Permanent fixation?

[Jack]

When it comes to fixation in laparoscopic hernia surgery it seems like the experts agree less is more. Dr David Chen gives lectures using a “battleship” game analogy, that the surgeon could hit nerves she can’t see. He says Coopers ligament is a “freebie” where fixation isn’t risky. Does it matter then, assuming the fixation is in this low risk place, whether it’s permanent or absorbable? I think Dr Towfigh has said metal is good, but other surgeons (Novitsky on Twitter) say metal tacks can protrude or come loose and should be taken off the market. Does permanent or absorbable matter?

[Good intentions]

Was Dr. Chen talking about open repair or laparoscopic? He does both now, apparently.

I think that the type of repair plays a part in whether or not to fixate, and what type of fixation.

[Jack]

Dr Chen was talking about with laparoscopic. My understanding is he uses progrip mesh which is self fixating so he doesn’t need to tack. But his message is don’t use too many tacks and the only truly safe place to put one is Coopers ligament. I think this is an area where best practices have improved with laparoscopic surgery, the good drs know now not to use several tacks all over the place.

I am curious about metal vs dissolvable tacks. Dr Towfigh, are you out there;)? Maybe people who use metal just do it because they’ve always done it? Or maybe there’s a better reason like it holds better? I think one of Dr Towfigh’s shows says she often doesn’t fixate but sometimes (big hernias or direct?) you have to in which case she uses metal. And then there is this other famous surgeon who says metal tacks should be taken off market. So I’m confused.

[Good intentions]

Three renowned experts have differing opinions. Which will you decide to believe?

Good luck Jack. The hernia repair field is very chaotic with differing opinions across the board, on numerous aspects. I’m not sure how a person would decide who to believe.

Dr. Chen is an Associate Professor at UCLA Health.

https://www.uclahealth.org/providers/david-chen

[Good intentions]

Dr. Novitsky is a Professor at Columbia University Medical Center.

https://columbiasurgery.org/yuri-novitsky-md

[Good intentions]

Dr. Towfigh was an Associate Professor at Cedars-Sinai Medical Center and is now CEO of a consulting company she started in 2014.

https://www.linkedin.com/in/shirintowfigh/

https://www.hexagonhealth.com/consulting/

[Author]

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