Home Forums A to Z Advanced Course Week 1 Complex and Challenging Cases in Inguinal Hernia Repair

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    • Site Admin
      Keymaster
      Post count: 3

      What questions or comments do you have about this lesson?

    • siddique ahmad
      Participant
      Post count: 2

      This is very important topic. I hope everyone of us will benefit from this discussion and from the opinions of experts. I reserves my questions for the interactive session. Thanks

      • Eduardo Parra-Davila
        Moderator
        Post count: 8

        Thank you for your comments
        The libe discussion is great and if any other questions are not answered due to time this media should be able to help

      • Jennifer Petrie
        Moderator
        Post count: 2

        HI! You spoke and we listened. To better accommodate your schedule as a participant, we have eliminated the time restrictive live Q&A and the new format for this course will include an interactive forum. On this forum, you will have the opportunity to learn from each other and interact with our course faculty. Please keep asking questions in this forum (like you have) and during our next case on December 11th, we will also have a live chat box for you to ask questions and provide feedback.

        Thanks again!

    • GERARDO MEZA
      Participant
      Post count: 2

      I am very grateful for the opportunity, excellent topics, I will be interested in interaction with the experts.

      • Eduardo Parra-Davila
        Moderator
        Post count: 8

        Thank you
        Live interaction is great during the webinars also looking forward to see you at the workshops
        Best

      • Jennifer Petrie
        Moderator
        Post count: 2

        HI! You spoke and we listened. To better accommodate your schedule as a participant, we have eliminated the time restrictive live Q&A and the new format for this course will include an interactive forum. On this forum, you will have the opportunity to learn from each other and interact with our course faculty. Please keep asking questions in this forum (like you have) and during our next case on December 11th, we will also have a live chat box for you to ask questions and provide feedback.

        Thanks again!

    • Maye Serrano
      Participant
      Post count: 1

      Buena tarde desde Colombia; que hacer en el caso de un paciente que ingresa por hernia encarcelada agudamente se lleva a quirófano con el plan de realizar abordaje inguinal localizado, tiene clínica de dolor de 20 horas de evolución y no reducción del saco inguinal, leucocitosis leve, no tiene gases arteriales y no se realizan imágenes, al anestesiar el paciente se reduce la hernia expontaneamente, recomiendan realizar laparoscopia para revisión de intestino? o simplemente reparan el defecto por el abordaje que habían planeado inicialmente?.

      Gracias.

      • Eduardo Parra-Davila
        Moderator
        Post count: 8

        Laparoscopia para revisar el intestino es recomendable si no pudo ser revisado en el saco
        Debes dejar el quirofano sabiendo que no hay ischemia o riesgo de perforacion

        • Salvador Morales-Conde
          Moderator
          Post count: 7

          Totalmente de acuerdo, considero que debe hacerse un abordaje laparoscópico para valorara el asa.
          Pero me gustaría ir más alla y recomendar hacer una laparoscopia tambien a aquellos casos en los que no se reduce el asa intetsinal.

        • Salvador Morales-Conde
          Moderator
          Post count: 7

          Totalmente de acuerdo, considero que debe hacerse un abordaje laparoscópico para valorara el asa.
          Pero me gustaría ir más alla y recomendar hacer una laparoscopia tambien a aquellos casos en los que no se reduce el asa intetsinal.

    • roberto tussi jr
      Participant
      Post count: 2

      firstly I want send my congratulations, the course is very important. Is there a trick to perform a safetty laparoscopic hernia repair in a pacient with previus pelvic surgery?

      • Eduardo Parra-Davila
        Moderator
        Post count: 8

        Thank you for your comment
        I believe TEP may be an option
        Robotics for me facilitates adhesiolysis
        Good laparoscopic skills and principles will do as well knowing that conversion may be needed in any of the techniques and is not considered a failure

        • Salvador Morales-Conde
          Moderator
          Post count: 7

          Agree…TEP is an option if a midline incision….the trick is to go and make the incision in the lateral side of the retcus muscle.
          The problem of a TEP in these cases is if the patient have a pfanestiel.

    • Jorge Gonzalez Hernandez
      Participant
      Post count: 1

      BUENA TARDES CUAL ES EL TRATAMIENTO DE HERNIAS INGUINALES QUE INVOLUCRAN EN FORMA IMPORTANTE AL CORDÓN ESPERMÁTICO Y LA DISECCIÓN COMPROMETE AL TEJIDO LINFÁTICO Y VENOSO, SE RECOMIENDA LA ORQUIECTOMIA?

      • FLAVIO MALCHER
        Moderator
        Post count: 8

        Hi Jorge,

        On those cases, perhaps is safer to stop the dissection and trasnsect the hernia sac. Better to deal with a seroma or hydrocele rather that ischemic orchitis.
        If we get to the point where there is a complete transection fo the vessels, an orchiectomy maybe necessary. Always better to involve urology for the decision. I always consent for possible orchiectomy for recurrent complex inguinal hernias.

    • Angel Escudero
      Participant
      Post count: 2

      in difficult approaches for inguinal hernia in tep, what percentage of cases do you add epidural block to general anesthesia???

      • FLAVIO MALCHER
        Moderator
        Post count: 8

        Hi Angel,

        Usually I don’t add epidura. I stopped many, many years ago.
        Good post op care with pain management should be enough. TAPP blocks may help.

      • Salvador Morales-Conde
        Moderator
        Post count: 7

        Agree…we have never add an epidural clock

    • John Eric Willianson
      Participant
      Post count: 4

      Buenos días, caso paciente joven de 35 años con hernia inguinal no dolorosa, recomiendan realizar procedimiento laparoscopico que técnica o abierto q técnica ?

      • FLAVIO MALCHER
        Moderator
        Post count: 8

        Hi John.

        Both techniques are safe and indicated. The latest guidelines from February 2018 suggest if the surgeon if proficient on both techniques, MIS should be preferred. That does not mean that open if worse.

        • John Eric Willianson
          Participant
          Post count: 4

          Realmente amo la técnica laparoscopica pero en este tipo de paciente joven no crees que el riesgo de que tenga algún problema prostatico en los siguientes años es probable y con estas técnica dañaríamos la vía de acceso y una posible disección oncólogica, Gracias

          • Salvador Morales-Conde
            Moderator
            Post count: 7

            Creo que es un dato a tener en cuenta, pero considero que los urólogos pueden tener algo más de dificultad para acceder a la zona de disección pero una vez que logran acceder no les dificulta ni la cirugía ni la disección oncológica.
            Por ese motivo, considero que el abordaje por via mínimamente invasiva es el más interesante para el paciente.

          • roberto tussi jr
            Participant
            Post count: 2

            I’ve the same affread. The next generation of urologists Will be able to perform a radical prostatectomy after tep ir tapp aproach? At course Dr. Flavio spoke at memorial they perform a lot of robotic prostatectomy. Is there any case after tep ou tapp aproach? And another question who solve the case? The urology ou the general surgeon? Thanks for the oportunity.

            • FLAVIO MALCHER
              Moderator
              Post count: 8

              Urologists are not complaining of prior MIS repairs.
              The truth is that the indications for lymphadenectomies are reducing largely.
              It is clears now, a decade after MIS approach that come back either way is feasible (us after prostatectomy and them after inguinal hernia repair). Indications change as much experience grows.

    • Adolfo Brea-Andrade MD
      Participant
      Post count: 4

      Excelente curso

    • Adolfo Brea-Andrade MD
      Participant
      Post count: 4

      Excelente curso

    • FLAVIO MALCHER
      Moderator
      Post count: 8

      Gracias!!

      Stay tuned.

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