6:32](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=392) Operative Approach Selection (Ep 6)
- [10:17](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=617) TAPP vs TEP and Patient Counseling (Ep 6)
- [13:28](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=808) Contraindications to Laparoscopy (Ep 6)
- [16:56](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1016) Laparoscopic Technique Principles (Ep 6)
- [21:02](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1262) Mesh Selection and Fixation (Ep 6)
- [24:26](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1466) Open Repair and Femoral Hernias (Ep 6)
- [27:19](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1639) Special Scenarios (Ep 6)
- [30:05](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1805) Conclusion (Ep 6)
- [0:00](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=0) Study Presentation: Perioperative Opioid Use in Pediatric Inguinal Hernia Patients (Ep 12)
- [3:18](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=198) Initial Commentary and Questions (Ep 12)
- [5:04](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=304) Response to Initial Questions (Ep 12)
- [7:48](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=468) Panel Discussion and Final Questions (Ep 12)
- [0:00](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=0) Timing of Inguinal Hernia Repair in Preterm Infants (Ep 15)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=0) Introduction and Clinical Scenario (Ep 17)
- [2:48](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=168) Article 1: Early vs Late Repair in Preterm Infants (Ep 17)
- [7:42](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=462) Clinical Scenario: Distance and Visit Logistics (Ep 17)
- [10:30](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=630) Article 2: One-Stop Surgery Model (Ep 17)
- [14:10](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=850) Article 3: Natural History of Patent Processus Vaginalis (Ep 17)
- [17:41](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=1061) Summary and Closing (Ep 17)
- [0:01](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=1) LMA vs ETT in Pediatric Laparoscopic Hernia Repair (Ep 18)
- [0:01](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1) Incidental Hernia During Laparoscopic G-Tube (Ep 2)
- [5:10](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=310) High Ligation Philosophy and Age Considerations (Ep 2)
- [10:32](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=632) Laparoscopic Hernia Repair Technique (Ep 2)
- [18:40](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1120) Retractile Testicle Management (Ep 2)
- [25:03](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1503) Diagnostic Approach to Missing Testicle (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=0) Introduction and Course Overview (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study examined over 53,000 children who had inguinal hernia repair across the United States" — Lizzie Lee (epidemiological) [Ep 20 · 0:06](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=6)
- "Approximately 16% of the children had laparoscopic surgery" — Lizzie Lee (epidemiological) [Ep 20 · 0:13](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=13)
- "Most children had an open repair" — Lizzie Lee (epidemiological) [Ep 20 · 0:15](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=15)
- "The study compared two key outcomes: hernia recurrence on the same side and the need for a second hernia operation later on" — Lizzie Lee (clinical) [Ep 20 · 0:17](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=17)
- "Laparoscopic repair had more than 3 times the risk of same side recurrence compared to open surgery" — Lizzie Lee (clinical) [Ep 20 · 0:23](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=23)
- "Laparoscopic repair was linked to fewer future surgeries on the opposite side (metachronous hernias)" — Lizzie Lee (clinical) [Ep 20 · 0:30](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=30)
- "The findings held up even after adjusting for hospital differences and patient factors" — Lizzie Lee (clinical) [Ep 20 · 0:36](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=36)
- "Open repair has a lower risk of recurrence" — Lizzie Lee (clinical) [Ep 20 · 0:40](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=40)
- "Laparoscopic repair may reduce the chance of needing surgery on the other side" — Lizzie Lee (clinical) [Ep 20 · 0:40](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=40)
- "The study examined over 53,000 children who had inguinal hernia repair across the United States" — Lizzie Lee (epidemiological) [Ep 21 · 0:06](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=6)
- "Approximately 16% of the children had laparoscopic surgery" — Lizzie Lee (epidemiological) [Ep 21 · 0:13](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=13)
- "Most children had an open repair" — Lizzie Lee (epidemiological) [Ep 21 · 0:15](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=15)
- "The study compared two key outcomes: hernia recurrence on the same side and the need for a second hernia operation later on" — Lizzie Lee (clinical) [Ep 21 · 0:17](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=17)
- "Laparoscopic repair had more than 3 times the risk of same side recurrence compared to open surgery" — Lizzie Lee (clinical) [Ep 21 · 0:23](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=23)
- "Laparoscopic repair was linked to fewer future surgeries on the opposite side (metachronous hernias)" — Lizzie Lee (clinical) [Ep 21 · 0:30](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=30)
- "The findings held up even after adjusting for hospital differences and patient factors" — Lizzie Lee (clinical) [Ep 21 · 0:36](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=36)
- "Open repair has a lower risk of recurrence" — Lizzie Lee (clinical) [Ep 21 · 0:40](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=40)
- "Laparoscopic repair may reduce the chance of needing surgery on the other side" — Lizzie Lee (clinical) [Ep 21 · 0:40](https://library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=40)
- "Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025" — Jill Knepprath (epidemiological) [Ep 22 · 0:10](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=10)
- "Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 22 · 0:22](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=22)
- "There was no difference in recurrence rates for open repairs based on surgeon volume" — Jill Knepprath (epidemiological) [Ep 22 · 0:30](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=30)
- "Laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence" — Jill Knepprath (epidemiological) [Ep 22 · 0:35](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=35)
- "The authors recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon" — Jill Knepprath (guideline) [Ep 22 · 0:44](https://library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=44)
- "High ligation hernia repair is traditionally a pediatric technique" — Jill Knepprath (clinical) [Ep 23 · 0:00](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=0)
- "The study was published in the International Journal of Surgery" — Jill Knepprath (clinical) [Ep 23 · 0:08](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=8)
- "The study used modified percutaneous internal ring suturing technique for laparoscopic non-mesh repair of indirect inguinal hernias in adults" — Jill Knepprath (clinical) [Ep 23 · 0:12](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=12)
- "The study included 20 patients" — Jill Knepprath (epidemiological) [Ep 23 · 0:23](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=23)
- "The majority of patients were male" — Jill Knepprath (epidemiological) [Ep 23 · 0:25](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=25)
- "No patients had hernia recurrence on follow-up" — Jill Knepprath (clinical) [Ep 23 · 0:26](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=26)
- "Median follow-up duration was 79 months" — Jill Knepprath (epidemiological) [Ep 23 · 0:26](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=26)
- "Patients reported a decrease in pain postoperatively" — Jill Knepprath (clinical) [Ep 23 · 0:31](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=31)
- "Patients reported improved activity postoperatively" — Jill Knepprath (clinical) [Ep 23 · 0:31](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=31)
- "This is a small single-center study" — Jill Knepprath (opinion) [Ep 23 · 0:35](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=35)
- "The study shows success with this technique in adults" — Jill Knepprath (opinion) [Ep 23 · 0:35](https://library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=35)
- "Contralateral patent processus vaginalis is present 30-40% of the time in children with unilateral inguinal hernia" — Todd Ponsky (epidemiological) [Ep 24 · 11:16](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=676)
- "Risk of metachronous hernia after unilateral repair is 3-11%" — Todd Ponsky (epidemiological) [Ep 24 · 11:50](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=710)
- "50% of patent processus vaginalis may never become hernias" — Todd Ponsky (clinical) [Ep 24 · 12:25](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=745)
- "Risk of incarceration is high in preemies but becomes negligible after 1 year of age, dropping to less than 1% per year" — Todd Ponsky (epidemiological) [Ep 24 · 14:11](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=851)
- "In rabbit studies, grabbing the vas deferens in a preemie-sized vessel with one grab can obliterate and scar it" — Todd Ponsky (clinical) [Ep 24 · 18:21](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1101)
- "The most common recurrence after indirect inguinal hernia repair is a direct hernia, not an indirect hernia" — Todd Ponsky (clinical) [Ep 24 · 39:39](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2379)
- "Recurrence rate for laparoscopic PIRS technique is 0.9% in unilateral repairs and 0.3% in bilateral repairs in large series" — Todd Ponsky (clinical) [Ep 24 · 43:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2580)
- "In rabbit studies, repairs with anterior peritoneal injury remained intact even after suture removal at 2 weeks with 36mmHg pressure, while suture-only repairs failed 75% of the time" — Todd Ponsky (clinical) [Ep 24 · 66:54](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4014)
- "In rabbit studies, braided non-absorbable suture (silk) had only 10% failure rate after suture removal, compared to 75% for prolene and 80% for vicryl" — Todd Ponsky (clinical) [Ep 24 · 69:00](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4140)
- "Studies by Felix Shear showed no impediment to cord blood flow after laparoscopic hernia repair" — Todd Ponsky (clinical) [Ep 24 · 82:23](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4943)
- "High ligation in adolescents aged 13-18 had 2% recurrence rate with only 0.9% confirmed recurrence at 2-year follow-up" — Todd Ponsky (clinical) [Ep 24 · 96:32](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5792)
- "Statistical analysis shows direct hernias begin to predominate around age 40, though most hernias remain indirect even at that age" — Todd Ponsky (epidemiological) [Ep 24 · 97:33](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5853)
- "Norwegian study of laparoscopic high ligation in adults showed zero recurrences" — Todd Ponsky (clinical) [Ep 24 · 98:22](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5902)
- "VA cooperative study showed chronic pain after mesh hernia repair can be as high as 30%" — Todd Ponsky (clinical) [Ep 24 · 118:27](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7107)
