drtowfigh
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Also, as discussed on this webinar, the European Hernia Society has some guidelines provided for patients. They can be accessed here: https://www.europeanherniasociety.eu/patient-info/umbilical-and-epigastric-hernia
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Glad you enjoyed the talk. I will be having more non-US hernia specialists. It is nice to see how different regions see different problems.
You can watch the full episode with Dr. East here: https://youtu.be/eoH_yJ8HOgI
And, yes, Dr. East does treat patients from outside of the Czech Republic.
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Tissue repairs are best for Indirect inguinal hernias. Not as good for directs. But most surgeons would not image an inguinal hernia obvious on examination.
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– the longer you wait after the prostate surgery, the better. Scar tissue will be less. This is most important for those who would benefit from laparoscopic hernia repair.
– Tissue repair Area is not related to prostate surgery area. So not much of an issue.
– almost all prostate surgery is performed robotically in the US and that is the best choice whether you need herni repair or not. -
We had a great conversation about imaging and also the intricacies of parastomal hernias. You can watch it on my YouTube channel here: https://youtu.be/1CwDi1DvD2M
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We had another great HerniaTalk **LIVE** session with Dr. Augenstein. You can watch it here: https://youtu.be/Lcb_Utz0p6o
We discussed management of complex hernias. This includes treatment of mesh infections, loss of domain, multiply recurrent hernias, indications for use of biologic mesh, protocols for preoperative optimization and postoperative recovery.
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Ventrio ST is intended for use in laparoscopic ventral hernias, such as umbilical hernias. It is meant for intraperitoneal placement, which is why the “ST” portion of the mesh is added. ST mesh is not intended for use in extraperitoneal repairs, such as with the Kugel type repair or open preperitoneal hernia repair. Studies show using mesh with ST or other barriers in the extraperitoneal space actually hinders the healing process.
Perhaps the surgeon is using Ventrio mesh because the Kugel patch is no longer being sold (for the reasons outlined above). The Ventrio mesh is less stiff than the original Kugel, but the concept is the same. It has a ring that keeps it open and it has 2 layers of mesh, not one, which makes it very heavyweight.
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Dr. Earle is a great choice in the Massachusetts area.
Also, thanks to your PT for viewing one of my HerniaTalks. I recommend you view the one on pelvic pain from a couple of weeks ago. It can be viewed here:
https://www.facebook.com/141698152571123/posts/3916457325095168/?d=nAlso, you can read about it in a blog I wrote here:
https://pelvicpainrehab.com/female-pelvic-pain/3565/hernia-may-cause-pelvic-pain/ -
Not sure where you read “Papers seem to show bio meshes are better than synthetic ones.” I do not agree with that statement and I know of no guideline that supports that statement, either.
There are risks and benefits to every mesh choice. Most absorbable mesh are biologic, though there are also synthetic options. Since they absorb, the risk of hernia recurrence is overall quite high. In that respect, it is definitely not a better choice and in almost every situation, it is not first choice therapy for any elective hernia. Some are more processed than others and act like any other synthetic in that they cause a lot of inflammation and scarring. That may be good or bad, depending on the reason for choosing the mesh.
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Evaluation by a pelvic floor physical therapist can help determine if you have pelvic floor spasm. These can cause pain, urinary problems, and bowel movement problems. Treatment of the hernias can help cure these problems. Also, some with diastasis recti have constipation issues, as their core is unbalanced and cannot coordinate the muscular contraction that aids in forming a bowel movement.
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Imaging such as Ultrasound can help clarify. Examination is not always accurate, though it can be when done by a skilled surgeon while you are standing.
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So glad to hear!
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The Kugel patch and On-flex are both mesh products used for open preperitoneal repairs. None of us who do hernia repairs for a living use these products, as they are stiff (aka chronic pain) and can wrinkle (aka pain, recurrence). In fact, I think Kugel patch is no longer marketed and the On-Flex is considered the next generation for this product.
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If I give you a button-down shirt that is 2 sizes too small for you to wear, what are the consequences?
– it will tear
– you will be very uncomfortable in itIf I use a patch over your sweater’s elbow that just barely covers the torn/worn area, what are the consequences?
– it will have minimal durability
– it will pull off and expose the worn area againIt’s all about physics, tension, area.
The same is true of open anterior repair for inguinals. The standard is 3×6 inches. Smaller mesh causes more recurrence and more chronic pain because they are pulling.
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Physical exam is not perfect for determining direct vs indirect for small inguinal hernias. Imaging can help confirm. In larger hernias, the indirect inguinal hernia will fall into the scrotum area.
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That is the access port for the laparoscope. The skin or the fascia was likely closed with suture. The knot may be felt under it. That feeling should go away. Seroma is a fluid collection, which can happen but not as commonly. See your surgeon if it persists beyond a few weeks.
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Just to clarify:
Dr. Felix is one of the original pioneers of laparoscopic hernia repair. The 9 Commandments was published by him and Dr. Daes with the goal of communicating the best techniques for critical view of laparoscopic/robotic inguinal hernia repair. The concepts are nothing new to those of use that perform hernia repair regularly, and yet they are regularly “violated” in many of the situations that I see that come to me for complications. Use of 10x15cm mesh for laparoscopic repair has been standard for the past 2-3 decades. Smaller mesh causes recurrences and an unstable repair, which contributes to groin pain.
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No hernia repair is recommended unless symptoms related to the prostate are addressed first.
If prostate surgery is done, we usually do not recommend any open hernia repair for at least 3 weeks. And no laparoscopic repair for at least 3-6 months.
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Whoa, if you are urinating hourly, that prostate needs to be addressed. An enlarged prostate must be addressed prior to any hernia repair because:
– straining due to an enlarged prostate will exacerbate a hernia
– straining due to an enlarged prostate will make a hernia repair (any technique) recur–that is not a good outcome
– an enlarged prostate will place you at high risk for urinary retention after hernia surgery, meaning you will have to have a urinary catheter placed in you and all the downstream effects of that proceddure.Most patients need only medication to control their prostatism (symptoms related to the prostate).
Most prostate surgery is done for cancer reasons. About 98% are done robotically in the US. With the robotic approach, there is little to no issue if you have had a mesh or tissue-based hernia, whether laparoscopic or open.
After robotic prostate surgery, laparoscopic hernia repair is slightly more risky. -
Great questions.
First, watchful waiting has no effect on the health of the testicle. In super giant hernias down to the knees or below (yes, it can happen!), which we almost never see in the first world, we consider orchiectomy (removal of the testicles) as part of the hernia repair, because those are quite complex. Short of that, the testicle health has no correlation with an inguinal hernia.
In finding surgeons, or type of surgery, Search this site for “Shouldice” and some names will pop up. As for recurrence rates and complications, there is no technique that offers 0% recurrence and 0% complications.
As we have said in other posts, pick a surgeon you trust and who can provide you with a variety of options so that you can learn which options suit your needs most. The Shouldice repair is a great repair. It may or may not be the best repair for you. In general, tissue repairs are not as good for direct hernias. Everything is a balance of risks and benefits and what is important to you.