Femoral Hernia
Everything in the library about femoral hernia — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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In-Depth Reviews
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Inguinal Hernia With M. Rosen
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An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner
podcast31:05 · Jul 2026
Inguinal Hernia With M. Rosen
Listen →
An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner
podcast31:05 · Jul 2026
Inguinal Hernia With M. Rosen
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An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner College of Medicine. Table of Contents 1:00:44 1 Introductions 2:02:45Work up for
podcast31:05 · Jul 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Inguinal Hernia With M. Rosen
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%
clinicalMichael Rosen3:22 ↗
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
clinicalMichael Rosen4:00 ↗
By five years follow-up in VA study, almost three-quarters of patients with initially asymptomatic hernias developed symptoms
clinicalMichael Rosen4:20 ↗
Learning curve for laparoscopic inguinal hernia repair is 200 to 250 cases in some studies
clinicalMichael Rosen9:00 ↗
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
clinicalMichael Rosen9:20 ↗
Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair
clinicalMichael Rosen12:10 ↗
Most important part of laparoscopic repair is parietalization of the cord - stripping peritoneum off the cord inferiorly and posteriorly
clinicalMichael Rosen18:20 ↗
Risk of recurrence in laparoscopic repair is peritoneum coming under the mesh inferiorly and going back out to the defect
clinicalMichael Rosen18:53 ↗
Stoppa's original description for unilateral inguinal hernia specified never using less than 15 by 15 centimeter mesh or 6 by 6 inch mesh
guidelineMichael Rosen19:40 ↗
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
clinicalMichael Rosen21:02 ↗
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
clinicalMichael Rosen21:50 ↗
No evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation
clinicalMichael Rosen24:09 ↗
If absorbable fixation is put through a nerve, it is the neuroma that causes the problem, not the tack itself
clinicalMichael Rosen24:20 ↗
Mounting evidence supports placing medium-weight polypropylene mesh in contaminated fields
clinicalMichael Rosen24:56 ↗
For recurrent hernia, should go where nobody has been before; if both spaces have been operated, go where surgeon is most skilled
opinionMichael Rosen28:12 ↗
For bilateral hernias in skilled laparoscopic surgeon, laparoscopy is the best approach
opinionMichael Rosen28:30 ↗
Surgeons learning laparoscopic technique should avoid bilateral and recurrent hernias during learning curve, though these patients may benefit most
opinionMichael Rosen28:40 ↗
In the Fitzgibbons VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, the risk of presenting with an emergency problem (incarceration/strangulation) requiring operation was less than 1% (actually one-third of 1%) over the initial study period.
host_summaryMichael Rosen3:22 ↗
In the Fitzgibbons study, almost one-third of observed patients developed symptoms requiring operation within two years, and by five years almost three-quarters developed symptoms.
host_summaryMichael Rosen4:00 ↗
Patients who developed symptoms during observation in the Fitzgibbons study did not do any worse with their eventual operation compared to immediate repair.
host_summaryMichael Rosen4:20 ↗
For an 89-year-old with asymptomatic hernia, observation is appropriate because odds are in a couple years they might not develop symptoms, but in younger patients the odds are against them living the rest of their life without symptoms.
opinionMichael Rosen4:40 ↗
Inguinal hernias can be repaired under local anesthesia in high-risk patients with severe comorbidities (cardiac disease, ascites, coagulopathy).
clinicalMichael Rosen6:32 ↗
The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200-250 cases required.
host_summaryMichael Rosen9:00 ↗
The primary advantage of laparoscopic repair is placing mesh away from nerves, resulting in lower risk of chronic pain compared to open repair when done correctly.
clinicalMichael Rosen9:20 ↗
Chronic pain incidence in open inguinal hernia repair varies depending on measurement method: very high if detailed surveys are used, lower if only counting patients who present with complaints.
epidemiologicalMichael Rosen9:50 ↗
Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair.
clinicalMichael Rosen12:10 ↗
The disadvantage of laparoscopic repair is operating near intestines with risk of intestinal injury and major blood vessel injury, though this risk should be incredibly low with proper technique.
clinicalMichael Rosen12:25 ↗
In elderly patients or those on anticoagulation requiring quick restart, open repair is preferred to avoid dissecting the retroperitoneal space.
opinionMichael Rosen13:20 ↗
In a 78-year-old with symptomatic hernia on one side and asymptomatic hernia discovered laparoscopically on the other side, repairing the asymptomatic side doubles anesthetic time and increases hematoma risk without clear benefit.
opinionMichael Rosen14:26 ↗
Previous lower abdominal surgery increases risk of enterotomy and OR time for laparoscopic repair; if patient has not had previous open inguinal hernia, open approach is preferred.
opinionMichael Rosen16:26 ↗
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