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: 17

      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: 10

        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: 3

        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: 3

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

      • Eduardo Parra-Davila
        Moderator
        Post count: 10

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

      • Jennifer Petrie
        Moderator
        Post count: 3

        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: 10

        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: 25

          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: 25

          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: 10

        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: 25

          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: 21

        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: 21

        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: 25

        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: 21

        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: 25

            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: 21

              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: 21

      Gracias!!

      Stay tuned.

    • Victor Hugo Perez Bocanegra
      Participant
      Post count: 1

      Very interesting topic

    • MAHOMEDRAFI JOOMA GAFOOR
      Participant
      Post count: 2

      does one have to fix the meshes in place after a TAPP or TEPP repair??

    • FLAVIO MALCHER
      Moderator
      Post count: 21

      Usually I don’t fix meshes at TEP for defects smaller than 3 cm
      At TAPP I still fix (ususally I’m doing tapp for some extra reason as recurrence, inguino-scrotal, ewtc..)

    • Paulo Santos
      Participant
      Post count: 1

      Congratulations for this course! I’m sure is gonna be an excellent opportunity to improve and learn a lot.

      My question is : is there any limit to perform laparoscopic approach in inguino scrotal hernias ?

      • This reply was modified 4 months, 4 weeks ago by Paulo Santos.
      • This reply was modified 4 months, 4 weeks ago by Paulo Santos.
      • This reply was modified 4 months, 4 weeks ago by Paulo Santos.
    • Francisco Muñoz López
      Participant
      Post count: 2

      Do you recommend simultaneous appendectomy and TAPP?

    • YASEEN HAMMOODI
      Participant
      Post count: 4

      how can manage the huge inguinoscrotal hernia when it contains omentume that attached firmly to end of sac ?

    • YASEEN HAMMOODI
      Participant
      Post count: 4

      in strangulated inguinal hernia and there is toxic fluid can I put the mesh safely ?

    • YASEEN HAMMOODI
      Participant
      Post count: 4

      if there is peritoneal loss can i put the omentum over the mesh to close the defect ?

    • YASEEN HAMMOODI
      Participant
      Post count: 4

      if the bowel perforated during reduction of strangulated inguinal hernia what can do regarding the repair laparoscopically?

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      Limits is established most of time by experience.
      Anyhow, if you perform a large scrotal hernias you must inform the patient about the possibility of having a chronic seroma or hematoma that makes take time to dissapear.

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      If patient have an acute appendicitis I will post-pone the TAPP. If the hernia need to be repair, my decission will depend on the grade of intraabdominal contamination to decide to do a TAPP or an open apporach.

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      In thses cases, you should consider to do a hybrid approach. You can perform an small incision to dissect the adhisions.

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      If there is an intense contamination, meshes are not recommended. In case is needed a synthetic mesh could be consider.

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      Yes, this is a good idea. You can also create a flap with the peritoneum and fatty tissue above the bladder that could cover the mesh.

    • Salvador Morales-Conde
      Moderator
      Post count: 25

      It is titally different the twoo situation:
      – perforation during the dissention: you can proceed after suturing the bowel
      – strangulation – it depends on the grade of contamination

    • esma sahbi
      Participant
      Post count: 2

      if a tep was performed in the right hernia and a left hernia appears how to proceed ?

    • Emmanuel Forti
      Participant
      Post count: 2

      muy bueno el curso felicitaciones

    • Emmanuel Forti
      Participant
      Post count: 2

      si no he hablado previamente con el pte no haría nada. resolvería solo lo que fui a operar ya que debería ser una hernia pequeña asintomática que no se identifico en el examen físico previo.

    • Sarai Lara
      Participant
      Post count: 4

      Muy buen curso

    • DINESH JOSHI
      Participant
      Post count: 1

      What are options for re recurrent umbilical hernia inlay repair with infected mesh with sinus formation.xurrent defect size is 6 by 7 cms

    • Soumendu Ghosh
      Participant
      Post count: 1

      just joined in . trying to navigate

    • mallikarjun sajjanshetty
      Participant
      Post count: 3

      what is the experience of team with large inguino scrotal hernia.
      I do a lot of TAPP repairs and fix the mesh with glue, all arround fixation.

      I am seeing more and more recurrences.

      My question to experts is , how is this repair different to bridging repairs in incisional hernia.

      how any one has experience of repairing the deep ring , is it worth trying.
      being very muscular in that region, is it going to hold??

    • JOSE JOAQUIN GUZMAN GOMEZ
      Participant
      Post count: 3

      hola, excelente curso,

      1. Frente a una hernia inguinal estrangulada, con imposibilidad de reducccion por via abierta anterior, sin disponibilidad de laparoscopia, realizar laparotomia mediana infraumbilical?

      2. Sin disponibildia dde enfoque laparoscopico, Frente a un gran defecto de pared posterior, componente mixto directo e indirecto, mejor malla preperitoneal (nyhus) o plug + mesh?

    • Jonas Jurgaitis
      Participant
      Post count: 1

      Thank you

    • JOSE ARTURO MENESES CERVANTES
      Participant
      Post count: 5

      1. Hernia inguinal estrangulada no reductible, abordaje por laparotomía.
      2. Hernia mixta grande, sin laparoscopía, Stoppa

    • Jorge Guillen
      Participant
      Post count: 4

      Excelente curso, gracias y saludos desde Mérida – Venezuela

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