New Book about Foregut Surgery with Inguinal Hernia Chapter

[pinto]

Thank you for your comments. My purpose is to raise my understanding about these things. We’ve got the latest authoritative scope on hernia, so how does it fit with what we already know. Can we sharpen our focus a bit. A big issue is chronic pain. Probably it’s been around that prior pain raises the chance for post-op complications.

William points out that some findings show it’s less clear: absence of prior pain is no guarantee. I would want to know if prior pain was truly absent before doubting the role of prior pain in surgery outcomes. Would you classify patient condition of “didn’t trouble them much” as an absence of pain? Perhaps it were enough to derail successful outcomes.

Why important? The more relevant prior pain is the more the patient condition factors into assessment of surgery. What’s more relevant, patient condition or surgeon skill? Various patients over the years here at HT describe how they have gotten the run around post-op by their surgeons. Isn’t it a matter of responsibility? How much is failure attributable to the surgeon? Some surgeons seem to avoid the question.

To be reasonable, the subject of pain is ill-understood scientifically/medically and unfortunately some patients with criminal intent will try to milk the system for whatever they can get. It’s fascinating that train wrecks typically invite onlookers who later jump onto the train posing as actual passengers for the victim benefits! I’m not a doctor but I must imagine that they must be on the lookout for scammers. This is maybe why only belatedly has chronic pain arrested the attention of hernia surgeons.

My commentary reminds of discussion at HT of methods, Kang Repair vs. Shouldice. Isn’t it interesting that Dr. Kang treats all comers whereas Shouldice has strict requirements as to who they will treat? Could this difference be ultimately that of responsibility? One is more willing than the other to assume responsibility? Or put another way, one is more fearful of responsibility than the other. How is it that Kang’s incision for IH repair is less than an inch and half but Shouldice’s, two to
three times bigger? Could this difference also be one of responsibility? The bigger the incision, the less responsible the surgeon needs to be? Just some random thoughts for pondering.

[RachelColeman]

interesting information

• This reply was modified 1 year, 9 months ago by  RachelColeman.

[William Bryant]

Oh one of the authors is Dr Sbayi who some posters wanted to know what had happened to.

[William Bryant]

Thanks Pinto for summarising and, in language, I can understand!!!

And to Good Intentions for the find.

I have read before that existing chronic pain seems to or can influence post operative chronic pain. However, I’ve read quite a few articles about hernia mesh injured who say the hernia didn’t even trouble them that much prior. So it can’t be the sole cause and can’t mean you cannot get chronic pain if your hernia is largely asymptomatic at time of surgery.

Which is a shame but perhaps those that say don’t leave a hernia could be on to something. Although being a bit of a non risk taker, I’ve left mine at the moment, it will be 2 years soon since I noticed it.

[pinto]

Assuming a state-of-the-art book, it would be worthwhile to evaluate the book’s overall assessment of hernia complications as follows:
“Chronic or severe pain following inguinal herniorrhaphy is reported in 10% to 14% of the
cases. It remains a perplexing and challenging problem. it is associated with preoperative
chronic pain and with recurrent inguinal hernia repair. The identification and protection
of the ilioinguinal, genitofemoral, and iliohypogastric nerves are important in preventing
nerve entrapment injuries. if a nerve is injured, it should be transected and ligated
proximally, allowing it to retract into the muscle or preperitoneal space. Operative
treatment with planned resection of the three nerves can improve or resolve the pain.
However, a multidisciplinary pain team approach is imperative for optimal patient
outcomes.” (Itani & Sbayi, 2023)

At least one of the two authors advocates “mesh-free” surgery (though he also does mesh perhaps even more). Both are distinguished professors of surgery. They recognize chronic pain can be a post-op complication and point out an association with preoperative pain. Surgical technique is implied as a factor also. The field has yet apparently been unable to sort this out. If acknowledgement of chronic pain is only recent, then hardly much will be known about causation. Perhaps why this book chapter avoids relative results between mesh and non-mesh methods despite an author of the two being a non-mesh advocate (but not totally).

• This reply was modified 1 year, 9 months ago by  pinto.

[Good intentions]

Here is a place to purchase it with more details.

https://shop.lww.com/Operative-Techniques-in-Foregut-Surgery/p/9781975176617