The use of mesh in hernia repair, risk management and the advantages of day surgery

HERNIA PRESENT
If a hernia is present it is an obligation to counsel the patient as to the required treatment, and choose an appropriate specialist for a decision regarding surgery. You know best about the patientís health. The patient may not be fully aware of the different possibilities available.

You may be able to discuss with the patient some of the possible risks of surgical intervention. It is the doctors duty as part of the risk management program, to convey to the patient the possible risks and outcomes following surgery, in a meaningful way.

Some of the issues I encounter are: doctors are not always aware that most of the procedures can be carried out under anesthesia infiltration. I believe local anesthesia reduces the risk to the patient in many ways.

It is also helpful to let the specialist know about medical problems from which the patient suffers, such as:
(a)     therapeutic agents, which alter the bleeding status of the patient.

(b)     presence of a heart valve or murmurs, which may require antibiotic cover for the surgery.

Of course, as a surgeon I have a responsibility to check all of this before considering surgery. As part of the risk management program it is wise for the surgeon to communicate these different findings to other specialists involved in the care previously. This is because there is a small risk attached when altering previously prescribed medication. Ideally a consensus view should be obtained.

The patient may ask you about the need for surgery or the urgency of the surgery and the type of surgery to be undertaken.

It is up to the surgeon to explain this and at the same time outline possible risks. In my practice this is supported with literature and also a website under development (www.melbourneherniaclinic.com), for patient information and brochures.

It is hoped that this series of articles will leave you more informed regarding some of these issues.

I recommend:
(1)     Repair under local anesthesia and sedation.
(2)     Day surgery where appropriate.
(3)     The use of the tension free repair with mesh as popularized by Lichtenstein (see British Hernia Centre, www.hernia.org).

There are other developments being made continually. During these presentations we will try to keep you updated on these different techniques and methods. We will provide some references to other Internet sites wherein detailed descriptions of other methods are demonstrated and discussed.

Herniae unlike skin cancer, other malignancies and many infections, are a common universal problem. The incidence is not affected by geographic distribution, race, genetics, skin pigmentation, dietary habits, climate or environment.

The optimal treatment for most herniae is operative. The symptoms from which the patient suffers and the risk of obstruction or strangulation influence the decision to operate, as well as the timing of such surgery . The age and health of the patient, the risk involved and the availability of resources may affect the decisions.
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