- "Recent adult surgery paper showed no difference in complications between resecting large hernia sacs versus abandoning them during laparoscopic repair" — Marcello Rambaldi (clinical) [Ep 24 · 121:20](https://library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7280)
- "Inguinal hernias are very common in preterm infants" (epidemiological) [Ep 16 · 0:00](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=0)
- "The optimal timing for surgical repair of inguinal hernias in preterm infants is still debated due to associated risks" (clinical) [Ep 16 · 0:00](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=0)
- "A European study showed 56% of surgeons recommend inguinal hernia surgery before discharge in preterm infants" (epidemiological) [Ep 16 · 0:08](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=8)
- "The study was published in JAMA 2024" (clinical) [Ep 16 · 0:19](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=19)
- "The study involved 338 preterm infants diagnosed with inguinal hernias before their initial hospital stay" (clinical) [Ep 16 · 0:39](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=39)
- "Infants were randomly assigned to either early repair before NICU discharge or late repair after NICU discharge" (clinical) [Ep 16 · 0:47](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=47)
- "The primary outcome was occurrence of predefined serious adverse events over a 10-month period, including death, hernia complications, and respiratory and cardiovascular morbidity" (clinical) [Ep 16 · 0:54](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=54)
- "Late repair significantly reduced the rate of serious adverse events, with 18% in the late repair group compared to 28% in the early repair group" (clinical) [Ep 16 · 1:07](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=67)
- "The late repair group experienced a 3 day reduction in length of stay" (clinical) [Ep 16 · 1:19](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=79)
- "Delaying inguinal hernia repair until after NICU discharge might be safer for preterm infants, potentially reducing the risk of serious complications" (opinion) [Ep 16 · 1:25](https://library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=85)
- "The study examined pediatric inguinal hernia repairs across 21 children's hospitals" — Lizzie Lee (epidemiological) [Ep 19 · 0:09](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=9)
- "When surgeons who mostly do open repairs performed a laparoscopic repair, the hernia recurrence rate was 3.6%" — Lizzie Lee (clinical) [Ep 19 · 0:15](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=15)
- "When laparoscopy was done by surgeons who primarily use that approach, the recurrence rate was 1.7%" — Lizzie Lee (clinical) [Ep 19 · 0:15](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=15)
- "Surgeons who primarily do laparoscopic repairs had similar low recurrence rates whether they operated laparoscopically or open" — Lizzie Lee (clinical) [Ep 19 · 0:27](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=27)
- "Surgeons tend to get the best results with the technique they use most often" — Lizzie Lee (opinion) [Ep 19 · 0:35](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=35)
- "If surgeons split their practice between open and laparoscopic hernia repairs, it's important to maintain strong skills in both so that outcomes can stay consistent" — Lizzie Lee (opinion) [Ep 19 · 0:39](https://library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=39)
- "The risk of presenting with an emergency problem needing an operation due to hernia incarceration or strangulation in asymptomatic elderly patients is 0.3%" — Michael Rosen (clinical) [Ep 6 · 3:49](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=229)
- "In the Fitzgibbons VA study over 2 years, almost one-third of patients with asymptomatic hernias went on to develop symptoms and need an operation" — Michael Rosen (clinical) [Ep 6 · 4:04](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=244)
- "By 5 years follow-up, almost three-fifths of patients with initially asymptomatic hernias developed symptoms" — Michael Rosen (clinical) [Ep 6 · 4:21](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=261)
- "Inguinal hernia repairs can be done under local anesthesia" — Michael Rosen (clinical) [Ep 6 · 6:06](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=366)
- "The learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases" — Michael Rosen (clinical) [Ep 6 · 9:04](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=544)
- "In laparoscopic repair, mesh is placed away from the nerves, resulting in lower risk of chronic pain compared to open repair" — Michael Rosen (clinical) [Ep 6 · 9:31](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=571)
- "Laparoscopic repair offers approximately 1 week to 10 days earlier recovery compared to open repair" — Michael Rosen (clinical) [Ep 6 · 12:23](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=743)
- "Laparoscopic repair has risk of intestinal injury and major blood vessel injury because of operating near these structures" — Michael Rosen (clinical) [Ep 6 · 12:45](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=765)
- "Parietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) is the most important part of any laparoscopic repair" — Michael Rosen (clinical) [Ep 6 · 18:15](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1095)
- "The inferior dissection is the Achilles heel of any laparoscopic repair because it is awkward to view and surgeons risk making holes in the peritoneum" — Michael Rosen (clinical) [Ep 6 · 18:53](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1133)
- "Stoppa's original description for unilateral inguinal hernia was to never use less than a 15 by 15 centimeter piece of mesh" — Michael Rosen (guideline) [Ep 6 · 19:30](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1170)
- "For large direct hernias, a heavier weight mesh material should be used" — Michael Rosen (clinical) [Ep 6 · 20:26](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1226)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)" — Michael Rosen (clinical) [Ep 6 · 21:47](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1307)
- "Midweight mesh is between 40 to 50 grams per meter squared" — Michael Rosen (clinical) [Ep 6 · 21:57](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1317)
- "Lightweight mesh (Ultrapro) is less than 30 grams per meter squared and contracts down to about 28 grams per meter squared over time" — Michael Rosen (clinical) [Ep 6 · 22:10](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1330)
- "Lightweight mesh is at risk for fracturing, particularly in direct hernias where it acts as a bridge" — Michael Rosen (clinical) [Ep 6 · 22:23](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1343)
- "For laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh to cover the whole myopectineal orifice" — Michael Rosen (clinical) [Ep 6 · 23:08](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1388)
- "There is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation" — Michael Rosen (clinical) [Ep 6 · 24:10](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1450)
- "If a tack is put through a nerve, it is the neuroma that causes the problem, not the tack itself" — Michael Rosen (clinical) [Ep 6 · 24:22](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1462)
- "There is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field" — Michael Rosen (clinical) [Ep 6 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1496)
- "The lacunar ligament can be released to gain an extra 1 centimeter of space when reducing incarcerated femoral hernias without destroying the inguinal ligament" — Michael Rosen (clinical) [Ep 6 · 26:58](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1618)
- "For recurrent hernias, surgeons should go where nobody has been before, or if both approaches have been used, go where they are best" — Michael Rosen (opinion) [Ep 6 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1692)
- "Surgeons learning laparoscopic hernia repair should avoid bilateral and recurrent hernias during their learning curve" — Michael Rosen (opinion) [Ep 6 · 28:36](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1716)
- "For truly incarcerated hernias, TEP approach is not a good idea because you want the contents out of the hernia sac; TAPP is preferred" — Michael Rosen (clinical) [Ep 6 · 29:31](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1771)
- "Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients" — Isabel Hageman (clinical) [Ep 12 · 0:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=33)
- "There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults" — Isabel Hageman (guideline) [Ep 12 · 0:40](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=40)
- "150 patients were included in the final analysis and were mostly premature males with the median age of 3 months" — Isabel Hageman (epidemiological) [Ep 12 · 1:24](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=84)
- "Nearly everyone was opioid naive" — Isabel Hageman (epidemiological) [Ep 12 · 1:24](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=84)
- "Median length of stay was 23.6 hours and duration of surgery was 41 minutes" — Isabel Hageman (epidemiological) [Ep 12 · 1:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=93)
- "The majority had general anesthesia with the addition of a regional block" — Isabel Hageman (epidemiological) [Ep 12 · 1:37](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=97)
- "20% of patients received opioids intraoperatively, which was mostly fentanyl" — Isabel Hageman (epidemiological) [Ep 12 · 1:41](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=101)
- "Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter" — Isabel Hageman (epidemiological) [Ep 12 · 1:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=106)
- "33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids" — Isabel Hageman (epidemiological) [Ep 12 · 1:53](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=113)
- "No patients received an opiate prescription at discharge" — Isabel Hageman (epidemiological) [Ep 12 · 2:02](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=122)
- "Increasing age increased the risk for postoperative and total opiate use" — Isabel Hageman (clinical) [Ep 12 · 2:06](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "There was a significant association between female sex and total opioid use" — Isabel Hageman (clinical) [Ep 12 · 2:06](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids" — Isabel Hageman (clinical) [Ep 12 · 2:16](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=136)
- "Addition of regional blocks significantly lowered postoperative opiate use" — Isabel Hageman (clinical) [Ep 12 · 2:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "General anesthesia was found to be a risk for total, but not postoperative opioid use" — Isabel Hageman (clinical) [Ep 12 · 2:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world" — Isabel Hageman (opinion) [Ep 12 · 2:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=153)
- "There was a wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients" — Isabel Hageman (clinical) [Ep 12 · 2:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=166)
- "Patients with regional anesthesia only had much lower doses than in patients with general anesthesia, with or without the addition of a regional" — Isabel Hageman (clinical) [Ep 12 · 2:54](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=174)
- "One of the big changes over the last decade is the shift from giving everybody narcotics after surgery to rarely prescribing narcotics" — Todd (opinion) [Ep 12 · 3:25](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=205)
