Busy Surgeon

Busy surgeon? Keep up to date

You are a busy general surgeon, just about keeping your head above water with your clinical load and juniors who can’t operate unsupervised.  Your time is limited, and I can see you about to click away – but wait – 30 seconds.

This page is for you to skim rapidly, to see what is happening in the world of hernias that may be of interest to you.  It is news about meetings, and short comments on articles that may be of interest.

I have applied the ‘so what’ test, and have therefore not included such appetizing titles as ‘Prolapse of bowel via a patent vitello-intestinal duct…’ Hernia  2011 15:481-483.

I have put a short personal comment alongside each article, and of course welcome your views, comments questions or criticisms.

ARTICLES
1)    A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair T Bisgaard et al  Hernia 15:542-546

The Danish National Hernia database continues to give us food for thought, and tell us what is happening in the real world.  3,500 umbilical and epigastric hernia repairs by lots of surgeons.  Low morbidity and mortality but lots of little problems – pain and seroma – leading to a high readmission rate.  Costly for the NHS.  Does your practice reflect this?

2)   Laparoscopic repair of extraction site ventral hernia after robotic prostatectomy: institutional experience with 42 consecutive cases  J. Ho and A. Pigazzi  Hernia 15:673-676 2011

ESVH (extraction site ventral hernia) – A new acronym for you.   The urologists already hate us for putting mesh in the pre-peritoneal space so they can’t do their radical prostatectomies. * Now they are providing us with work, with a steady stream of what are essentially large port-site hernias after robot assisted laparoscopic prostatectomies (RALPs).  This hospital utrologists do 1000 RAPs a year and the surgeons who wrote this paper are seeing one new ESVH a week. Good business?

* Impact of previous surgery on endoscopic extraperitoneal radical prostatectomy
Jens-Uwe Stolzenburg et al   Urology 65:325-331, 2005

3) Chung, L., Norrie, J and O’Dwyer PJ  Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. British Journal of Surgery, 98:595-599  2011

Up to one-third of patients with an inguinal hernia have no symptoms. What happens if you leave these alone; if you don’t operate and just observe. Is this dangerous? Are they likely to strangulate or enlarge rapidly? These are important questions, particularly in view of the (variable) incidence of long-term pain that can occur apparently randomly after an otherwise uneventful routine repair.
The question was addressed some years ago by two different groups, independently, one in Scotland, the other in USA. The results at two years, published in JAMA and in the Annals of Surgery in 2006 were surprisingly similar and showed that almost one-quarter of the non-operated patients ‘converted’ to surgery.

The conclusion:-

“This study has confirmed previous findings that most patients with minimal symptoms from an inguinal hernia develop pain over time. Pain was the most common reason for requesting operation, followed by effect on quality of life and increase in size of the hernia. Surgical repair is recommended for medically fit patients with a painless inguinal hernia.”