If you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.
if you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon. It's that you didn't dissect out the space to put the mesh.
If you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.
If you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.
The risk of presenting with an emergency problem needing an operation due to your hernia, due to incarceration or strangulation or something in the middle of the night was less than 1%, it was actually 0.3 of 1%.
The risk of presenting with an emergency problem needing an operation due to your hernia, due to incarceration or strangulation or something in the middle of the night was less than 1%, it was actually 0.3 of 1%.
clinicalThe risk of presenting with an emergency problem needing an operation due to hernia incarceration or strangulation in asymptomatic elderly patients is 0.3%↗
▶Ep 6 · 3:49
quoteThe risk of presenting with an emergency problem needing an operation due to your hernia, due to incarceration or strangulation or something in the middle of the night was less than 1%, it was actually 0.3 of 1%.↗
▶Ep 6 · 4:04
clinicalIn the Fitzgibbons VA study over 2 years, almost one-third of patients with asymptomatic hernias went on to develop symptoms and need an operation↗
▶Ep 6 · 4:21
clinicalBy 5 years follow-up, almost three-fifths of patients with initially asymptomatic hernias developed symptoms↗
▶Ep 6 · 6:06
clinicalInguinal hernia repairs can be done under local anesthesia↗
clinicalThe learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases↗
▶Ep 6 · 9:31
quoteThe risk of chronic pain and laparoscopic inguinal hernia repair, when done right, is lower than the risk in opening oral hernias.↗
▶Ep 6 · 9:31
clinicalIn laparoscopic repair, mesh is placed away from the nerves, resulting in lower risk of chronic pain compared to open repair↗
▶Ep 6 · 11:26
quoteIt's the same room. One comes through the front door, one comes through the ceiling, ultimately you work in the same space and it should be the same operation regardless.↗
▶Ep 6 · 11:55
quoteIf it was my family member who called me and had an inguinal hernia, was seeing a surgeon, I would say make sure you pick somebody that you like who's done this operation a lot.↗
▶Ep 6 · 12:23
clinicalLaparoscopic repair offers approximately 1 week to 10 days earlier recovery compared to open repair↗
▶Ep 6 · 12:45
clinicalLaparoscopic repair has risk of intestinal injury and major blood vessel injury because of operating near these structures↗
▶Ep 6 · 15:50
quoteYou have to check your minimally invasive ego at the door and make sure that you also can do opening oral hernias.↗
▶Ep 6 · 18:15
quoteParietalization of the cord, which essentially just means stripping the peritoneum off the cord inferiorly and posteriorly, and that length is what's critical.↗
▶Ep 6 · 18:15
clinicalParietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) is the most important part of any laparoscopic repair↗
▶Ep 6 · 18:53
quoteThe inferior dissection is the Achilles heel any laparoscopic repair because it's awkward to view it.↗
▶Ep 6 · 18:53
clinicalThe inferior dissection is the Achilles heel of any laparoscopic repair because it is awkward to view and surgeons risk making holes in the peritoneum↗
▶Ep 6 · 19:30
guidelineStoppa's original description for unilateral inguinal hernia was to never use less than a 15 by 15 centimeter piece of mesh↗
▶Ep 6 · 20:26
clinicalFor large direct hernias, a heavier weight mesh material should be used↗
▶Ep 6 · 21:47
clinicalHeavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)↗
▶Ep 6 · 21:57
clinicalMidweight mesh is between 40 to 50 grams per meter squared↗
▶Ep 6 · 22:10
clinicalLightweight mesh (Ultrapro) is less than 30 grams per meter squared and contracts down to about 28 grams per meter squared over time↗
▶Ep 6 · 22:23
clinicalLightweight mesh is at risk for fracturing, particularly in direct hernias where it acts as a bridge↗
▶Ep 6 · 23:08
clinicalFor laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh to cover the whole myopectineal orifice↗
▶Ep 6 · 23:20
quoteIf you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.↗
▶Ep 6 · 24:10
clinicalThere is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 6 · 24:22
clinicalIf a tack is put through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 6 · 24:22
quoteIf you put it through the nerve, it's the neuroma that causes the problem, not the attack.↗
▶Ep 6 · 24:56
clinicalThere is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field↗
▶Ep 6 · 26:58
clinicalThe lacunar ligament can be released to gain an extra 1 centimeter of space when reducing incarcerated femoral hernias without destroying the inguinal ligament↗
