# Low Cardiac Output — GCMD Library living collection Experts: Dr. Jeffrey Ponsky, Dr. Michael Rosen Updated: n/a · 1 episodes · 24 cited statements ## Episodes ### 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) ## Chapters - [0:00](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=0) Introduction and Asymptomatic Hernias (Ep 1) - [3:12](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=192) Evidence for Observation and High-Risk Patients (Ep 1) - [6:32](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=392) Operative Approach Selection (Ep 1) - [10:17](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=617) TAPP vs TEP and Patient Counseling (Ep 1) - [13:28](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=808) Contraindications to Laparoscopy (Ep 1) - [16:56](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1016) Laparoscopic Technique Principles (Ep 1) - [21:02](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1262) Mesh Selection and Fixation (Ep 1) - [24:26](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1466) Open Repair and Femoral Hernias (Ep 1) - [27:19](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1639) Special Scenarios (Ep 1) - [30:05](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1805) Conclusion (Ep 1) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 29:31](https://library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1771) ## Changelog - Aug 31: 2 doctors auto-found from episode dossiers - Aug 30: 2 doctors auto-found from episode dossiers - Aug 30: 2 doctors auto-found from episode dossiers - Aug 29: 2 doctors auto-found from episode dossiers - Aug 29: 2 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 1 items, 1 dossiers, summaries for 2 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 1 items, 1 dossiers, summaries for 0 audience(s) - Aug 29: Collection generated from campaign corpus: 1 items, 1 dossiers, summaries for 2 audience(s) - Aug 29: Collection generated from campaign corpus: 1 items, 1 dossiers, summaries for 1 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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