Dr Ralph Lorenz Hernia Talk 6th June

[John]

This is an interesting longer follow-up on Desarda from 2021

After 15 years of follow-up, three recurrences were found (1.5%). Recurrences occurred 2, 3, and 5 years after the surgery. All patients expressed their satisfaction with the treatment. Twenty-eight patients (14.4%) reported a rare occurrence of mild pain while performing certain activities. Three patients reported persistent chronic pain (1.5%).

Conclusion: Surgical repair of primary inguinal hernia using the Desarda technique is a simple, feasible, repeatable procedure, using the patient’s own tissues, and with a low learning curve. It seems that the Desarda repair can still be a safe alternative to other non-mesh surgical techniques, especially when the patient refuses the use a synthetic mesh. https://misjournal.net/article/view/4027

[Good intentions]

I mis-wrote above. Dr. Lorenz seems to be one of the newer members of the HerniaSurge group. His name is not shown on the 2018 list of members that were involved in the Bard and Ethicon sponsored meeting that bumped the Guidelines up to the “International” label.

https://link.springer.com/article/10.1007/s10029-017-1668-x

HerniaSurge in 2018 –

“The HerniaSurge Group
M. P. Simons, M. Smietanski, H. J. Bonjer, R. Bittner, M. Miserez, Th. J. Aufenacker, R. J. Fitzgibbons, P. K. Chowbey, H. M. Tran, R. Sani, F. Berrevoet, J. Bingener, T. Bisgaard, K. Bury, G. Campanelli, D. C. Chen, J. Conze, D. Cuccurullo, A. C. de Beaux, H. H. Eker, R. H. Fortelny, J. F. Gillion, B. J. van den Heuvel, W. W. Hope, L. N. Jorgensen, U. Klinge, F. Köckerling, J. F. Kukleta, I. Konate, A. L. Liem, D. Lomanto, M. J. A. Loos, M. Lopez-Cano, M. C. Misra, A. Montgomery, S. Morales-Conde, F. E. Muysoms, H. Niebuhr, P. Nordin, M. Pawlak, G. H. van Ramshorst, W. M. J. Reinpold, D. L. Sanders, N. Schouten, S. Smedberg, R. K. J. Simmermacher, S. Tumtavitikul, N. van Veenendaal, D. Weyhe & A. R. Wijsmuller”

[Good intentions]

I did not watch the Lorenz interview. Did Dr. Towfigh ask Dr. Lorenz about the HerniaSurge Collaboration’s release of the “International Guidelines for Groin Hernia Management” update that is almost six month’s behind the promised release date? Dr. Towfigh vouched for the group in the Topic I created about HerniaSurge, so she was/is aware of the delay. It was an opportune time to ask, especially since Dr. Lorenz is becoming known for non-mesh repairs but was also one of the original authors of the mesh Guidelines. Maybe she could follow-up with him?

Choose HerniaSurge Collaboration from the side menu if the link below does not take you directly there.

https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11195/full#h7

“HerniaSurge Collaboration
F. Agresta, F. Berrevoet, I. Burgmans, D. C. Chen (AHS), A. de Beaux, B. East, N. Henriksen, F. Köckerling, M. Lopez-Cano, R. Lorenz, M. Miserez, A. Montgomery, S. Morales-Conde, C. Oppong, M. Pawlak, M. Podda, D. Sanders, A. Sartori, M.P. Simons (former EHS secretary for quality), C. Stabilini (EHS secretary for Science), H. M. Tran (Australasian Hernia Society), N. van Veenendaal, M. Verdauguer, R. Wiessner.”

https://herniatalk.com/forums/topic/herniasurge-what-happened-to-it-no-updates-no-contact-points/

Herniasurge – what happened to it? No updates, no contact points

[pinto]

“Could Dr. Lorenz mean as far as he knows the suturing is the only difference between a Kang repair and conventional Marcy.”
I don’t think so. If he meant to be so tentative, then he would have said so. He is well experienced about such matters and knows quite well the difference even if speaking in a language not his own. He didn’t do anything wrong; it’s just simply how he views methodological differences.

“Agree with Jack that it’s a shame Dr.Lorenz didn’t reveal who his surgeon was. Mind you I suppose it’s giving publicity to a rival and presumably one in Germany.”
It was interesting how Dr T asked him and left it at that—shifting between professional and personal levels. She let him have his space; besides the matter of “shifting,” his cultural background might have figured into it also. If he were American and possibly more familiar, the outcome might have been different. She handled it very well.