▶Ep 6 · 28:12
opinionFor recurrent hernias, surgeons should go where nobody has been before, or if both approaches have been used, go where they are best↗
▶Ep 6 · 28:36
opinionSurgeons learning laparoscopic hernia repair should avoid bilateral and recurrent hernias during their learning curve↗
▶Ep 6 · 29:31
clinicalFor truly incarcerated hernias, TEP approach is not a good idea because you want the contents out of the hernia sac; TAPP is preferred↗
Inguinal Hernia With M. Rosen
▶Ep 26 · 3:22
clinicalIn 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%↗
▶Ep 26 · 4:00
clinicalIn VA study over two years, almost one-third of observed patients developed symptoms and needed operation, with no worse outcomes than immediate surgery group↗
▶Ep 26 · 4:20
clinicalBy five years follow-up in VA study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms↗
▶Ep 26 · 9:00
clinicalLearning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies↗
▶Ep 26 · 9:20
clinicalRisk 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↗
▶Ep 26 · 12:00
quoteI think that that surgical skill is critical. And you don't want to be getting an inguinal hernia in the surgeon's first couple laparoscopic inguinal hernia operators because there is a real learning curve.↗
▶Ep 26 · 12:10
clinicalLaparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair↗
▶Ep 26 · 16:00
quoteI think you should check your minimally invasive ego at the door and make sure that you also can do opening oral hernias or in a patient who's a candidate, send it to somebody who can do opening oral hernias.↗
▶Ep 26 · 18:20
clinicalMost important part of laparoscopic repair is parietalization of the cord - stripping peritoneum off the cord inferiorly and posteriorly↗
▶Ep 26 · 18:53
clinicalRisk of recurrence in laparoscopic repair is peritoneum coming under the mesh inferiorly and going back out to the defect↗
▶Ep 26 · 19:40
guidelineStoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter mesh or 6 by 6 inch mesh↗
▶Ep 26 · 21:02
clinicalHeavyweight 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↗
▶Ep 26 · 21:50
clinicalLighter 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↗
▶Ep 26 · 23:20
quoteIf you're doing an inguinal hernia, I don't think you should ever use smaller than a large of those preformed meshes because you need to cover the whole myelope.↗
▶Ep 26 · 24:09
clinicalNo evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 26 · 24:20
clinicalIf absorbable fixation is put through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 26 · 24:56
clinicalMounting evidence supports placing medium-weight polypropylene mesh in contaminated fields↗
▶Ep 26 · 28:12
opinionFor recurrent hernia, should go where nobody has been before; if both spaces have been operated, go where surgeon is most skilled↗
▶Ep 26 · 28:30
opinionFor bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach↗
▶Ep 26 · 28:40
opinionSurgeons learning laparoscopic technique should avoid bilateral and recurrent hernias during learning curve, though these patients may benefit most↗
Inguinal Hernia With M. Rosen
▶Ep 27 · 2:10
clinicalSmall hernias on physical exam are extremely difficult to feel, and cord structures always give impulse during valsalva even without hernia present↗
▶Ep 27 · 3:22
clinicalRisk of emergency presentation requiring operation due to incarceration or strangulation in asymptomatic inguinal hernia is less than 1%, specifically one-third of 1%↗
▶Ep 27 · 4:00
clinicalIn Fitzgibbons VA study of asymptomatic hernias, almost one-third of patients developed symptoms requiring operation within two years↗
▶Ep 27 · 4:20
clinicalBy five years follow-up in Fitzgibbons study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms↗
clinicalLearning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies↗
▶Ep 27 · 9:05
clinicalRisk 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↗
▶Ep 27 · 12:10
clinicalLaparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair↗
▶Ep 27 · 16:00
quoteyou have to check your minimally invasive ego at the door↗
▶Ep 27 · 18:20
clinicalParietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly) is the most important part of any laparoscopic repair, as promoted by Rene Stoppa↗
▶Ep 27 · 19:00
clinicalInferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for peritoneal holes, and close to vessels↗
▶Ep 27 · 19:30
clinicalRisk of recurrence in laparoscopic repair occurs when peritoneum comes under the mesh and goes back out the defect inferiorly↗
▶Ep 27 · 20:00
guidelineStoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter (6 by 6 inch) piece of mesh↗
