Category: Hernia

Americas Hernia Society Presentation of Morgagni Hernia Repair​

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Americas Hernia Society Presentation of Robotic Removal of Infected Inguinal Mesh

Part of being a physician and a surgeon is constantly continuing to improve. Medicine and surgery continue to evolve and to progress and the same is true of hernia surgery. While the principles and techniques I learned in training were invaluable, many of those exact procedures I no longer perform. Not because they weren’t good techniques, but because techniques, knowledge, and experience continue to improve.

It is important to perpetually hone your craft. Becoming a master takes thousands of hours of dedication. Part of that honing involves sharing your knowledge with others as well as learning from your colleagues. I relish in opportunities to collaborate with hernia surgeons across the country and across the world at the annual American Hernia Society.

This year I had the opportunity to present a video of a challenging case in the Spectacular Cases section. Fortunately, mesh infections are rare especially regarding inguinal hernia mesh. I have only ever seen two cases of infected inguinal mesh. Removing mesh carries more risk and challenges than typical hernia surgery. This patient had inguinal mesh that appeared to be improperly placed, resulting in a central cavity which became infected many years later during episodes of diverticulitis.

It was a pleasure and an honor to present amongst colleagues and I look forward to the American Hernia Society meeting next year in 2023 in Austin, TX.

You can see the video on YouTube here.

Americas Hernia Society Presentation of Morgagni Hernia Repair​

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Americas Hernia Society Presentation of Morgagni Hernia Repair

Dr. Mark Glover presented a video presentation at the 2020 Americas Hernia Society annual meeting on an interesting case of a congenital Morgagni diaphragmatic hernia repair. The repair highlights the utility of the robotic platform in this situation. The surgery revealed a contralateral defect that was not seen on preoperative CT and could not be seen from the intraperiteonal view.  Standard laparoscopic intraperitoneal repair would not have detected the defect which could lead to later recurrence or ongoing symptoms.  The video can be seen here: 

HerniaSurge Inguinal Hernia Guidelines

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HerniaSurge Releases Inguinal Hernia Treatment Guidelines

HerniaSurge just released a comprehensive treatment guideline regarding best practices in inguinal hernia repair. HerniaSurge is an international collection of major hernia societies from the Americas, Asia, Europe, and Australia. The highlights and my takeaways from the guidelines are below:

  • Ultrasound is rarely needed
  • Asymptomatic individuals may be managed with “watchful waiting”, however, the majority will eventually require surgery
  • Mesh repair is recommended as first choice
  • Flat mesh is recommended, plugs and other configurations are not
  • Surgeons should offer both anterior (open) and posterior (laparoscopic) repairs. One technique for all hernias does not exist
  • Laparoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective
  • The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques
  • It is suggested that women with groin hernias undergo laparoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia

I agree with the findings here and my practice choices align with them. While not every patient fits into the mold of a guideline, the majority of hernias should be repaired following these criteria unless specific situations or indications warrant deviating from them.

The guidelines have been endorsed by the following societies: European Hernia Society (EHS), Americas Hernia Society (AHS), Asia Pacific Hernia Society (APHS), Afro Middle East Hernia Society (AMEHS), Australasian Hernia Society, International Endo Hernia Society (IEHS), European Association for Endoscopic Surgery and Other Interventional Techniques (EAES).

Read the guidelines here.