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Pediatric Surgery Update: Clinical Advances
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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At lower volume institutions where neonatologists are very involved with care, switching to early repair when only putting one or two children on ECMO per year for CDH is a challenge and requires whole team buy-in. Update Course Rewind: 2024 Top Ten Key Takeaways · 7:12
Update Course Rewind: 2024 Top Ten Key Takeaways
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Join us for a highlight reel of the Top 10 Key Takeaways from the 12th Annual Update Course in Pediatric Surgery. This session covers the latest advances, pract
podcast18:01 · Jul 2026
Congenital Diaphragmatic Hernia1 item
Does the Presence of a Hernia Sac Improve Survival in Newborns with Congenital Diaphragmatic Hernia? A United Kingdom Single-Center Experience
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Introduction A developing body of literature suggests that the presence of a hernia sac in fetuses with congenital diaphragmatic hernia (CDH) may indicate improved prognosis. By examining a large cohort of CDH newborns admitted to a single
article · Jun 2020
If an incarcerated hernia cannot be reduced laparoscopically, it should be done open, because making holes in the bowel increases the morbidity of the operation unacceptably high. — Michael Rosen, Inguinal Hernia: Adult · 29:53
Adult Inguinal Hernia1 item
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
podcast31:02 · Dec 2020
Laparoscopic Approaches1 item
Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study
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Petter Fosse Gjessing, Todd Ponsky, Rolv-Ole LindsetmoBackgroundInguinal hernia surgery has undergone significant and extensive transformation, including the advent of tissue-based repairs and, later, tension-free repair with the acceptance
video0:43 · May 2026
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Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study
The study was published in the International Journal of Surgery.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:08 ↗
The study used the modified percutaneous internal ring suturing technique to evaluate whether a laparoscopic non-mesh repair works on indirect inguinal hernias in adults.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:12 ↗
There were 20 patients in the study.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:23 ↗
The majority of patients were male.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:25 ↗
No patients had hernia recurrence on follow-up, with a median follow-up of 79 months.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:26 ↗
Patients reported a decrease in pain and an improved activity post-operatively.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:31 ↗
This is a small single-center study.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:35 ↗
The study shows success with the modified PIRS technique in adults.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:35 ↗
Inguinal Hernia: Adult
In the Fitzgibbons VA study of minimally symptomatic to asymptomatic inguinal hernias in patients in their 70s-80s, the risk of presenting with an emergency problem (incarceration or strangulation) requiring operation was 0.3% over 2 years.
epidemiologicalMichael Rosen3:30 ↗
In the Fitzgibbons study, almost one-third of patients in the observation group developed symptoms requiring operation by 2 years.
epidemiologicalMichael Rosen4:11 ↗
In long-term follow-up of the Fitzgibbons study, almost three-fifths of patients in the observation group developed symptoms requiring operation by 5 years.
epidemiologicalMichael Rosen4:21 ↗
For an 89-year-old patient with an asymptomatic hernia, watchful waiting is acceptable because the odds are they may not develop symptoms over their remaining lifespan.
opinionMichael Rosen4:33 ↗
For younger patients with asymptomatic hernias, the odds are against them living the rest of their life without the hernia becoming symptomatic, so repair should be recommended when the time is right.
opinionMichael Rosen4:36 ↗
Inguinal hernia repairs can be performed under local anesthesia in high-risk patients.
clinicalMichael Rosen6:06 ↗
For symptomatic hernias in high-risk patients, it is much worse for them to present with an emergency problem in the middle of the night, which could be life-threatening, so they should still be offered repair.
opinionMichael Rosen6:06 ↗
For unilateral primary inguinal hernias, tissue repair, open mesh repair, or laparoscopic mesh repair are all acceptable approaches with ample literature support.
clinicalMichael Rosen7:56 ↗
The best approach for inguinal hernia repair is what the surgeon does best, and this is supported by literature.
opinionMichael Rosen8:29 ↗
The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200-250 cases required.
epidemiologicalMichael Rosen9:04 ↗
In laparoscopic inguinal hernia repair, the mesh is placed away from the nerves, and the risk of chronic pain is lower than in open inguinal hernia repair when done correctly.
clinicalMichael Rosen9:18 ↗
Chronic pain after open inguinal hernia repair can occur due to technical problems or simply due to mesh laying on the nerves, and affected patients are absolutely miserable.
clinicalMichael Rosen9:51 ↗
For young, healthy patients with unilateral hernias who are not anesthetic risks, laparoscopic repair is preferred by Dr. Rosen if the surgeon is past the learning curve.
opinionMichael Rosen9:04 ↗
TAPP (transabdominal preperitoneal) and TEP (total extraperitoneal) approaches have not been studied well enough to provide level-one evidence distinguishing their outcomes.
epidemiologicalMichael Rosen10:45 ↗
TEP repair requires use of a balloon dissector, which is more expensive, and provides a smaller working space but perhaps easier angles to operate with.
clinicalMichael Rosen10:58 ↗
TAPP repair provides a better view and larger working space, and makes it easier for surgeons early in their learning curve to look intraperitoneally and confirm hernia reduction.
clinicalMichael Rosen11:09 ↗
TAPP and TEP ultimately work in the same anatomical space—one enters through the front door, one through the ceiling—and should result in the same operation.
clinicalMichael Rosen11:26 ↗
Laparoscopic inguinal hernia repair offers approximately 1 week to 10 days earlier recovery compared to open repair.
clinicalMichael Rosen12:23 ↗
Laparoscopic inguinal hernia repair carries a risk of intestinal injury and injury to major blood vessels because the operation is performed near these structures, but this risk should be incredibly low if the surgeon knows the planes and operates safely.
clinicalMichael Rosen12:45 ↗
In elderly patients with any anesthetic risk or anyone on anticoagulation who needs to restart quickly, Dr. Rosen prefers open repair because he does not want to dissect the retroperitoneal space in these patients.
opinionMichael Rosen13:28 ↗
In a 78-year-old patient with a symptomatic hernia on one side and an asymptomatic hernia discovered laparoscopically on the other side, Dr. Rosen does not fix the asymptomatic side, citing concerns about doubling anesthetic time and increasing hematoma risk.
opinionMichael Rosen14:10 ↗
Pneumoperitoneum is rarely a problem in patients with reduced cardiac capacity as long as insufflation is done slowly, pressures are kept low, and the patient is positioned in Trendelenburg to help cardiac return.
clinicalMichael Rosen15:17 ↗
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