- "The median length of stay was high due to a number of preemies and children that were already admitted to the hospital and then had inguinal hernia surgery" — Isabel Hageman (clinical) [Ep 12 · 5:07](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=307)
- "All the elective inguinal hernia patients only get admitted for a couple of hours and straight after from the PACU they go home" — Isabel Hageman (clinical) [Ep 12 · 5:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=333)
- "General anesthesia was a risk factor for opioid use in general" — Isabel Hageman (clinical) [Ep 12 · 6:19](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=379)
- "In very young children especially, it's easy to do a spinal because they don't really experience the potentially traumatic things from being in the OR" — Isabel Hageman (opinion) [Ep 12 · 7:05](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=425)
- "All patients were open inguinal hernia patients" — Isabel Hageman (epidemiological) [Ep 12 · 8:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=503)
- "There wasn't an association between length of stay and opiate use, but it could be due to the relatively small sample size" — Isabel Hageman (clinical) [Ep 12 · 8:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=503)
- "2 or 3 years before this study, the warnings around opioids and the level of narcotics classification was changed in Australia" — Isabel Hageman (guideline) [Ep 12 · 9:51](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=591)
- "Even in this young population, females have higher opioid dose requirements than males" — Isabel Hageman (clinical) [Ep 12 · 10:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=646)
- "The systematic review and meta-analysis examined timing of inguinal hernia repair in preterm babies" — Cecilia Gigena (clinical) [Ep 15 · 0:10](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=10)
- "The review included 6 articles" — Cecilia Gigena (epidemiological) [Ep 15 · 0:21](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=21)
- "Patients operated before discharge in the first hospitalization had lower odds of incarceration" — Cecilia Gigena (clinical) [Ep 15 · 0:21](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=21)
- "Patients operated before discharge in the first hospitalization had higher risk of respiratory complications in the post-op" — Cecilia Gigena (clinical) [Ep 15 · 0:32](https://library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=32)
- "Preterm infants with inguinal hernia have a very high rate of incarceration" — Todd Ponsky (clinical) [Ep 17 · 1:17](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=77)
- "The younger the baby, the higher the risk of incarceration" — Jose Campos (clinical) [Ep 17 · 1:43](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=103)
- "The multi-center RCT included 308 patients: 159 in early repair group and 149 in late repair group, across 39 US hospitals between 2013 and 2021" — Gody (clinical) [Ep 17 · 2:59](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=179)
- "44 patients in early repair group versus 27 in late repair group had at least one serious adverse event (28% vs 18%)" — Gody (clinical) [Ep 17 · 3:36](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=216)
- "Incarceration rate was around 4% in the late repair group" — Gody (clinical) [Ep 17 · 4:07](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=247)
- "In the early group 4% had spontaneous resolution, in the late group 11% had spontaneous resolution" — Jose Campos (clinical) [Ep 17 · 4:27](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=267)
- "One patient had a bowel injury during repair" — Todd Ponsky (clinical) [Ep 17 · 4:56](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=296)
- "There were more reintubations and more apnea in the early repair group" — Todd Ponsky (clinical) [Ep 17 · 5:26](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=326)
- "The study used 16 adverse events as a composite outcome including apnea, prolonged intubation, inguinal hernia complications like recurrence, incarceration, and re-operation" — Gody (clinical) [Ep 17 · 5:56](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=356)
- "The study was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated" — Gody (clinical) [Ep 17 · 7:12](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=432)
- "The one-stop surgery study from Netherlands included 91 patients: 54 one-stop surgery and 37 usual care, for children older than 3 months with inguinal hernia and ASA grade 1 or 2" — Gody (clinical) [Ep 17 · 10:32](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=632)
- "All but one of the one-stop surgery patients were discharged home on the day of surgery" — Gody (clinical) [Ep 17 · 10:54](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=654)
- "Post-op complication and recurrence rates did not differ between intervention and control patients in the one-stop surgery study" — Gody (clinical) [Ep 17 · 10:59](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=659)
- "General satisfaction and inclusion of family were higher after one-stop surgery experience" — Gody (clinical) [Ep 17 · 11:05](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=665)
- "There was no diagnostic uncertainty in the one-stop surgery program" — Jose Campos (clinical) [Ep 17 · 11:35](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=695)
- "A surgery journal article found that routine follow-up for pediatric surgical conditions like circumcision, orchiopexy, and inguinal hernia altered management less than 1% of the time" — Jose Campos (clinical) [Ep 17 · 12:26](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=746)
- "When facing medical problems with low risk of complications, family satisfaction becomes a surrogate for quality" — Jose Campos (opinion) [Ep 17 · 13:28](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=808)
- "The patent processus vaginalis study enrolled infants under 4 months undergoing laparoscopic pyloromyotomy at 8 children's hospitals, with 246 eligible infants with PPV and 85% responding to at least one annual follow-up" — Gody (clinical) [Ep 17 · 15:34](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=934)
- "Of all patients with PPV, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for total of 3 hernia repairs" — Gody (clinical) [Ep 17 · 15:49](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=949)
- "The presence of patent processus vaginalis at time of pyloromyotomy was common, but need for hernia repair was around 1% in first year of follow-up" — Gody (clinical) [Ep 17 · 16:13](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=973)
- "A Mayo Clinic study by Ben Zendejas showed contralateral hernia occurrence after 50 year follow-up" — Todd Ponsky (clinical) [Ep 17 · 16:43](https://library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=1003)
- "In laparoscopic surgery, the traditional airway approach is using endotracheal intubation" — Lizzie Lee (clinical) [Ep 18 · 0:11](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=11)
- "A randomized trial studied 50 kids having laparoscopic hernia repair comparing LMA to endotracheal intubation" — Lizzie Lee (clinical) [Ep 18 · 0:21](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=21)
- "There was no difference in oxygen saturation between LMA and endotracheal intubation groups" — Lizzie Lee (clinical) [Ep 18 · 0:26](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=26)
- "There was no difference in tidal carbon dioxide levels between LMA and endotracheal intubation groups" — Lizzie Lee (clinical) [Ep 18 · 0:26](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=26)
- "There was only one desaturation event in the LMA group" — Lizzie Lee (clinical) [Ep 18 · 0:33](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=33)
- "There was only one desaturation event in the endotracheal intubation group" — Lizzie Lee (clinical) [Ep 18 · 0:33](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=33)
- "For certain laparoscopic surgeries in children, an LMA might be just as safe as a traditional endotracheal tube" — Lizzie Lee (opinion) [Ep 18 · 0:37](https://library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=37)
- "A patent processus vaginalis carries a 4 times greater risk than the general population of developing a hernia at some point in life" (epidemiological) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=120)
- "Hernia repair is not the type of conversation to have quickly in the waiting room with a family because of potential injury risk and the fact that the patient may never have a problem" (opinion) [Ep 2 · 2:14](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=134)
- "Age 5 is used as a cutoff for stopping contralateral exploration or intervention for patent processus vaginalis" (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=179)
- "A patent processus vaginalis is the same pathology from day of life one to end of life" (clinical) [Ep 2 · 5:45](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=345)
- "High ligation is the appropriate repair for indirect inguinal hernia at any age" (clinical) [Ep 2 · 5:57](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=357)
- "Examining for hernia by placing finger up the inguinal canal is not accurate and causes patient discomfort" (clinical) [Ep 2 · 7:25](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=445)
- "Adult surgeons do not use the finger-up-the-canal examination technique for hernias" (clinical) [Ep 2 · 7:39](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=459)
- "It is not possible to reliably distinguish direct from indirect hernia on physical examination" (clinical) [Ep 2 · 8:06](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=486)
- "A prospective trial in an adult institution is studying high ligation alone in adults up to 80 years old" (clinical) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=550)
- "Historically, herniotomy alone had a 70% success rate with 30% recurrence" (epidemiological) [Ep 2 · 9:31](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=571)
- "Adult surgeons' McVay and Bassini repairs have a 10% recurrence rate" (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=600)
- "Lichtenstein mesh repair reduced hernia recurrence to 1%" (epidemiological) [Ep 2 · 10:10](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=610)
- "Hydrodissection with bupivacaine dissects cord structures away from peritoneum during laparoscopic hernia repair" (clinical) [Ep 2 · 15:13](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=913)
- "In rabbit studies, causing peritoneal injury during hernia repair resulted in more durable closure that remained intact even after suture removal at 12 weeks" (clinical) [Ep 2 · 14:25](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=865)
- "Braided non-absorbable suture produces better hernia repair than monofilament in rabbit studies" (clinical) [Ep 2 · 17:18](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1038)
- "Silk and non-absorbable sutures historically caused groin abscesses and suture spitting requiring removal years after placement" (clinical) [Ep 2 · 18:52](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1132)
- "A retractile testicle that can be pulled down and stays down is considered descended" (clinical) [Ep 2 · 19:59](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1199)
- "There are reports of true retractile testicles occasionally ascending and becoming trapped" — Corn (clinical) [Ep 2 · 20:29](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1229)
- "After puberty, larger testicles cannot retract and will stay in the scrotum" — Corn (clinical) [Ep 2 · 21:39](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1299)
- "Retractile testicles under anesthesia will appear down and normal" (clinical) [Ep 2 · 24:11](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1451)