▶Ep 27 · 21:20
clinicalHeavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)↗
▶Ep 27 · 21:35
clinicalMidweight mesh is between 40 to 50 grams per meter squared↗
▶Ep 27 · 21:45
clinicalLightweight mesh (Ultrapro) is less than 30 grams per meter squared, starting heavier but degrading to about 28 grams per meter squared over time↗
▶Ep 27 · 22:10
clinicalLighter 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↗
▶Ep 27 · 23:10
quoteif you're doing an inguinal hernia, I don't think you should ever use smaller than a large of those preformed meshes because you need to cover the whole myelope↗
▶Ep 27 · 23:24
quoteif you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon. It's that you didn't dissect out the space to put the mesh.↗
▶Ep 27 · 24:09
clinicalNo evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 27 · 24:16
clinicalIf absorbable fixation is placed through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 27 · 24:56
clinicalMounting evidence supports placing medium-weight polypropylene mesh in contaminated fields↗
▶Ep 27 · 27:00
clinicalLacunar ligament can be released to gain an extra centimeter of space when reducing incarcerated femoral hernia without dividing inguinal ligament↗
▶Ep 27 · 28:12
opinionFor recurrent hernia, surgeon should go where nobody has been before; if both spaces have been operated, go where you are most skilled↗
▶Ep 27 · 28:30
opinionFor bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach↗
▶Ep 27 · 28:40
opinionBilateral and recurrent hernias should be avoided during laparoscopic learning curve despite potentially offering most benefit, due to highest risk↗
Inguinal Hernia With M. Rosen
▶Ep 28 · 2:10
clinicalSmall hernias on physical exam are extremely difficult to feel, and cord structures always give impulse during valsalva even without hernia present↗
▶Ep 28 · 3:22
clinicalRisk of emergency presentation requiring operation due to incarceration or strangulation in asymptomatic inguinal hernia is less than 1%, specifically one-third of 1%↗
▶Ep 28 · 4:00
clinicalIn Fitzgibbons VA study of asymptomatic hernias, almost one-third of patients developed symptoms requiring operation within two years↗
▶Ep 28 · 4:20
clinicalBy five years follow-up in Fitzgibbons study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms↗
clinicalLearning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies↗
▶Ep 28 · 9:05
clinicalRisk 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↗
▶Ep 28 · 12:10
clinicalLaparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair↗
▶Ep 28 · 16:00
quoteyou have to check your minimally invasive ego at the door↗
▶Ep 28 · 18:20
clinicalParietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly) is the most important part of any laparoscopic repair, as promoted by Rene Stoppa↗
▶Ep 28 · 19:00
clinicalInferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for peritoneal holes, and close to vessels↗
▶Ep 28 · 19:30
clinicalRisk of recurrence in laparoscopic repair occurs when peritoneum comes under the mesh and goes back out the defect inferiorly↗
▶Ep 28 · 20:00
guidelineStoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter (6 by 6 inch) piece of mesh↗
▶Ep 28 · 21:20
clinicalHeavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)↗
▶Ep 28 · 21:35
clinicalMidweight mesh is between 40 to 50 grams per meter squared↗
▶Ep 28 · 21:45
clinicalLightweight mesh (Ultrapro) is less than 30 grams per meter squared, starting heavier but degrading to about 28 grams per meter squared over time↗
▶Ep 28 · 22:10
clinicalLighter 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↗
▶Ep 28 · 23:10
quoteif you're doing an inguinal hernia, I don't think you should ever use smaller than a large of those preformed meshes because you need to cover the whole myelope↗
▶Ep 28 · 23:24
quoteif you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon. It's that you didn't dissect out the space to put the mesh.↗
▶Ep 28 · 24:09
clinicalNo evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 28 · 24:16
clinicalIf absorbable fixation is placed through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 28 · 24:56
clinicalMounting evidence supports placing medium-weight polypropylene mesh in contaminated fields↗
▶Ep 28 · 27:00
clinicalLacunar ligament can be released to gain an extra centimeter of space when reducing incarcerated femoral hernia without dividing inguinal ligament↗
▶Ep 28 · 28:12
opinionFor recurrent hernia, surgeon should go where nobody has been before; if both spaces have been operated, go where you are most skilled↗
▶Ep 28 · 28:30
opinionFor bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach↗
