Practical pearls
Here are a couple tips for better hernia outcomes:
1. Less is not more.
It's important to
choose the right size mesh for the type of hernia,
says surgeon Shirin Towfigh, MD, of the Beverly
Hills (Calif.) Hernia Center. She recommends cer-
tain standard sizes, such as
• minimum 7.5 cm x 15 cm for open inguinal her-
nia repair,
• 10 x 15 cm for laparoscopic inguinal hernia, and
• 4 cm to 6 cm radial overlap for ventral hernias.
"Putting in a smaller size mesh is not helping
the hernia repair," says Dr. Towfigh. "It will result
in a recurrence, pulling pain or balling up of an
ineffective piece. It's like wearing too small a size
of clothing."
2. Predictive app.
An app called ORACLE
(ahsqc.org) lets ventral hernia repair patients
visualize outcomes. ORACLE,
which stands for Outcomes
Reporting App for Clinical and
Patient Engagement, predicts
the following outcomes: risk for
surgical site infection within 30
days of surgery; 30-day risk for
a recurrent ventral hernia
requiring another surgery; 30-
day risk for unplanned hospital
readmission; one-year risk for
hernia recurrence; and length of
hospital stay.
"The objective of the tool is to
have patients not just take
responsibility for good outcomes,
but to know that some of their
lifestyle behaviors contribute to
both good and bad outcomes
postoperatively, and to have sur-
geons make sure that the expecta-
tions are realistic for the patient,"
says Ivy Haskins, MD, a general
surgery chief resident at George
Washington University, in
Washington, D.C., in a release.
OSM
4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
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• SIZE MATTERS This 1.5 cm x 5 cm mesh shown here is much too small to be effective.
Shirin
Towfigh,
MD