- "High-riding testicle after hernia repair may result from cremasteric muscle or vessels becoming stuck in external oblique closure" (clinical) [Ep 2 · 24:39](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1479)
- "Ultrasound is not indicated for non-palpable testicle workup; laparoscopy is the appropriate diagnostic approach" (clinical) [Ep 2 · 26:29](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1589)
- "One-stage Fowler-Stevens is probably just as good as two-stage based on retrospective data and prospective pilot data" (clinical) [Ep 2 · 27:45](https://library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1665)
- "In a rabbit model, grabbing the vas deferens once with pickups obliterates it" — Todd Ponsky (clinical) [Ep 1 · 17:05](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1025)
- "A study by Zendejas in Journal of American College of Surgeons found 5% infertility rate after hernia repair, matching the general population" — Todd Ponsky (epidemiological) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1080)
- "A study in Andrologia found markedly reduced semen quality in 8500 patients in fertility clinics who had prior hernia repairs, with morphology problems" — Todd Ponsky (clinical) [Ep 1 · 18:23](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1103)
- "The most common cause of recurrence after open indirect hernia repair is development of a direct hernia" — Todd Ponsky (clinical) [Ep 1 · 24:51](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1491)
- "Recent large studies from multiple countries show laparoscopic hernia repair recurrence rate of approximately 1% or less" — Todd Ponsky (clinical) [Ep 1 · 27:39](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1659)
- "In rabbit model at 2 weeks, 75% of suture-alone repairs opened when suture was removed, but 87% of injury-plus-suture repairs stayed closed" — Todd Ponsky (clinical) [Ep 1 · 44:16](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2656)
- "In rabbit model at 4 weeks, only 17% of suture-alone repairs stayed closed after suture removal, but 100% of injury-plus-suture repairs were reperitonealized" — Todd Ponsky (clinical) [Ep 1 · 44:33](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2673)
- "Braided non-absorbable sutures worked best in rabbit hernia repair model compared to dissolvable or monofilament" — Todd Ponsky (clinical) [Ep 1 · 44:58](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2698)
- "A retrospective two-center study (Kansas City and Rainbow) found 1.9% recurrence rate with open high ligation in adolescents" — Todd Ponsky (clinical) [Ep 1 · 85:45](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5145)
- "There is a bimodal distribution of hernias with peaks in infancy and older adulthood, with few adolescent cases" — Todd Ponsky (epidemiological) [Ep 1 · 83:03](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4983)
- "Direct hernias start developing around age 29, suggesting a change in floor integrity at that age" — Todd Ponsky (clinical) [Ep 1 · 83:38](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5018)
- "Felix Shear's ultrasound study showed no deficiency in testicular blood flow after laparoscopic hernia repair in babies" — Todd Ponsky (clinical) [Ep 1 · 93:39](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5619)
- "Wit Holcomb published in 1994 that contralateral patent processus presents in 30-40% of cases" — Todd Ponsky (epidemiological) [Ep 1 · 10:56](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=656)
- "There is a 4 times greater risk of developing a hernia if a patent processus vaginalis is present" — Todd Ponsky (clinical) [Ep 1 · 11:05](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=665)
- "The risk of metachronous hernia is 3-11%" — Todd Ponsky (epidemiological) [Ep 1 · 11:17](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=677)
- "In open hernia repair, the stitch likely dissolves (when using Vicryl) and the repair works because the cut sac ends scar together" — Todd Ponsky (opinion) [Ep 1 · 41:48](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2508)
- "Munther Haddad from Leeds published a series on open division of the sac without ligation with the same recurrence rate as traditional repair" — Todd Ponsky (clinical) [Ep 1 · 42:14](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2534)
- "When ligating the sac, you create a new smaller hernia sac that still vaginates into the muscle" — Todd Ponsky (opinion) [Ep 1 · 42:27](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2547)
- "The most common thing mistaken for a hernia is the testicle riding up into the groin" — Todd Ponsky (clinical) [Ep 1 · 5:51](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=351)
- "With laparoscopy, incarcerated hernias can be taken directly to OR without reduction attempts, as the repair is not harder when inflamed" — Todd Ponsky (opinion) [Ep 1 · 22:28](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1348)
- "In babies, single knot ligation is preferred over double ligation to reduce risk of suture granuloma due to thin subcutaneous tissue" — Todd Ponsky (clinical) [Ep 1 · 52:05](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=3125)
- "The NIH study quoted 30% chronic pain rate after adult mesh hernia repair, though expert hernia surgeons claim their rates are lower" — Todd Ponsky (clinical) [Ep 1 · 80:28](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4828)
- "In open repair, pulling up the cord may take fibers of the floor and cause a direct hernia, especially in premature infants with very thin floors" — Todd Ponsky (opinion) [Ep 1 · 25:35](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1535)
- "Adult general surgeons doing Lichtenstein repairs always cover the floor with mesh even for indirect hernias because pulling up the cord disrupts the floor" — Jeff Gander (clinical) [Ep 1 · 25:55](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1555)
- "CK Young in Hong Kong has done approximately 2000 laparoscopic hernia repairs with ligation alone (no injury) with very few recurrences" — Todd Ponsky (clinical) [Ep 1 · 63:40](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=3820)
- "Postoperative hydroceles after laparoscopic hernia repair are extremely rare, with almost no cases requiring intervention" — Todd Ponsky (clinical) [Ep 1 · 67:18](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4038)
- "A patient had a patent processus identified incidentally years prior, then presented with groin pain and at laparoscopy the patent processus was gone" — Todd Ponsky (clinical) [Ep 1 · 10:18](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=618)
- "The groin has a very high density of nerves, making it a problematic location for incisions" — Todd Ponsky (clinical) [Ep 1 · 17:41](https://library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1061)
- "Patent processus vaginalis confers 4 times greater risk than general population of developing hernia at some point in life" — Todd Ponsky (epidemiological) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=115)
- "Hernia repair is not the type of conversation to have quickly in the waiting room with a family because if there were some injury, that was a rushed conversation about something they may never have a problem with their entire lives" — Todd Ponsky (opinion) [Ep 3 · 2:14](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=134)
- "Age 5 is used as cutoff to stop scoping the contralateral side or doing anything else for patent processus vaginalis" — Todd Ponsky (clinical) [Ep 3 · 2:59](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=179)
- "Patent processus vaginalis is the same from day of life one to end of life" — Todd Ponsky (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=345)
- "High ligation is the appropriate repair for any age if it is a patent processus vaginalis" — Todd Ponsky (clinical) [Ep 3 · 5:54](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=354)
- "First operation for hernia repair was herniotomy with 70% success rate but 30% recurrence rate" (clinical) [Ep 3 · 9:31](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=571)
- "Ladd and Gross started doing high ligation while adult surgeons thought it was a floor problem and did McVay repairs with 10% recurrence rate" (clinical) [Ep 3 · 10:00](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=600)
- "Lichtenstein technique got hernia recurrence rate down to 1%" (clinical) [Ep 3 · 10:10](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=610)
- "In rabbit study, when injury was caused and repair done, it was much more durable - even if stitch was cut out after 12 weeks, closure remained intact" — Todd Ponsky (clinical) [Ep 3 · 14:34](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=874)
- "Injury really keeps things closed in hernia repair" — Todd Ponsky (clinical) [Ep 3 · 14:44](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=884)
- "When non-absorbable braided suture is used, the repair is better, at least in rabbits" — Todd Ponsky (clinical) [Ep 3 · 17:18](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1038)
- "There was a generation that spent a lot of time picking out silk sutures spitting out of the groin or abscesses years after placement" (clinical) [Ep 3 · 18:52](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1132)
- "A true retractile testis that can be pulled down has occasionally gone up and gotten trapped" — Corn (clinical) [Ep 3 · 20:33](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1233)
- "Once testicles have gone through puberty and are much larger, they cannot retract" — Corn (clinical) [Ep 3 · 21:39](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1299)
- "There is theoretical risk of retractile testicle going back up and being caught between time of initial exam and puberty" — Corn (clinical) [Ep 3 · 22:01](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1321)
- "Riding up after hernia repair happens when getting a little bit of cremaster or some vessels in the cord stuck in external oblique closure" (clinical) [Ep 3 · 24:39](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1479)
- "If there is an absent testicle that cannot be found on exam, ultrasound is not needed - go straight to laparoscopy" (clinical) [Ep 3 · 26:29](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1589)
- "If testicle was in the canal, should have been able to find it on groin exam" (clinical) [Ep 3 · 26:50](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1610)
- "One-stage Fowler-Stevens is probably just as good as two-stage based on retrospective data and prospective pilot data" — Todd Ponsky (clinical) [Ep 3 · 27:58](https://library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1678)
- "Felix Schier's original laparoscopic hernia recurrence rate was 6%, more recent data 3%." (clinical) [Ep 4 · 37:47](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2267)
- "Craig Albanese and Sanjeev Dutta reported 1.5% recurrence with the SEAL repair." (clinical) [Ep 4 · 38:18](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2298)
- "CK Young has had one or two recurrences in over 2000 laparoscopic hernia repairs." (clinical) [Ep 4 · 38:33](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2313)
- "In the Mayo Clinic 50-year follow-up study of open hernia repair, 5% of patients were infertile." (epidemiological) [Ep 4 · 40:40](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2440)
- "In a fertility clinic study of 8500 patients, 6% had prior hernioplasty, but semen quality was markedly reduced in those with hernia repair." (clinical) [Ep 4 · 41:07](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2467)
- "In the rabbit model, grabbing the vas with pickups obliterates it." (clinical) [Ep 4 · 39:41](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2381)