▶Ep 28 · 28:40
opinionBilateral and recurrent hernias should be avoided during laparoscopic learning curve despite potentially offering most benefit, due to highest risk↗
quoteThe risk of presenting with an emergency problem needing an operation due to your hernia, due to incarceration or strangulation or something in the middle of the night was less than 1%, it was actually 0.3 of 1%.↗
▶Ep 1 · 3:49
clinicalThe risk of presenting with an emergency problem needing an operation due to hernia incarceration or strangulation in asymptomatic elderly patients is 0.3%↗
▶Ep 1 · 4:04
clinicalIn the Fitzgibbons VA study over 2 years, almost one-third of patients with asymptomatic hernias went on to develop symptoms and need an operation↗
▶Ep 1 · 4:21
clinicalBy 5 years follow-up, almost three-fifths of patients with initially asymptomatic hernias developed symptoms↗
▶Ep 1 · 6:06
clinicalInguinal hernia repairs can be done under local anesthesia↗
clinicalThe learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases↗
▶Ep 1 · 9:31
quoteThe risk of chronic pain and laparoscopic inguinal hernia repair, when done right, is lower than the risk in opening oral hernias.↗
▶Ep 1 · 9:31
clinicalIn laparoscopic repair, mesh is placed away from the nerves, resulting in lower risk of chronic pain compared to open repair↗
▶Ep 1 · 11:26
quoteIt's the same room. One comes through the front door, one comes through the ceiling, ultimately you work in the same space and it should be the same operation regardless.↗
▶Ep 1 · 11:55
quoteIf it was my family member who called me and had an inguinal hernia, was seeing a surgeon, I would say make sure you pick somebody that you like who's done this operation a lot.↗
▶Ep 1 · 12:23
clinicalLaparoscopic repair offers approximately 1 week to 10 days earlier recovery compared to open repair↗
▶Ep 1 · 12:45
clinicalLaparoscopic repair has risk of intestinal injury and major blood vessel injury because of operating near these structures↗
▶Ep 1 · 15:50
quoteYou have to check your minimally invasive ego at the door and make sure that you also can do opening oral hernias.↗
▶Ep 1 · 18:15
quoteParietalization of the cord, which essentially just means stripping the peritoneum off the cord inferiorly and posteriorly, and that length is what's critical.↗
▶Ep 1 · 18:15
clinicalParietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) is the most important part of any laparoscopic repair↗
▶Ep 1 · 18:53
clinicalThe inferior dissection is the Achilles heel of any laparoscopic repair because it is awkward to view and surgeons risk making holes in the peritoneum↗
▶Ep 1 · 18:53
quoteThe inferior dissection is the Achilles heel any laparoscopic repair because it's awkward to view it.↗
▶Ep 1 · 19:30
guidelineStoppa's original description for unilateral inguinal hernia was to never use less than a 15 by 15 centimeter piece of mesh↗
▶Ep 1 · 20:26
clinicalFor large direct hernias, a heavier weight mesh material should be used↗
▶Ep 1 · 21:47
clinicalHeavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)↗
▶Ep 1 · 21:57
clinicalMidweight mesh is between 40 to 50 grams per meter squared↗
▶Ep 1 · 22:10
clinicalLightweight mesh (Ultrapro) is less than 30 grams per meter squared and contracts down to about 28 grams per meter squared over time↗
▶Ep 1 · 22:23
clinicalLightweight mesh is at risk for fracturing, particularly in direct hernias where it acts as a bridge↗
▶Ep 1 · 23:08
clinicalFor laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh to cover the whole myopectineal orifice↗
▶Ep 1 · 23:20
quoteIf you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.↗
▶Ep 1 · 24:10
clinicalThere is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 1 · 24:22
clinicalIf a tack is put through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 1 · 24:22
quoteIf you put it through the nerve, it's the neuroma that causes the problem, not the attack.↗
▶Ep 1 · 24:56
clinicalThere is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field↗
▶Ep 1 · 26:58
clinicalThe lacunar ligament can be released to gain an extra 1 centimeter of space when reducing incarcerated femoral hernias without destroying the inguinal ligament↗
▶Ep 1 · 28:12
opinionFor recurrent hernias, surgeons should go where nobody has been before, or if both approaches have been used, go where they are best↗
▶Ep 1 · 28:36
opinionSurgeons learning laparoscopic hernia repair should avoid bilateral and recurrent hernias during their learning curve↗
▶Ep 1 · 29:31
clinicalFor truly incarcerated hernias, TEP approach is not a good idea because you want the contents out of the hernia sac; TAPP is preferred↗
