bassini & shouldice

[lazycat]

hi, iam looking for infomation about bassini and shouldice technique in the surgical treatment of inguinal hernia, if you know about this, please tell me! thanks a lot!

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[Winged Scapula]

Both the Bassini and the Shouldice repairs are consider "tension" repairs in which the layers of tissue are directly sutured together with permanent suture material, under tension. Many places, especially outside of residency training programs, do a tension free mesh repair (ie, "plug and patch") perhaps laparoscopically.

The Shouldice Clinic could probably tell you a thing or two about their "Canadian" repair: http://www.shouldice.com/operate.htm They self-describes as the "mecca" for hernia repair. Do not be convinced by their reported failure rate of < 1%; their patient population is VERY highly selected to do well.

Skandalakis and Skandalakis or Zollinger's Surgical Atlas have plenty of pictures or you can check this website http://herniaplasty.med.nyu.edu/bassinirepair.html or several others, which while not as detailed as the books above, may help.

 

[Tired]

Dr. Cox

Anyone still do these regularly (I mean, other than the clinics who have their name on it)? When I was on Gen Surg, I only heard them tossed around as jokes.

I liked the Kugel. We had one surgeon who did those exclusively, and liked to tell us about how Dr. Kugel had made the first mesh out of a screen and wrapped fishing line.

 

[dbhvt]

The surgeons here have told me anyone can get their recurrance rate down to 1% with mesh, but the canadian repair has wide surgeon variability, or something. You might be less likely to catch a nerve with the canadian method? Dr. Cox?

 

[Winged Scapula]

Dr. Cox

Anyone still do these regularly (I mean, other than the clinics who have their name on it)? When I was on Gen Surg, I only heard them tossed around as jokes.

I liked the Kugel. We had one surgeon who did those exclusively, and liked to tell us about how Dr. Kugel had made the first mesh out of a screen and wrapped fishing line.

Actually yes. I was taught the Bassini and Lichtenstein during residency - something about learning the "old school" way. Of course, when we did other rotations especially at the private hospital, they all did them either lap or open plug and patch. Guess in central PA we were more old fashioned!

I would venture that its reasonable to learn how to do the traditional repair although from a billing standpoint they take longer and are not more durable (some evidence that there is a higher risk of recurrence).

 

[Winged Scapula]

The surgeons here have told me anyone can get their recurrance rate down to 1% with mesh, but the canadian repair has wide surgeon variability, or something. You might be less likely to catch a nerve with the canadian method? Dr. Cox?

I have no data to back me up on this, but:

a good surgeon is not likely to catch the nerve or cord structures very often regardless of the procedure he does, as long as he does them often enough to and is aware of the potential to do so

an open procedure (ie, traditional repair) is almost always less frought with such potential complications as unrecognized variant anatomy or nerve entrapment

in the plug and patch you are not as close to the neurovascular bundle (I can still recall my bassini repairs as an intern with the attending watching me closely around the vessels as I took my bites), there's less tension (so presumably less recurrence but I'm not sure the data backs that up) even compared to those with a relaxing incision and the recovery tends to hurt less and I find less long term pain complaints with the plug and patch as opposed to traditional tension repairs.

But in most cases, you need to choose the correct procedure for the right patient. If an adult is getting a bilateral procedure, you should probably do it laparoscopically if there is no other CI; the recovery is pretty painful for a bilateral tension repair and besides (important point here) if the patient's tissues or protoplasm is so weak to begin with that they have bilat hernias, do you really think suturing to that crappy tissue is going to work well? Probably not. An extraperitoneal approach is probably best, IMHO. Kiddies different story - open procedures for all.

BTW, patients like to call the mesh, "screen doors". Dr. Kugel would be proud.

 

[Winged Scapula]

I liked the Kugel. We had one surgeon who did those exclusively, and liked to tell us about how Dr. Kugel had made the first mesh out of a screen and wrapped fishing line.

KUGEL MESH RECALL - my email box is stuffed full of "warnings" about this. I must get 3 a week.

Always made me think of the German noodle dish.

 

[Tired]

KUGEL MESH RECALL - my email box is stuffed full of "warnings" about this. I must get 3 a week.

Always made me think of the German noodle dish.

I had no idea. Oh well. Hernia repairs are boring anyway; no K-wires.

 

[Winged Scapula]

I had no idea. Oh well. Hernia repairs are boring anyway; no K-wires.

Ahhh....K wires. Reminds me of all the hand cases I did in medical school because I had a crush on the Hand fellow (and please, no obvious jokes here). Fun stuff...every now and again I wonder if I should have done ortho. I agree hernias are boring, except ventrals - I liked those.

Here's what you've been missing:

http://www.milbergweiss.com/page.aspx?pageid=5368&s_kwcid=kugel%20mesh|703733406&gclid=COnVqabQkYwCFRTTgAodHBV24Q

http://www.williamsbailey.com/kugel_mesh/landing_page.shtml?gclid=CIjAidTQkYwCFQQRgQodQhk04A

just to name a couple of emails I've gotten...

 

[Tired]

Ahhh....K wires. Reminds me of all the hand cases I did in medical school because I had a crush on the Hand fellow (and please, no obvious jokes here). Fun stuff...every now and again I wonder if I should have done ortho. I agree hernias are boring, except ventrals - I liked those.

Thanks for the info, very interesting.

If I can get the Navy to approve it, I'll definitely look seriously at a Hand/Upper Extremity fellowship. On my last MSIV hand rotation, I missed an elbow replacement by a couple weeks; I desperately wanted to stick around a little while longer to scrub on it.

Everyone should do Ortho. Except that they shouldn't, because my prospective job market is looking pretty sweet down the road, and I don't want any competition.