- "At 2 weeks post-repair in rabbits, 25% of suture-alone repairs stayed closed after stitch removal; 87% with anterior injury stayed closed." (clinical) [Ep 4 · 63:40](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3820)
- "At 4 weeks, 17% of suture-alone repairs stayed closed; 100% with anterior injury stayed closed even at 36 mmHg insufflation." (clinical) [Ep 4 · 63:53](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3833)
- "In rabbit model comparing suture materials without injury, silk had lower failure rate than Vicryl or Prolene at 6 weeks." (clinical) [Ep 4 · 65:12](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3912)
- "Recurrent pediatric hernias are often direct hernias, not indirect; Mayo Clinic and other studies show direct hernias are as common or more common than indirect in recurrences." (clinical) [Ep 4 · 29:59](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1799)
- "Laparoscopy eliminates the risk of floor injury and allows identification of direct hernias, potentially reducing long-term recurrence." (opinion) [Ep 4 · 31:14](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1874)
- "In a 5-year follow-up of adolescent open hernia repairs (age 13–18), recurrence rate was 3% at both institutions." (clinical) [Ep 4 · 104:08](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6248)
- "Chronic pain after adult mesh hernia repair is quoted at 10–15% in large studies, with one study showing 30%." (clinical) [Ep 4 · 105:16](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6316)
- "The speaker has had two stitch abscesses in premature infants where the suture extruded but the hernia remained closed." (clinical) [Ep 4 · 67:23](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4043)
- "The speaker has had two hydroceles form after laparoscopic hernia repair, both on asymptomatic contralateral sides repaired with the SEAL technique." (clinical) [Ep 4 · 77:11](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4631)
- "In the UK, open hernia repair involves dividing the sac without ligation, with recurrence rates equivalent to traditional high ligation." (clinical) [Ep 4 · 59:56](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3596)
- "The speaker uses 3-0 Prolene for the initial loop because it is stiff enough to pass through an 18-gauge needle." (clinical) [Ep 4 · 64:42](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3882)
- "The speaker exchanges the Prolene loop for 2-0 Ethibond (braided suture) before tying, based on rabbit data favoring braided suture." (clinical) [Ep 4 · 66:11](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3971)
- "The speaker performs anterior peritoneal injury (cautery or scissors at 5–7 o'clock) to promote scarring and reduce reliance on permanent suture." (clinical) [Ep 4 · 74:45](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4485)
- "Matthias Bruzzoni reports 1.4% recurrence in 210 hernia repairs over 4 years using the modified two-pass SEAL technique." — Matthias Bruzzoni (clinical) [Ep 4 · 139:22](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8362)
- "The two-pass SEAL technique (one pass through sac center, second encircling neck) has lower recurrence than the original single-pass SEAL (2–3%)." — Matthias Bruzzoni (clinical) [Ep 4 · 139:37](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8377)
- "Right-sided hernias are more difficult to repair laparoscopically because the needle must approach the epigastric artery from lateral to medial." — Matthias Bruzzoni (opinion) [Ep 4 · 135:10](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8110)
- "Leaving a medial defect next to the epigastric artery is a common cause of immediate recurrence." — Matthias Bruzzoni (clinical) [Ep 4 · 135:33](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8133)
- "The speaker has never had a premature infant hernia recurrence with laparoscopic repair, only older children." (clinical) [Ep 4 · 23:26](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1406)
- "Incarcerated hernias can be reduced laparoscopically by pushing and pulling, similar to intussusception reduction." (clinical) [Ep 4 · 26:36](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1596)
- "The speaker proposes that small indirect inguinal hernias in adults (any age) may be suitable for laparoscopic high-ligation without mesh if the defect is <2 cm." (opinion) [Ep 4 · 109:01](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6541)
- "Mesh was designed for direct hernias (muscle defects), not indirect hernias (patent processus vaginalis)." (opinion) [Ep 4 · 108:34](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6514)
- "The speaker uses an infraumbilical incision with marcaine injection to lift the inferior umbilical lip, believing it is more cosmetically hidden than transumbilical." (opinion) [Ep 4 · 114:38](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6878)
- "The speaker uses a 3 mm 70-degree scope for better visualization around the internal ring compared to a 30-degree scope." (clinical) [Ep 4 · 113:43](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6823)
- "The speaker hydrodissects from the lateral side (not 12 o'clock) to lift peritoneum off vessels, using marcaine with epinephrine or saline." (clinical) [Ep 4 · 75:57](https://library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4557)
- "Inguinal hernia repair is the second most common surgery performed by pediatric surgeons" — Meera Kotagal (epidemiological) [Ep 11 · 0:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=0)
- "Indirect hernias are above the inguinal ligament but lateral to the epigastric vessels" — Meera Kotagal (clinical) [Ep 11 · 1:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=90)
- "Direct hernias are above the inguinal ligament and medial to the epigastric vessels" — Meera Kotagal (clinical) [Ep 11 · 1:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=105)
- "Femoral hernias are below the inguinal ligament" — Meera Kotagal (clinical) [Ep 11 · 2:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=120)
- "The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns" — Meera Kotagal (epidemiological) [Ep 11 · 2:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=150)
- "Incidence increases to about 13% in premature infants who are less than 32 weeks of gestational age" — Meera Kotagal (epidemiological) [Ep 11 · 2:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=165)
- "Over 90% of hernias in children are indirect" — Meera Kotagal (epidemiological) [Ep 11 · 3:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=180)
- "Direct hernias are pretty rare in children and are much more commonly found in adolescence" — Meera Kotagal (epidemiological) [Ep 11 · 3:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=195)
- "Femoral hernias are very rare in children and are more common in females" — Meera Kotagal (epidemiological) [Ep 11 · 3:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=210)
- "Indirect inguinal hernias in children are a congenital anomaly present at the time of birth" — Meera Kotagal (clinical) [Ep 11 · 4:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=240)
- "Inguinal hernias occur as a result of the failure of the processus vaginalis to fuse" — Meera Kotagal (clinical) [Ep 11 · 4:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=255)
- "The right processus vaginalis usually obliterates after the left, explaining the higher prevalence of right-sided hernias" — Meera Kotagal (clinical) [Ep 11 · 4:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=285)
- "The number one risk factor for inguinal hernias in children is prematurity" — Meera Kotagal (clinical) [Ep 11 · 6:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=390)
- "Risk factors include male sex, family history of inguinal hernias, history of undescended testicle or hydrocele, and connective tissue disorder" — Meera Kotagal (clinical) [Ep 11 · 7:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=420)
- "More than half of incarcerations are in patients less than six months old" — Meera Kotagal (epidemiological) [Ep 11 · 12:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=720)
- "Two-thirds of incarcerations are in patients less than a year old" — Meera Kotagal (epidemiological) [Ep 11 · 12:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=735)
- "If corrected gestational age is less than 60 weeks, patients are at increased risk of post-operative apnea and should be admitted after repair" — Meera Kotagal (clinical) [Ep 11 · 12:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=750)
- "Children with incarcerated hernia may present with pain, abdominal distension, or emesis if obstruction is present" — Meera Kotagal (clinical) [Ep 11 · 13:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=795)
- "Patients with strangulated hernia may present with fever, tachycardia, leukocytosis, severe pain, or overlying erythema" — Meera Kotagal (clinical) [Ep 11 · 14:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=840)
- "If you can reduce an incarcerated hernia, you want to go to the OR within 24 to 72 hours after reduction" — Meera Kotagal (guideline) [Ep 11 · 19:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1140)
- "With laparoscopy, you don't necessarily need to wait for edema to resolve because it's not much more difficult and edema can help lift the peritoneum" — Meera Kotagal (opinion) [Ep 11 · 19:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1185)
- "High ligation of the processus vaginalis is needed whether done laparoscopically or open" — Meera Kotagal (guideline) [Ep 11 · 22:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1320)
- "Unlike in adults, mesh is not generally used in pediatric inguinal hernia repair" — Meera Kotagal (clinical) [Ep 11 · 23:00](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1380)
- "Outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar" — Meera Kotagal (clinical) [Ep 11 · 23:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1395)
- "A floor repair should be considered in children with long-standing or very large hernias where the floor might be blown out" — Meera Kotagal (guideline) [Ep 11 · 24:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1485)
- "Superficial site infection occurs in less than 1% of children after inguinal hernia repair" — Meera Kotagal (epidemiological) [Ep 11 · 26:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1575)
- "Recurrence rates vary from 1 to 5% depending on which studies you look at" — Meera Kotagal (epidemiological) [Ep 11 · 26:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1590)
- "Most children can return to normal activities within one to two days after hernia repair" — Meera Kotagal (guideline) [Ep 11 · 27:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1665)
- "If a patient has an undescended testicle palpable in the inguinal canal, you should plan to do an orchidopexy at the time of inguinal hernia repair" — Meera Kotagal (guideline) [Ep 11 · 31:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1890)
- "Children with absent vas deference noted on hernia repair should be worked up for cystic fibrosis or unilateral renal agenesis" — Meera Kotagal (guideline) [Ep 11 · 32:30](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1950)
- "Testicular ischemia after hernia repair is best evaluated with ultrasound looking for Doppler flow" — Meera Kotagal (clinical) [Ep 11 · 33:45](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=2025)
- "Patients with testicular ischemia are monitored and observed with pain control; only frankly necrotic testicles are removed, not partially ischemic ones" — Meera Kotagal (guideline) [Ep 11 · 34:15](https://library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=2055)