clinicalThe risk of presenting with an emergency problem needing an operation due to hernia incarceration or strangulation in asymptomatic elderly patients is 0.3%↗
▶Ep 10 · 3:49
quoteThe risk of presenting with an emergency problem needing an operation due to your hernia, due to incarceration or strangulation or something in the middle of the night was less than 1%, it was actually 0.3 of 1%.↗
▶Ep 10 · 4:04
clinicalIn the Fitzgibbons VA study over 2 years, almost one-third of patients with asymptomatic hernias went on to develop symptoms and need an operation↗
▶Ep 10 · 4:21
clinicalBy 5 years follow-up, almost three-fifths of patients with initially asymptomatic hernias developed symptoms↗
▶Ep 10 · 6:06
clinicalInguinal hernia repairs can be done under local anesthesia↗
clinicalThe learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases↗
▶Ep 10 · 9:31
quoteThe risk of chronic pain and laparoscopic inguinal hernia repair, when done right, is lower than the risk in opening oral hernias.↗
▶Ep 10 · 9:31
clinicalIn laparoscopic repair, mesh is placed away from the nerves, resulting in lower risk of chronic pain compared to open repair↗
▶Ep 10 · 11:26
quoteIt's the same room. One comes through the front door, one comes through the ceiling, ultimately you work in the same space and it should be the same operation regardless.↗
▶Ep 10 · 11:55
quoteIf it was my family member who called me and had an inguinal hernia, was seeing a surgeon, I would say make sure you pick somebody that you like who's done this operation a lot.↗
▶Ep 10 · 12:23
clinicalLaparoscopic repair offers approximately 1 week to 10 days earlier recovery compared to open repair↗
▶Ep 10 · 12:45
clinicalLaparoscopic repair has risk of intestinal injury and major blood vessel injury because of operating near these structures↗
▶Ep 10 · 15:50
quoteYou have to check your minimally invasive ego at the door and make sure that you also can do opening oral hernias.↗
▶Ep 10 · 18:15
clinicalParietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) is the most important part of any laparoscopic repair↗
▶Ep 10 · 18:15
quoteParietalization of the cord, which essentially just means stripping the peritoneum off the cord inferiorly and posteriorly, and that length is what's critical.↗
▶Ep 10 · 18:53
quoteThe inferior dissection is the Achilles heel any laparoscopic repair because it's awkward to view it.↗
▶Ep 10 · 18:53
clinicalThe inferior dissection is the Achilles heel of any laparoscopic repair because it is awkward to view and surgeons risk making holes in the peritoneum↗
▶Ep 10 · 19:30
guidelineStoppa's original description for unilateral inguinal hernia was to never use less than a 15 by 15 centimeter piece of mesh↗
▶Ep 10 · 20:26
clinicalFor large direct hernias, a heavier weight mesh material should be used↗
▶Ep 10 · 21:47
clinicalHeavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene)↗
▶Ep 10 · 21:57
clinicalMidweight mesh is between 40 to 50 grams per meter squared↗
▶Ep 10 · 22:10
clinicalLightweight mesh (Ultrapro) is less than 30 grams per meter squared and contracts down to about 28 grams per meter squared over time↗
▶Ep 10 · 22:23
clinicalLightweight mesh is at risk for fracturing, particularly in direct hernias where it acts as a bridge↗
▶Ep 10 · 23:08
clinicalFor laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh to cover the whole myopectineal orifice↗
▶Ep 10 · 23:20
quoteIf you're doing a laparoscopic inguinal hernia repair and you are struggling with the mesh, it is never that you're not a good enough laparoscopic surgeon, it's that you didn't dissect out the space to put the mesh.↗
▶Ep 10 · 24:10
clinicalThere is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation↗
▶Ep 10 · 24:22
quoteIf you put it through the nerve, it's the neuroma that causes the problem, not the attack.↗
▶Ep 10 · 24:22
clinicalIf a tack is put through a nerve, it is the neuroma that causes the problem, not the tack itself↗
▶Ep 10 · 24:56
clinicalThere is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field↗
▶Ep 10 · 26:58
clinicalThe lacunar ligament can be released to gain an extra 1 centimeter of space when reducing incarcerated femoral hernias without destroying the inguinal ligament↗
▶Ep 10 · 28:12
opinionFor recurrent hernias, surgeons should go where nobody has been before, or if both approaches have been used, go where they are best↗
▶Ep 10 · 28:36
opinionSurgeons learning laparoscopic hernia repair should avoid bilateral and recurrent hernias during their learning curve↗
▶Ep 10 · 29:31
clinicalFor truly incarcerated hernias, TEP approach is not a good idea because you want the contents out of the hernia sac; TAPP is preferred↗