[William Bryant]

Could Dr. Lorenz mean as far as he knows the suturing is the only difference between a Kang repair and conventional Marcy. Although I’m sure Dr Kang also closes a ring or tap that others don’t. Even if suturing IS the only difference, it isn’t too important as long as it works which it seems to.

Hopefully, as Jack, suggests, Dr. Kang could join Dr. Towfigh for a discussion.

Agree with Jack that it’s a shame Dr.Lorenz didn’t reveal who his surgeon was. Mind you I suppose it’s giving publicity to a rival and presumably one in Germany.

Not sure what to make of Dr. Lorenz choosing Shouldice over Desarda unless there aren’t other Desarda capable surgeons in Germany and he can hardly operate on himself!

[pinto]

Mention of Kang Repair (KR) by Lorenz: I got a mixed impression. On the one hand Lorenz is enthusiastic and apparently open to various approaches and excited that the field is growing, precisely the reason he mentioned Kang Repair, but I thought also he was a bit dismissive of it. He stated, “it’s a modified Marcy and of course the difference is only that you” suture horizontally not vertically [emphasis, mine]. He says that so authoritatively. Perhaps he truly knows but Kang himself might disagree. Kang might be able to identify other substantial departures from Marcy. I say so only based on how he described KR here at HT.

• This reply was modified 10 months, 1 week ago by  pinto.

[Jack2021]

I was disappointed that Dr Lorenz didn’t answer Dr Towfigh’s question about who did his Shouldice repair, just saying it was a friend.

It would have been helpful if Dr Towfigh had asked more about their repairs and why they chose Shouldice at the time. Did their respective bio-data dictate only Shouldice repair, as you say Pinto, or did they have their repairs before they knew much about the Desarda repair, was Dr Lorenz’s friend unable to do a Desarda repair and personally preferred the Shouldice option etc etc.

It was also very interesting to hear Dr Lorenz mention @drkang’s repair and explain how he believes it differs from its Marcy repair based origins.

@drkang, @drtowfigh mentioned the possibility of having you as a guest on Hernia Talk Live, to talk about your repair. I think that all forum members would welcome that.

[pinto]

William, this is a bit unrelated about Shouldice but you might be interested nonetheless. Sometime ago I might have been part of a discussion about a rather biased (negatively) surgeon against Shouldice Hospital (maybe you too). Because of her bias, I took her article with a grain of salt:
https://canadianfemalesurgeon.wordpress.com/2015/05/19/the-problem-with-shouldice-or-the-most-dangerous-phrase-in-the-english-language-weve-always-done-it-this-way/

However more notable are the comments by patients, which give an inside look at the hospital. I am surprised to read some of the criticisms. Please note this only pertains to the hospital not the surgical method. If I were to choose the same method, it would not be at the “head” hospital for sure. I suppose elsewhere hospital policies are quite different for patients. (However implications arise for the claimed success of Shouldice based on such hospital policies! Success rates might only be achievable there, a concerning point.)

[William Bryant]

It seems most surgeons with hernia opt for Shouldice if they have a tissue repair. Is that 3 now that we know about, these 2 and Dr. Voeller.

Granted it’s only 3, so hardly exhaustive!

I’ll have to watch this as Dr. Lorenz is a possible. Still seems strange so few people have posted on here about German surgeons, a few about Bio and a couple for Dr Lorenz and Dr Conze. Very grateful for those that have.

[pinto]

Some takeaways:

— Both tissue repair and mesh repair important methods of surgery
— Unrealistic to think mesh can be done away with
— Imaging is vital prior to any surgery as it can plot out the situation for the surgeon
— Hernia size/type and age of patient dictate surgical method
— Suturing, if absorbable, better to use one not with half-year life but much longer
— Stainless steel sutures out of favor in favor of prolene

Dr. Lorenz appears to be eclectic in approach but apparently favors Shouldice by the fact that he and his surgeon friend repaired each other’s own personal hernia by that method to both their full satisfaction. (Or did their respective bio-data dictate only Shouldice repair? 😀 )

We thank Dr. Lorenz for kindly sharing his expertise!

[Jack2021]

I’ve just watched it too and agree this is definitely worth watching.

It was very interesting to hear Dr Towfigh say that Dr Lorenz had got her rethinking her perspective about the Desarda repair – “I need to go and visit Dr Desarda. You’re making me rethink my thoughts about it.”

[JD]

This episode is now up on Dr. Towfigh’s YouTube channel, and I watched it today. An excellent conversation between Dr. Towfigh and Dr. Lorenz. Anyone on this forum who is principally interested in non-mesh repairs should watch it.