- "Inguinal hernia repairs are some of the most common pediatric surgical procedures and are traditionally performed under general anesthesia for open surgery" — Wendy (clinical) [Ep 14 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=0)
- "Many centers have recently started utilizing the minimally invasive approach with regional anesthesia instead of traditional general anesthesia with open surgery" — Wendy (clinical) [Ep 14 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=60)
- "Over the last five years at BC Children's Hospital, surgeons and anesthesiologists have utilized four different combinations of surgical and anesthetic techniques" — Wendy (clinical) [Ep 14 · 1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=90)
- "The safety of caudal anesthesia with laparoscopy (CL) was demonstrated in a prior case study" — Wendy (clinical) [Ep 14 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=120)
- "The CL technique has previously not been described in literature for comparison with other approaches" — Wendy (clinical) [Ep 14 · 2:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=150)
- "The study included all infants less than one year old undergoing elective inguinal hernia repair from July 2016 to 2021 at a single tertiary care teaching center" — Wendy (clinical) [Ep 14 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=180)
- "Inguinal hernia repairs with concomitant procedures and emergent procedures from strangulated or incarcerated hernias were excluded from the study" — Wendy (clinical) [Ep 14 · 3:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=210)
- "Eight surgeons and 25 anesthesiologists contributed patients with approach dictated by practitioner preference" — Wendy (clinical) [Ep 14 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=240)
- "465 infants were initially assessed for eligibility of which 338 patients were included in the final study analysis" — Wendy (clinical) [Ep 14 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=270)
- "Most patients underwent an open procedure with only 63 cases being laparoscopic" — Wendy (clinical) [Ep 14 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=300)
- "There was a relatively even split between caudal anesthesia and general anesthesia" — Wendy (clinical) [Ep 14 · 5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=330)
- "Most included patients were pre-term males and were followed for a median of 2.5 years" — Wendy (clinical) [Ep 14 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=360)
- "There were two crossovers: one conversion in the GL group to open surgery because the patient was unable to tolerate the pneumoperitoneum" — Wendy (clinical) [Ep 14 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=390)
- "One case required conversion to general anesthesia in the caudal group because the patient did not tolerate the incision despite initially passing the pinch test" — Wendy (clinical) [Ep 14 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=420)
- "There was no statistical difference found between groups for the aggregate post-operative complication rates, including recurrence" — Wendy (clinical) [Ep 14 · 7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=450)
- "Metachronous hernias occurred at a similar rate for open and laparoscopic approaches, albeit with a modest follow-up irrespective of anesthetic choice" — Wendy (clinical) [Ep 14 · 8:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=480)
- "Total OR time was significantly different between groups with caudal anesthesia with open surgery being the shortest" — Wendy (clinical) [Ep 14 · 8:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=510)
- "Caudal anesthesia with open surgery was significantly shorter than caudal anesthesia with laparoscopy by 15 minutes" — Wendy (clinical) [Ep 14 · 9:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=540)
- "Caudal anesthesia with open surgery was significantly shorter than general anesthesia with open surgery by 9 minutes" — Wendy (clinical) [Ep 14 · 9:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=570)
- "There was no difference in anesthetic preparation time or skin to skin time between the groups" — Wendy (clinical) [Ep 14 · 10:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=600)
- "Overall post procedure time was significantly shorter in patients receiving a caudal blockade than general anesthesia, with four minutes saved in the laparoscopic group" — Wendy (clinical) [Ep 14 · 10:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=630)
- "Overall post procedure time was significantly shorter in patients receiving a caudal blockade than general anesthesia, with eight minutes saved in the open group" — Wendy (clinical) [Ep 14 · 11:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=660)
- "The use of laparoscopy with caudal anesthesia appears to be a safe and effective option in terms of post-operative complications compared to other groups" — Wendy (opinion) [Ep 14 · 11:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=690)
- "Caudal anesthesia with open surgery appeared to be the most resource efficient inguinal hernia repair method" — Wendy (opinion) [Ep 14 · 12:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=720)
- "Due to the retrospective nature of the project, it is subject to the normal bias of any retrospective review" — Wendy (opinion) [Ep 14 · 12:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=750)
- "Due to lack of cross hospital EMRs, the study follow-up was unable to capture post-operative complications managed at any other hospital or clinic" — Wendy (clinical) [Ep 14 · 13:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=780)
- "Inguinal hernia repair is the second most common surgery that pediatric surgeons perform" — Rod (epidemiological) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=0)
- "Indirect hernias are a defect above the inguinal ligament and lateral to the epigastric vessels" — Rae Hanke (clinical) [Ep 7 · 0:56](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=56)
- "A direct hernia is a defect above the inguinal ligament and medial to the epigastric vessels" — Rae Hanke (clinical) [Ep 7 · 0:56](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=56)
- "Femoral hernia is a defect below the inguinal ligament" — Rae Hanke (clinical) [Ep 7 · 0:56](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=56)
- "The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns" — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Inguinal hernia incidence increases to about 13% in premature infants who are less than 32 weeks of gestational age" — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Over 90% of hernias in children are indirect" — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Direct hernias are pretty rare in children and are much more commonly found in adolescents" — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Femoral hernias are very rare in children and are more common in females" — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Indirect inguinal hernias in children are a congenital anomaly present at the time of birth" — Meera Kotagal (clinical) [Ep 7 · 1:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "Inguinal hernias occur as a result of the failure of the processus vaginalis to fuse" — Meera Kotagal (clinical) [Ep 7 · 1:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "The right processus vaginalis usually obliterates after the left, explaining the higher prevalence of right-sided hernias" — Meera Kotagal (clinical) [Ep 7 · 1:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "A communicating hydrocele occurs when fluid can move from the peritoneal cavity through the inguinal canal and into the scrotum" — Meera Kotagal (clinical) [Ep 7 · 2:28](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=148)
- "A non-communicating hydrocele occurs when the proximal part closes and some fluid is trapped distally" — Meera Kotagal (clinical) [Ep 7 · 2:34](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=154)
- "The number one risk factor for inguinal hernias in children is prematurity" — Meera Kotagal (epidemiological) [Ep 7 · 2:47](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=167)
- "Risk factors for inguinal hernias include male sex, family history of inguinal hernias, history of undescended testicle or hydrocele, and connective tissue disorder" — Meera Kotagal (epidemiological) [Ep 7 · 2:47](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=167)
- "Patients with increased intra-abdominal pressure present more symptomatically, including those with cystic fibrosis, chronic ventilation, chronic constipation, VP shunts, or peritoneal dialysis" — Meera Kotagal (clinical) [Ep 7 · 2:47](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=167)
- "The differential diagnosis for a groin mass in a child includes inguinal hernia, hydroceles, or lymphadenopathy" — Meera Kotagal (clinical) [Ep 7 · 3:35](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=215)
- "If groin mass is associated with significant pain, differential should include testicular torsion, epididymitis, orchitis, or torsion of the appendix testes" — Meera Kotagal (clinical) [Ep 7 · 3:35](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=215)
- "A retractile testicle or undescended testicle in the groin can be mistaken for a hernia" — Todd (clinical) [Ep 7 · 4:03](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=243)
- "Timing for repair of inguinal hernias balances the risks of anesthesia with the risks of incarceration" — Meera Kotagal (clinical) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "Inguinal hernia repair is considered an elective operation and does not need to be urgently performed" — Meera Kotagal (guideline) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "More than half of incarcerations occur in patients less than six months old" — Meera Kotagal (epidemiological) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "Two-thirds of incarcerations occur in patients less than one year old" — Meera Kotagal (epidemiological) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "If corrected gestational age is less than 60 weeks, patients have a high risk for premature apnea postoperatively and need admission for monitoring" — Meera Kotagal (clinical) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "Children with incarcerated hernia may present with pain, particularly groin pain, abdominal distension, or emesis if obstruction is present" — Meera Kotagal (clinical) [Ep 7 · 5:24](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=324)
- "Patients with strangulated hernia may present with fever, tachycardia, leukocytosis, severe pain, or overlying erythema in the skin" — Meera Kotagal (clinical) [Ep 7 · 5:24](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=324)
- "Keeping the patient calm with pain control and sedation is important for reducing an incarcerated hernia" — Meera Kotagal (clinical) [Ep 7 · 5:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=359)
- "For reduction, place patient supine in Trendelenburg position with head down, use two hands with one guiding contents through inguinal ring and other applying gentle steady pressure" — Meera Kotagal (clinical) [Ep 7 · 5:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=359)
- "Reduction requires squeezing incarcerated bowel to push edema out, which can take several minutes" — Todd (clinical) [Ep 7 · 6:41](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=401)
- "After reducing incarcerated hernia under anesthesia, a laparoscope should be used to watch the bowel being reduced to ensure viability" — Todd (opinion) [Ep 7 · 7:17](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=437)
- "If an incarcerated hernia can be reduced, repair should occur within 24 to 72 hours after reduction" — Meera Kotagal (guideline) [Ep 7 · 7:34](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=454)
