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you're looking at hernias that are less than 2 centimeters in size is probably no different with or without fixation, and some people believe there's less pain with no fixation. But without fixation the mesh will definitely migrate, so it's an approach you'd only want to take with incisions of 2 centimeters or less."
Concerned about migration, Dr. Ross prefers the cautious approach. "Studies have shown that there is no difference in pain if you do or do not use a fixation device," she says. "So I think to prevent movement of the mesh or possible recurrence, fixation is good practice."
4. Post-op pain management
It used to be a given that once the hernia patient got home, he was in for a couple of very painful days. Not anymore.
"We use bupivacaine solution to irrigate the diaphragm in all of our laparoscopic procedures to minimize post-operative pain," says Dr. Ross.
Bupivacaine is the active ingredient in the drug Exparel, which now incorporates a time-release delivery platform that dramatically extends the period of post-op pain relief (see "Pain, Pain, Go Away — For Several Days" on page 35).
"I'm a huge proponent of Exparel," says Dr. Ross.
So is Dr. Voeller. "We have used it for the last year or so," he says, "Now that they've put it in liposomes to make it time-released, instead of 3 hours of pain relief, it provides more like 2 or 3 days. Patients simply don't hurt afterward."
E-mail jburger@outpatientsurg ery.net.
