ing on a healthy 40-year-old male with no significant comorbidities, I'd
suggest either a laparoscopic approach, and discuss a variety of mesh
options, or — if they don't want mesh in their body — an open
approach with no mesh and a tissue repair. An important point here:
Patients are increasingly driving the mesh issue. Patients are online
and they're coming in with concerns, because they've read about
mesh lawsuits and mesh complications.
Other surgeons might offer an open mesh repair or just a laparo-
scopic repair, because that's what they do most commonly. The "right"
approach, even for a relatively straightforward patient, can vary
according to local environments.
Square pegs
One reason open inguinal hernia surgery with mesh has become such
a common procedure it that it's relatively easy to teach and learn. And
it works very well on a lot of patients. But unfortunately, there's a sub-
set of people who have severe chronic pain after open inguinal proce-
dures with mesh. And that group is both growing and having a major
impact on hernia repair. Every year somewhere between 10,000 and
15,000 patients experience that severe chronic pain.
The question becomes, what can be done differently for those
patients? Would a laparoscopic approach be better? Should you use
mesh, and if so, what type? There are a lot of different options out
there. Multiple factors contribute to success or lack of success.
Some of those patients might do better with other techniques, but
the more traditional open non-mesh procedures are a lot more com-
plex to teach. The laparoscopic approach is also very difficult to teach
and learn. The groin is a very complex area and it's difficult to learn
the whole 3-dimensional anatomy of it. There's definitely a barrier in
terms of the learning curve.
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