- "With laparoscopy, waiting after reduction may not be necessary because edema can help lift the peritoneum off and the operation is not more difficult" — Todd (opinion) [Ep 7 · 7:50](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=470)
- "For incarcerated hernia in the middle of the day with time availability, one could go straight to OR under laparoscopy without attempting reduction in the ER" — Todd (opinion) [Ep 7 · 7:50](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=470)
- "Pediatric inguinal hernia repair requires high ligation of the processus vaginalis whether done laparoscopically or open" — Meera Kotagal (clinical) [Ep 7 · 8:57](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=537)
- "Mesh is not generally used in repair of pediatric inguinal hernia" — Meera Kotagal (clinical) [Ep 7 · 8:57](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=537)
- "Outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar, although there is some controversy" — Meera Kotagal (opinion) [Ep 7 · 9:31](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=571)
- "If a child needs orchiopexy in addition to hernia repair, most would approach the hernia in an open fashion" — Meera Kotagal (guideline) [Ep 7 · 9:44](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=584)
- "Undescended testicle cases can be done laparoscopically with the hernia addressed at the same time" — Todd (opinion) [Ep 7 · 9:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=599)
- "Some surgeons just cut the sac without ligating anything, learning from orchiopexies where the hole is not ligated and patients usually do not get hernias" — Todd (opinion) [Ep 7 · 9:59](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=599)
- "A floor repair should be considered in children with longstanding or very large hernias where the floor might be blown out or unsupported" — Meera Kotagal (clinical) [Ep 7 · 10:54](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=654)
- "Superficial site infection occurs in less than 1% of children after inguinal hernia repair" — Meera Kotagal (epidemiological) [Ep 7 · 11:10](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Recurrence rates vary from 1% to 5% depending on which studies are reviewed" — Meera Kotagal (epidemiological) [Ep 7 · 11:10](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Rare complications include testicular atrophy or damage to the vas deferens" — Meera Kotagal (clinical) [Ep 7 · 11:10](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Seroma after hernia repair will resolve with time" — Meera Kotagal (clinical) [Ep 7 · 11:10](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Post-operative hydrocele can occur after laparoscopic repair and all observed cases have resolved on their own" — Todd (clinical) [Ep 7 · 11:52](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=712)
- "Activities are not limited in children after hernia repair and most can return to normal activities within one to two days" — Meera Kotagal (guideline) [Ep 7 · 12:19](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=739)
- "With incarcerated hernia unable to be reduced, the main concern is bowel ischemia and necrosis, particularly with overlying skin changes suggesting strangulation" — Meera Kotagal (clinical) [Ep 7 · 12:51](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=771)
- "Necrotic bowel can be resected through a groin incision or small midline incision, or the case can be approached laparoscopically to run the bowel" — Meera Kotagal (clinical) [Ep 7 · 12:51](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=771)
- "An incarcerated hernia unable to be reduced in the ER may spontaneously reduce once the patient is under anesthesia and relaxed" — Meera Kotagal (clinical) [Ep 7 · 13:29](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=809)
- "Thorough preoperative exam is important to identify undescended testes, and orchiopexy should be planned at time of hernia repair if an undescended testicle is palpable in the inguinal canal" — Meera Kotagal (guideline) [Ep 7 · 13:49](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=829)
- "Children with absent vas deferens noted on hernia repair should be worked up for cystic fibrosis or unilateral renal agenesis postoperatively" — Meera Kotagal (guideline) [Ep 7 · 14:18](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=858)
- "Testicular ischemia is the main concern if patients have significant testicular pain after hernia repair" — Meera Kotagal (clinical) [Ep 7 · 14:35](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=875)
- "Ultrasound looking for Doppler flow is the best way to evaluate for testicular ischemia" — Meera Kotagal (clinical) [Ep 7 · 14:35](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=875)
- "Patients with testicular ischemia are monitored and observed with pain control; only frankly necrotic testicles are removed, not partially ischemic ones" — Meera Kotagal (guideline) [Ep 7 · 14:35](https://library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=875)
- "Incision is placed in the lower abdominal crease for female neonatal inguinal hernia repair" — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:00](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=0)
- "Subcutaneous tissue and scarpa's fascia are bluntly dissected" — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:30](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=30)
- "Palpating the hernial sac helps in its location and grasping" — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:45](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=45)
- "The sac and its coverings are bluntly dissected and exteriorized" — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:00](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=60)
- "Coverings are peeled off the sac until extraperitoneal fat is reached" — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:20](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=80)
- "The sac is opened to check for a sliding fallopian tube" — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:00](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=120)
- "The round ligament is clearly seen in female inguinal hernia repair" — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:20](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=140)
- "No tube was found in this case" — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:35](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=155)
- "The sac is twisted and transfixed at the proper neck" — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:45](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=165)
- "4-0 absorbable suture is used for sac ligation" — Tamer Ashraf Wafa (clinical) [Ep 8 · 3:00](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=180)
- "The external ring is closed using absorbable one or two stitches" — Tamer Ashraf Wafa (clinical) [Ep 8 · 3:15](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=195)
- "Scarpa's fascia is closed by inverted absorbable sutures" — Tamer Ashraf Wafa (clinical) [Ep 8 · 4:00](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=240)
- "Skin is closed by subcuticular sutures" — Tamer Ashraf Wafa (clinical) [Ep 8 · 4:15](https://library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=255)
- "Over half a million opioid-related deaths occurred in the last 20 years" — Jeremy Warren (epidemiological) [Ep 13 · 1:30](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=90)
- "Prescription opioid-related deaths increased by 17% in the last year" — Jeremy Warren (epidemiological) [Ep 13 · 1:45](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=105)
- "Transition to synthetic opioids and heroin often begins with exposure to prescribed opioids" — Jeremy Warren (epidemiological) [Ep 13 · 1:55](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=115)
- "Patients were prescribed between 15 and 120 opioid tablets after inguinal hernia repair, with an average of over 30 pills prescribed" — Jeremy Warren (clinical) [Ep 13 · 2:45](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=165)
- "Patients reported taking only 15 to 30 percent of prescribed tablets after inguinal hernia repair" — Jeremy Warren (clinical) [Ep 13 · 3:05](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=185)
- "More than 60 percent of inguinal hernia patients in a Greenville study required no opioid consumption" — Jeremy Warren (clinical) [Ep 13 · 3:20](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=200)
- "Overprescribing increases the risk of opioid misuse and abuse" — Jeremy Warren (clinical) [Ep 13 · 3:35](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=215)
- "The ACHQC is a national hernia-specific registry containing over 100,000 patients" — Jeremy Warren (clinical) [Ep 13 · 3:55](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=235)
- "Over 80 percent of patients reported taking less than 10 pills after inguinal hernia repair" — Jeremy Warren (clinical) [Ep 13 · 4:40](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=280)
- "Over 50 percent of patients reported taking no opioids at all after inguinal hernia repair" — Jeremy Warren (clinical) [Ep 13 · 4:50](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=290)
- "56 percent of patients were prescribed more than 10 pills" — Jeremy Warren (clinical) [Ep 13 · 4:30](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=270)
- "The study analyzed 1,937 patients undergoing elective, clean inguinal hernia repair with completed 30-day follow-up and complete opioid data" — Jeremy Warren (clinical) [Ep 13 · 5:05](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=305)
- "59 percent of cases were minimally invasive inguinal hernia repairs, 35 percent open mesh repairs, and 6 percent open tissue repairs" — Jeremy Warren (clinical) [Ep 13 · 5:20](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=320)
- "Patients reported consuming zero narcotics in 50 percent of cases" — Jeremy Warren (clinical) [Ep 13 · 5:35](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=335)
- "Only 8 percent of patients reported consuming more than 10 tablets" — Jeremy Warren (clinical) [Ep 13 · 5:45](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=345)
- "Older age, ASA 1 or 2, use of local anesthetic, use of sedation versus general anesthetic, and shorter operative time all increase the chances that patients would use zero narcotics post-op" — Jeremy Warren (clinical) [Ep 13 · 6:00](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=360)
- "Patients with no opioid use prior to surgery or prescribed fewer than seven pills were the most likely to consume zero narcotics post-operatively" — Jeremy Warren (clinical) [Ep 13 · 6:25](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=385)
- "Younger age, smokers, ASA 3 or 4, preoperative opioid use, open mesh repairs, longer operative times, and worse baseline quality of life are significant factors that increased the risk of high opioid consumption post-op" — Jeremy Warren (clinical) [Ep 13 · 6:40](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=400)
- "Patients are at significantly higher risk of opioid consumption when prescribed a higher volume of pills" — Jeremy Warren (clinical) [Ep 13 · 7:05](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=425)
- "History of smoking increases the risk of opioid consumption" — Jeremy Warren (clinical) [Ep 13 · 7:25](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=445)
- "Patients with prior or recent opioid use are at higher risk of postoperative opioid consumption" — Jeremy Warren (clinical) [Ep 13 · 7:35](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=455)
- "Minimally invasive approach and use of local anesthetic are surgeon-modifiable factors that reduce opioid consumption" — Jeremy Warren (clinical) [Ep 13 · 7:45](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=465)
