Low Cardiac Output
With Jeffrey Ponsky · Michael Rosen
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
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Inguinal Hernia: Adult
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Dr Michael Rosen discusses Adult Inguinal Hernias with Dr Jeffrey Ponsky Edited by Harveen LambaIntroductions:Dr. Ponsky, professor of surgery at the Cleveland Clinic Lerner College of Medicine and Department of Surgery and Dr. Michael Rose
podcast · 31:02 · Dec 2020
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Every statement below comes from the recorded discussions, with its speaker and moment.
Inguinal Hernia: Adult
The risk of presenting with an emergency problem needing an operation due to hernia incarceration or strangulation in asymptomatic elderly patients is 0.3%
clinicalMichael Rosen3:49 ↗
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
clinicalMichael Rosen4:04 ↗
By 5 years follow-up, almost three-fifths of patients with initially asymptomatic hernias developed symptoms
clinicalMichael Rosen4:21 ↗
Inguinal hernia repairs can be done under local anesthesia
clinicalMichael Rosen6:06 ↗
The learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases
clinicalMichael Rosen9:04 ↗
In laparoscopic repair, mesh is placed away from the nerves, resulting in lower risk of chronic pain compared to open repair
clinicalMichael Rosen9:31 ↗
Laparoscopic repair offers approximately 1 week to 10 days earlier recovery compared to open repair
clinicalMichael Rosen12:23 ↗
Laparoscopic repair has risk of intestinal injury and major blood vessel injury because of operating near these structures
clinicalMichael Rosen12:45 ↗
Parietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) is the most important part of any laparoscopic repair
clinicalMichael Rosen18:15 ↗
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
clinicalMichael Rosen18:53 ↗
Stoppa's original description for unilateral inguinal hernia was to never use less than a 15 by 15 centimeter piece of mesh
guidelineMichael Rosen19:30 ↗
For large direct hernias, a heavier weight mesh material should be used
clinicalMichael Rosen20:26 ↗
Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)
clinicalMichael Rosen21:47 ↗
Midweight mesh is between 40 to 50 grams per meter squared
clinicalMichael Rosen21:57 ↗
Lightweight mesh (Ultrapro) is less than 30 grams per meter squared and contracts down to about 28 grams per meter squared over time
clinicalMichael Rosen22:10 ↗
Lightweight mesh is at risk for fracturing, particularly in direct hernias where it acts as a bridge
clinicalMichael Rosen22:23 ↗
For laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh to cover the whole myopectineal orifice
clinicalMichael Rosen23:08 ↗
There is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation
clinicalMichael Rosen24:10 ↗
If a tack is put through a nerve, it is the neuroma that causes the problem, not the tack itself
clinicalMichael Rosen24:22 ↗
There is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field
clinicalMichael Rosen24:56 ↗
The lacunar ligament can be released to gain an extra 1 centimeter of space when reducing incarcerated femoral hernias without destroying the inguinal ligament
clinicalMichael Rosen26:58 ↗
For recurrent hernias, surgeons should go where nobody has been before, or if both approaches have been used, go where they are best
opinionMichael Rosen28:12 ↗
Surgeons learning laparoscopic hernia repair should avoid bilateral and recurrent hernias during their learning curve
opinionMichael Rosen28:36 ↗
For truly incarcerated hernias, TEP approach is not a good idea because you want the contents out of the hernia sac; TAPP is preferred
clinicalMichael Rosen29:31 ↗