- "Patient-reported opioid use is significantly impacted by surgeon prescribing" — Jeremy Warren (clinical) [Ep 13 · 8:10](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=490)
- "Most state legislation has changed to allow prescribing limited opioids through EMRs without hand-off" — Rosen (guideline) [Ep 13 · 8:40](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=520)
- "The rate of refill calls for inguinal hernias when following guidelines is 4%" — Rosen (clinical) [Ep 13 · 9:30](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=570)
- "The number one predictor of how many opioid tablets a patient takes is how many they are prescribed" — Rosen (clinical) [Ep 13 · 9:40](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=580)
- "One surgeon reports zero narcotic prescriptions for laparoscopic inguinal hernias for six months with only one refill request" — Rosen (clinical) [Ep 13 · 10:10](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=610)
- "Other specialties use drugs like gabapentin and Tylenol to achieve effective pain relief without narcotics" — Todd Ponsky (clinical) [Ep 13 · 10:40](https://library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=640)
- "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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 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 26 · 28:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1720)
- "Risk of emergency presentation requiring operation due to incarceration or strangulation in asymptomatic inguinal hernia is less than 1%, specifically one-third of 1%" — Michael Rosen (clinical) [Ep 27 · 3:22](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=202)
- "In Fitzgibbons VA study of asymptomatic hernias, almost one-third of patients developed symptoms requiring operation within two years" — Michael Rosen (clinical) [Ep 27 · 4:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=240)
- "By five years follow-up in Fitzgibbons study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms" — Michael Rosen (clinical) [Ep 27 · 4:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=260)
- "Learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies" — Michael Rosen (clinical) [Ep 27 · 8:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=530)
- "Risk of chronic pain in laparoscopic inguinal hernia repair, when done correctly, is lower than in open inguinal hernias because mesh is placed away from nerves" — Michael Rosen (clinical) [Ep 27 · 9:05](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=545)
- "Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair" — Michael Rosen (clinical) [Ep 27 · 12:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=730)
- "Stoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter (6 by 6 inch) piece of mesh" — Michael Rosen (guideline) [Ep 27 · 20:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1200)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)" — Michael Rosen (clinical) [Ep 27 · 21:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1280)
- "Midweight mesh is between 40 to 50 grams per meter squared" — Michael Rosen (clinical) [Ep 27 · 21:35](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1295)
- "Lightweight mesh (Ultrapro) is less than 30 grams per meter squared, starting heavier but degrading to about 28 grams per meter squared over time" — Michael Rosen (clinical) [Ep 27 · 21:45](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1305)
- "Lighter weight mesh has advantage of less foreign body and potentially less contraction, but disadvantage of half the material with risk of fracturing in direct hernias under stress" — Michael Rosen (clinical) [Ep 27 · 22:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1330)
- "No evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation" — Michael Rosen (clinical) [Ep 27 · 24:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1449)
- "If absorbable fixation is placed through a nerve, it is the neuroma that causes the problem, not the tack itself" — Michael Rosen (clinical) [Ep 27 · 24:16](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1456)
- "Mounting evidence supports placing medium-weight polypropylene mesh in contaminated fields" — Michael Rosen (clinical) [Ep 27 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1496)
- "Lacunar ligament can be released to gain an extra centimeter of space when reducing incarcerated femoral hernia without dividing inguinal ligament" — Michael Rosen (clinical) [Ep 27 · 27:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1620)
- "For recurrent hernia, surgeon should go where nobody has been before; if both spaces have been operated, go where you are most skilled" — Michael Rosen (opinion) [Ep 27 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1692)
- "For bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach" — Michael Rosen (opinion) [Ep 27 · 28:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1710)
- "Bilateral and recurrent hernias should be avoided during laparoscopic learning curve despite potentially offering most benefit, due to highest risk" — Michael Rosen (opinion) [Ep 27 · 28:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1720)
- "Small hernias on physical exam are extremely difficult to feel, and cord structures always give impulse during valsalva even without hernia present" — Michael Rosen (clinical) [Ep 27 · 2:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=130)
- "Parietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly) is the most important part of any laparoscopic repair, as promoted by Rene Stoppa" — Michael Rosen (clinical) [Ep 27 · 18:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1100)
- "Inferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for peritoneal holes, and close to vessels" — Michael Rosen (clinical) [Ep 27 · 19:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1140)
- "Risk of recurrence in laparoscopic repair occurs when peritoneum comes under the mesh and goes back out the defect inferiorly" — Michael Rosen (clinical) [Ep 27 · 19:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13757?t=1170)
- "Risk of emergency presentation requiring operation due to incarceration or strangulation in asymptomatic inguinal hernia is less than 1%, specifically one-third of 1%" — Michael Rosen (clinical) [Ep 28 · 3:22](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=202)
- "In Fitzgibbons VA study of asymptomatic hernias, almost one-third of patients developed symptoms requiring operation within two years" — Michael Rosen (clinical) [Ep 28 · 4:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=240)
- "By five years follow-up in Fitzgibbons study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms" — Michael Rosen (clinical) [Ep 28 · 4:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=260)
- "Learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies" — Michael Rosen (clinical) [Ep 28 · 8:50](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=530)
- "Risk of chronic pain in laparoscopic inguinal hernia repair, when done correctly, is lower than in open inguinal hernias because mesh is placed away from nerves" — Michael Rosen (clinical) [Ep 28 · 9:05](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=545)
- "Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair" — Michael Rosen (clinical) [Ep 28 · 12:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=730)
- "Stoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter (6 by 6 inch) piece of mesh" — Michael Rosen (guideline) [Ep 28 · 20:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1200)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)" — Michael Rosen (clinical) [Ep 28 · 21:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1280)
- "Midweight mesh is between 40 to 50 grams per meter squared" — Michael Rosen (clinical) [Ep 28 · 21:35](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1295)
- "Lightweight mesh (Ultrapro) is less than 30 grams per meter squared, starting heavier but degrading to about 28 grams per meter squared over time" — Michael Rosen (clinical) [Ep 28 · 21:45](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1305)
- "Lighter weight mesh has advantage of less foreign body and potentially less contraction, but disadvantage of half the material with risk of fracturing in direct hernias under stress" — Michael Rosen (clinical) [Ep 28 · 22:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1330)
- "No evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation" — Michael Rosen (clinical) [Ep 28 · 24:09](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1449)
- "If absorbable fixation is placed through a nerve, it is the neuroma that causes the problem, not the tack itself" — Michael Rosen (clinical) [Ep 28 · 24:16](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1456)
- "Mounting evidence supports placing medium-weight polypropylene mesh in contaminated fields" — Michael Rosen (clinical) [Ep 28 · 24:56](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1496)
- "Lacunar ligament can be released to gain an extra centimeter of space when reducing incarcerated femoral hernia without dividing inguinal ligament" — Michael Rosen (clinical) [Ep 28 · 27:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1620)
- "For recurrent hernia, surgeon should go where nobody has been before; if both spaces have been operated, go where you are most skilled" — Michael Rosen (opinion) [Ep 28 · 28:12](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1692)
- "For bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach" — Michael Rosen (opinion) [Ep 28 · 28:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1710)
- "Bilateral and recurrent hernias should be avoided during laparoscopic learning curve despite potentially offering most benefit, due to highest risk" — Michael Rosen (opinion) [Ep 28 · 28:40](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1720)
- "Small hernias on physical exam are extremely difficult to feel, and cord structures always give impulse during valsalva even without hernia present" — Michael Rosen (clinical) [Ep 28 · 2:10](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=130)
- "Parietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly) is the most important part of any laparoscopic repair, as promoted by Rene Stoppa" — Michael Rosen (clinical) [Ep 28 · 18:20](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1100)
- "Inferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for peritoneal holes, and close to vessels" — Michael Rosen (clinical) [Ep 28 · 19:00](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1140)
- "Risk of recurrence in laparoscopic repair occurs when peritoneum comes under the mesh and goes back out the defect inferiorly" — Michael Rosen (clinical) [Ep 28 · 19:30](https://library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13758?t=1170)

## Common questions
### What are the types of hernia repair?
Three primary repair approaches exist for inguinal hernia: tissue repair, open mesh repair, and laparoscopic mesh repair. Within open repair, surgeons can perform repairs without mesh or with mesh using techniques such as Lichtenstein. Laparoscopic approaches include preperitoneal or extraperitoneal repairs. Literature supports all three approaches for unilateral primary hernias, with approach selection individualized to patient factors rather than one technique being substantially superior.

## Changelog
- Aug 31: 21 doctors auto-found from episode dossiers
- Aug 30: 16 doctors auto-found from episode dossiers
- Aug 30: 10 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 12 doctors auto-found from episode dossiers
- Aug 29: 12 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 36 items, 15 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 1 audience(s)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai