# Inguinal Hernia — GCMD Library living collection

Also covered as: incarcerated hernia · direct hernia · indirect hernia · femoral hernia · strangulated hernia · chronic pain · patent processus vaginalis · recurrent hernia

Experts: Dr. Todd Ponsky, Dr. Michael Rosen, Dr. Jeffrey Ponsky, Dr. Lizzie Lee

Updated: n/a · 25 episodes · 310 cited statements

## Episodes
### Fundamentals
- [Inguinal Hernias: Diagnosis and Management](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891) — podcast · 16:29 · [machine version](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891.md)
- [Pediatric Inguinal Hernia in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457) — video · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457.md)

### Surgical Management
- [Laparoscopic Pediatric Hernia Repair: Online Course 2017](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414) — video · 102:10 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414.md)
- [Focus on Technique- Laparoscopic Pediatric Hernia Repair 2015](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046) — video · 140:52 · [machine version](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046.md)
- [Female Neonatal Inguinal Hernia Repair Dr. Tamer Ashraf Wafa](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354) — video · 4:42 · [machine version](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354.md)
- [Pediatric Open Herniotomy in boys 15 Minutes Unedited Dr. Tamer Ashraf Wafa](https://qa.library.globalcastmd.com/watch/pediatric-open-herniotomy-in-boys-15-minutes-unedited-dr-tamer-ashraf-wafa-4393) — video · 16:29 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-open-herniotomy-in-boys-15-minutes-unedited-dr-tamer-ashraf-wafa-4393.md)
- [Herniotomy in a Neonate 1 month old boy By Dr. Tamer Ashraf Wafa](https://qa.library.globalcastmd.com/watch/herniotomy-in-a-neonate-1-month-old-boy-by-dr-tamer-ashraf-wafa-4412) — video · 9:59 · [machine version](https://qa.library.globalcastmd.com/watch/herniotomy-in-a-neonate-1-month-old-boy-by-dr-tamer-ashraf-wafa-4412.md)

### Evidence & Research
- [Pediatric inguinal hernias: should repair be open versus laparoscopic?](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernias-should-repair-be-open-versus-laparoscopic-2356) — video · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernias-should-repair-be-open-versus-laparoscopic-2356.md)
- [PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424) — video · 11:59 · [machine version](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424.md)
- [Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864) — video · 11:00 · [machine version](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864.md)
- [BOB Ped Surg 2023 - Wendy Song, CAPS  - Presentation](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352) — video · [machine version](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352.md)
- [Delayed versus early repair of inguinal hernia in preterm infants](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705) — video · 0:43 · [machine version](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705.md)
- [Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401) — video · 1:35 · [machine version](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401.md)
- [The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030) — video · 0:49 · [machine version](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030.md)
- [Effect of a Pediatric Surgeon's Primarily Performed Technique on Inguinal Hernia Recurrence Rates: A Multicenter Retrospective Cohort Study](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386.md)
- [A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460.md)
- [A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527.md)
- [Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554) — video · 0:54 · [machine version](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554.md)
- [Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894) — video · 0:43 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894.md)

### Case-Based Learning
- [Groin Controversies: Update Course 2016](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437) — video · 28:58 · [machine version](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437.md)
- [Groin Controversies - Todd Ponsky: Update Course 2014](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661) — video · 28:58 · [machine version](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661.md)
- [Case-Based Journal Review: Inguinal Hernia 2025](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168) — podcast · 19:13 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168.md)

### In-Depth Reviews
- [Inguinal Hernia: Adult](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441) — podcast · 31:02 · [machine version](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441.md)
- [2026 Laparoscopic Pediatric Hernia Repair](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251) — video · 123:40 · [machine version](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251.md)
- [Inguinal Hernia With M. Rosen](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756) — podcast · 31:05 · [machine version](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=0) Introduction and Course Overview (Ep 1)
- [3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=180) Clinical Controversies in Hernia Management (Ep 1)
- [8:38](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=518) Open vs. Laparoscopic Repair: The Debate (Ep 1)
- [16:58](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1018) Incarceration Management and Direct Hernia Recurrence (Ep 1)
- [28:18](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1698) Laparoscopic Techniques: CK Young and LILS (Ep 1)
- [36:40](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2200) SEAL Technique and Ponsky's Concerns (Ep 1)
- [43:20](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2600) Takahara/Patkowski Percutaneous Technique (Ep 1)
- [51:40](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=3100) Stitch vs. Scar: The Injury Hypothesis (Ep 1)
- [61:40](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=3700) Suture Material and Technique Refinements (Ep 1)
- [71:40](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4300) Sac Excision Techniques and Hydrocele Repair (Ep 1)
- [79:10](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4750) Adolescent and Young Adult Hernias: The Gray Zone (Ep 1)
- [88:20](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5300) Telementoring, Q&A, and Closing Remarks (Ep 1)
- [0:01](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1) Incidental hernia discovery during laparoscopic G-tube placement (Ep 2)
- [4:33](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=273) High ligation technique across age spectrum (Ep 2)
- [6:03](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=363) Physical examination techniques and direct versus indirect hernia differentiation (Ep 2)
- [10:32](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=632) Laparoscopic percutaneous hernia repair technique demonstration (Ep 2)
- [18:31](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1111) Management of retractile testes (Ep 2)
- [22:30](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1350) Retractile testicle with concurrent hernia repair (Ep 2)
- [25:03](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1503) Approach to history-only inguinal hernia (Ep 2)
- [26:11](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1571) Non-palpable testicle evaluation and management (Ep 2)
- [0:01](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1) Incidental hernia discovery during laparoscopic G-tube placement (Ep 3)
- [4:33](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=273) High ligation technique across age spectrum (Ep 3)
- [6:04](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=364) Physical examination techniques for hernia diagnosis (Ep 3)
- [10:33](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=633) Laparoscopic percutaneous hernia repair technique demonstration (Ep 3)
- [18:40](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1120) Management of retractile testis (Ep 3)
- [22:31](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1351) Hernia repair in patient with retractile testis (Ep 3)
- [26:12](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1572) Non-palpable testis management and Fowler-Stevens procedure (Ep 3)
- [2:51](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=171) Introduction and technique overview: open versus laparoscopic hernia repair (Ep 4)
- [22:20](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1340) Challenging cases: preemies, incarceration, recurrent hernias (Ep 4)
- [45:00](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2700) Extracorporeal techniques: CK Young, Lil's, and SEAL approaches (Ep 4)
- [65:00](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3900) Rabbit model research: anterior injury promotes scarring (Ep 4)
- [88:20](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=5300) Modified technique: prolene loop exchange and preparation (Ep 4)
- [108:20](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6500) Adolescent and adult hernias: questioning the mesh paradigm (Ep 4)
- [121:40](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=7300) SEAL technique demonstration by Matthias Bruzzoni (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=0) Open Inguinal Hernia Repair in Female Neonate (Ep 8)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=0) Anatomy and epidemiology of pediatric inguinal hernias (Ep 11)
- [3:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=180) Risk factors and differential diagnosis (Ep 11)
- [6:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=360) Timing considerations and incarceration risk (Ep 11)
- [9:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=540) Presentation and bedside reduction technique (Ep 11)
- [12:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=720) Surgical approach and technique (Ep 11)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Contralateral patent processus vaginalis presents in 30-40% of children with unilateral hernia (Holcomb 1994), with 4× greater risk of developing symptomatic hernia and 3-11% metachronous hernia rate." — Todd Ponsky (host_summary) [Ep 1 · 11:05](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=665)
- "In a rabbit model, grabbing the vas deferens once with pickups obliterates it." — Todd Ponsky (clinical) [Ep 1 · 17:03](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1023)
- "Zendejas 50-year follow-up (Journal of American College of Surgeons) found 5% infertility rate after hernia repair, matching general population—no evidence of infertility problem from hernia surgery." — Todd Ponsky (host_summary) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1080)
- "Andrologia study of 8500 fertility clinic patients showed markedly reduced semen quality and morphology problems in men with prior hernia repair compared to fertile controls." — Todd Ponsky (host_summary) [Ep 1 · 18:23](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1103)
- "The most common cause of recurrence after open pediatric hernia repair is development of a direct hernia, not indirect recurrence." — Todd Ponsky (clinical) [Ep 1 · 24:51](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1491)
- "Direct hernias after initial indirect repair may be iatrogenic: pulling up the cord during open dissection in premature infants with see-through thin floors may take fibers of the floor and cause a direct defect." — Todd Ponsky (opinion) [Ep 1 · 25:35](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1535)
- "Adult general surgeons performing Lichtenstein mesh repairs argue that pulling up the cord disrupts the floor even in indirect hernias, so they always reinforce with mesh or fascia repair." — Jeff Gander (host_summary) [Ep 1 · 25:55](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1555)
- "Current large studies from multiple countries (mostly China) report laparoscopic pediatric hernia recurrence rates of approximately 1% or less." — Todd Ponsky (host_summary) [Ep 1 · 27:39](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1659)
- "Early laparoscopic hernia repairs using Z-stitch technique (Felix Shear era) had 6% or higher recurrence rates; modern techniques with modifications have reduced this substantially." — Todd Ponsky (host_summary) [Ep 1 · 27:28](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1648)
- "Postoperative hydrocele after laparoscopic hernia repair is extremely rare; in 10+ years Ponsky has never required intervention for one." — Todd Ponsky (clinical) [Ep 1 · 67:18](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4038)
- "In rabbit hernia model, suture ligation alone without peritoneal injury resulted in 75% failure at 2 weeks and 83% failure at 4 weeks when suture was removed." — Todd Ponsky (clinical) [Ep 1 · 44:16](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2656)
- "In rabbit model, anterior peritoneal injury plus suture resulted in 87% closure at 2 weeks and 100% reperitonealisation at 4 weeks even after suture removal." — Todd Ponsky (clinical) [Ep 1 · 44:33](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2673)
- "Braided non-absorbable suture (Ethibond) performed best in rabbit hernia repair studies compared to absorbable (Vicryl) or monofilament non-absorbable (Prolene)." — Todd Ponsky (clinical) [Ep 1 · 44:58](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2698)
- "Repeat study comparing absorbable vs. non-absorbable suture with peritoneal injury showed equal failure rates on both sides, suggesting technical error rather than suture type determined outcome." — Todd Ponsky (clinical) [Ep 1 · 45:49](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2749)
- "Patent processus vaginalis may close spontaneously even years after initial identification; one case showed complete closure 3 years after documented patent processus on prior laparoscopy." — Todd Ponsky (host_summary) [Ep 1 · 10:18](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=618)
- "Direct inguinal hernias begin appearing around age 29 in adults, suggesting a floor pathophysiology change at that age that may distinguish pediatric-type indirect hernias from adult-type requiring floor reinforcement." — Todd Ponsky (opinion) [Ep 1 · 83:38](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5018)
- "Two-center retrospective study (Kansas City and Rainbow) of adolescents receiving open high ligation showed 1.9% recurrence rate." — Todd Ponsky (epidemiological) [Ep 1 · 85:45](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5145)
- "NIH study reported 30% chronic groin pain rate after adult mesh hernia repairs, though expert hernia surgeons argue their rates are lower." — Todd Ponsky (host_summary) [Ep 1 · 80:28](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4828)
- "Felix Shear ultrasound study showed no deficiency in testicular blood flow after laparoscopic hernia repair in infants." — Todd Ponsky (host_summary) [Ep 1 · 93:39](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5619)
- "When performing laparoscopic hernia repair, if cord structures are visible between peritoneum and needle, the needle has passed under the cord—safe passage shows only peritoneum over the needle." — Todd Ponsky (clinical) [Ep 1 · 38:14](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2294)
- "In babies, single knot ligation is preferred over double ligation to reduce suture granuloma risk from thin subcutaneous tissue; older children tolerate double ligation without granuloma formation." — Todd Ponsky (clinical) [Ep 1 · 52:04](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=3124)
- "With laparoscopic approach, waiting 24-48 hours after reducing an incarcerated hernia may be unnecessary since inflammation does not complicate the laparoscopic repair as it does open surgery." — Todd Ponsky (opinion) [Ep 1 · 22:28](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1348)
- "The 'ocean argument': laparoscopic hernia repair difficulty remains constant regardless of external complexity (incarceration, prematurity, inflammation), unlike open repair where external factors significantly increase difficulty." — Todd Ponsky (opinion) [Ep 1 · 19:20](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=1160)
- "Munther Haddad (Leeds, UK) published series on open hernia repair with sac division but no ligation, achieving same recurrence rate as traditional ligation; argues ligation creates a smaller hernia sac rather than eliminating it." — Todd Ponsky (host_summary) [Ep 1 · 42:14](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2534)
- "Mario Raquelme performs complete laparoscopic sac excision without suture closure, relying on muscle layer apposition after sac removal; reports minimal recurrences." — Todd Ponsky (host_summary) [Ep 1 · 49:56](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2996)
- "Bernia technique (Godoy/Varela/Guelfand, Chile): in girls, grasp and invert the patent processus sac, then cauterize extensively to obliterate it without suture; two-center study (with Navotny) reported no recurrences." — Todd Ponsky (host_summary) [Ep 1 · 40:00](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2400)
- "SEAL technique (Harrison/Albanese/Novahara, Stanford) uses large CT needle to capture substantial tissue in single pass; very fast (<1 minute) but Ponsky found high postoperative pain, possibly from capturing nerves or excessive tissue." — Todd Ponsky (clinical) [Ep 1 · 34:20](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=2060)
- "Survey of pediatric vs. adult surgeons on same adolescent hernia case: 86% of pediatric surgeons chose high ligation, while adult surgeons predominantly chose muscle/mesh repair—same anatomy, different training." — Todd Ponsky (epidemiological) [Ep 1 · 80:55](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4855)
- "At IPEG Hawaii ~10 years ago, ~90% of audience favored open hernia repair; at BAPS London recently, ~70-80% favored laparoscopic—represents major practice shift." — Todd Ponsky (epidemiological) [Ep 1 · 91:48](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=5508)
- "Choi (Seoul, Korea) published comparison of totally laparoscopic hydrocelectomy vs. scrotal incision for pediatric cord hydrocele, demonstrating feasibility of laparoscopic approach." — Todd Ponsky (host_summary) [Ep 1 · 72:41](https://qa.library.globalcastmd.com/watch/laparoscopic-pediatric-hernia-repair-online-course-2017-414?t=4361)
- "A patent processus vaginalis confers a 4 times greater risk than the general population of developing a hernia at some point in life, but the patient may never have a problem." — Todd Ponsky (epidemiological) [Ep 2 · 2:00](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=120)
- "Witt's argument is that hernia repair is not the type of conversation to have quickly in the waiting room with a family because if there were some injury, that was a rushed conversation about something they may never have a problem with their entire lives." — Todd Ponsky (host_summary) [Ep 2 · 2:11](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=131)
- "For children under 5 years old, the argument is that a patent processus vaginalis hasn't been there long enough to show whether it will become symptomatic." — Todd Ponsky (opinion) [Ep 2 · 3:06](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=186)
- "Scott Bollinger said, 'Why eat tomorrow's lunch today?' regarding elective repair of asymptomatic patent processus vaginalis." — Todd Ponsky (host_summary) [Ep 2 · 3:33](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=213)
- "A patent processus vaginalis is the same pathology from day of life one to the end of life; if there's a muscle problem, that's a different type of hernia." — Todd Ponsky (clinical) [Ep 2 · 5:45](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=345)
- "High ligation is the appropriate repair for indirect inguinal hernia at any age." — Todd Ponsky (clinical) [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=357)
- "Adult surgeons at the SAGES hernia course do not use the finger-in-canal examination technique; they all palpate over the external ring area." — Todd Ponsky (clinical) [Ep 2 · 7:39](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=459)
- "The finger-up-the-canal examination is worthless and just tortures kids; you can feel better with fingers over the area of the internal and external ring." (opinion) [Ep 2 · 7:11](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=431)
- "No study has been done showing clinicians can reliably differentiate direct from indirect inguinal hernias on physical examination." (clinical) [Ep 2 · 8:06](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=486)
- "The first operation for hernia repair was herniotomy, which worked 70% of the time but had a 30% recurrence rate." (host_summary) [Ep 2 · 9:31](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=571)
- "Ladd and Gross started doing high ligation, while adult surgeons thought it was a floor problem and started doing Bassini and McVay repairs, which have a 10% recurrence rate." (host_summary) [Ep 2 · 10:00](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=600)
- "Lichtenstein mesh repair got the recurrence rate down to 1% in adults." (host_summary) [Ep 2 · 10:10](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=610)
- "In a rabbit study, when injury was caused to the peritoneum and then repair performed, the closure was much more durable; even if the stitch was cut out after 12 weeks, the closure remained intact." — Todd Ponsky (clinical) [Ep 2 · 14:34](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=874)
- "The injury to the peritoneum really keeps the hernia closure intact." — Todd Ponsky (clinical) [Ep 2 · 14:44](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=884)
- "When a braided non-absorbable suture is used for laparoscopic hernia repair, the repair is better, at least in rabbits." — Todd Ponsky (clinical) [Ep 2 · 17:18](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1038)
- "There was a generation of surgeons who spent a lot of time picking out silk sutures spitting out of the groin or abscesses years after placement." (clinical) [Ep 2 · 18:52](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1132)
- "A retractile testicle is defined as one that can be pulled down and stays down after you let go." — Todd Ponsky (clinical) [Ep 2 · 19:59](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1199)
- "A true retractile testis that can be pulled down has occasionally gone up and gotten trapped; it's a known phenomenon that has been reported." — Corn (clinical) [Ep 2 · 20:29](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1229)
- "Once a child has gone through puberty and the testicle is much larger, it cannot retract, so following them until post-pubertal ensures the testicle will stay in the scrotum." — Corn (clinical) [Ep 2 · 21:37](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1297)
- "If a testicle can be pulled down easily, even if it pulls back, it should be considered descended." (opinion) [Ep 2 · 22:23](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1343)
- "Post-operative ascent of a retractile testicle after hernia repair is likely due to getting cremasteric muscle or cord vessels stuck in the external oblique closure during open repair." (clinical) [Ep 2 · 24:39](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1479)
- "If there's an absent testicle that cannot be found on exam, you don't need an ultrasound; you go straight to laparoscopy." (clinical) [Ep 2 · 26:29](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1589)
- "Dr. Ricketts would say that if a testicle was in the inguinal canal, you should have been able to find it on groin examination." (host_summary) [Ep 2 · 26:47](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1607)
- "Retrospective data and prospective pilot data presented at IPEG suggest that one-stage Fowler-Stevens is just as good as two-stage." — Todd Ponsky (clinical) [Ep 2 · 27:58](https://qa.library.globalcastmd.com/watch/groin-controversies-update-course-2016-437?t=1678)
- "A patent processus vaginalis confers a 4 times greater risk than the general population of developing a hernia at some point in life" (epidemiological) [Ep 3 · 2:00](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=120)
- "Witt argues that hernia repair is not the type of conversation to have quickly in the waiting room because if there were injury, it would be a rushed conversation about something the patient may never have a problem with" (host_summary) [Ep 3 · 2:11](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=131)
- "For children under age 5, there is concern that a patent processus vaginalis has not been present long enough to declare whether it will become symptomatic" (opinion) [Ep 3 · 2:59](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=179)
- "High ligation is the appropriate repair for a patent processus vaginalis at any age, from day of life one to end of life" (clinical) [Ep 3 · 5:45](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=345)
- "If there is a muscle problem in the inguinal floor, that represents a different type of hernia than a patent processus vaginalis" (clinical) [Ep 3 · 5:54](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=354)
- "Adult surgeons at a SAGES hernia course do not perform digital examination up the inguinal canal; they palpate externally over the internal and external ring areas" (host_summary) [Ep 3 · 7:39](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=459)
- "Digital examination up the inguinal canal is painful for children and causes them to cower during subsequent examinations" (clinical) [Ep 3 · 7:51](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=471)
- "Studies show that clinicians cannot reliably distinguish direct from indirect inguinal hernias on physical examination" (host_summary) [Ep 3 · 8:06](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=486)
- "The first operation for hernia repair was herniotomy, which worked 70% of the time but had a 30% recurrence rate" (host_summary) [Ep 3 · 9:31](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=571)
- "Ladd and Gross introduced high ligation for pediatric hernias" (host_summary) [Ep 3 · 10:00](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=600)
- "Adult surgeons developed floor repairs (McVay, Bassini) which have a 10% recurrence rate" (host_summary) [Ep 3 · 10:00](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=600)
- "Lichtenstein mesh repair reduced adult hernia recurrence to 1%" (host_summary) [Ep 3 · 10:10](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=610)
- "In rabbit studies, when injury was caused to the peritoneum during hernia repair, the closure was much more durable; even when the stitch was cut out after 12 weeks, the closure remained intact" (clinical) [Ep 3 · 14:34](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=874)
- "Hydrodissection with bupivacaine (0.25% or 0.5%) dissects the cord structures away from the peritoneum during laparoscopic hernia repair" (clinical) [Ep 3 · 15:13](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=913)
- "When performing percutaneous laparoscopic hernia repair, it is acceptable to leave 1 millimeter of tissue and skip over the vas deferens rather than risk injury" (clinical) [Ep 3 · 16:35](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=995)
- "Braided non-absorbable suture produces better hernia repairs than monofilament in rabbit studies" (clinical) [Ep 3 · 17:18](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1038)
- "Prolene suture knots are thick and patients complain about them; ethibond or other braided sutures produce softer knots" (clinical) [Ep 3 · 17:09](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1029)
- "Non-absorbable sutures (silk, ethibond) used in hernia repairs can spit out of the groin or form abscesses years after placement" (clinical) [Ep 3 · 18:52](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1132)
- "A retractile testis is defined as one that can be pulled down into the scrotum and stays there after release" (clinical) [Ep 3 · 19:59](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1199)
- "A true retractile testis has occasionally been reported to ascend and become trapped in a higher position" (host_summary) [Ep 3 · 20:29](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1229)
- "Retractile testes should be followed with brief office visits every year until after puberty, when the larger testis size prevents retraction" (clinical) [Ep 3 · 20:43](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1243)
- "Once a patient has gone through puberty and has a good-sized testis, it will stay in the scrotum and cannot retract" (clinical) [Ep 3 · 21:39](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1299)
- "If a testis can be pulled down easily, even if it retracts back up, it should be considered descended" (opinion) [Ep 3 · 22:23](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1343)
- "A testis that cannot be palpated in the office may descend into the scrotum once the patient is under anesthesia" (clinical) [Ep 3 · 22:38](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1358)
- "After hernia repair, scarring can sometimes cause a previously retractile testis to ride up into a higher position" (clinical) [Ep 3 · 24:21](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1461)
- "Testis ascent after open hernia repair occurs when cremaster muscle or cord vessels become entrapped in the external oblique closure" (clinical) [Ep 3 · 24:39](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1479)
- "Ultrasound is not useful for non-palpable testis; if no testis is palpable on exam, proceed directly to laparoscopic exploration" (clinical) [Ep 3 · 26:29](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1589)
- "If a testis is in the inguinal canal, it should be palpable on physical examination; if not palpable, the exam was inadequate" (host_summary) [Ep 3 · 26:47](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1607)
- "For intra-abdominal testis at the internal ring, Fowler-Stevens orchiopexy is the appropriate procedure" (clinical) [Ep 3 · 27:41](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1661)
- "Retrospective data and prospective pilot data suggest that one-stage Fowler-Stevens is just as effective as two-stage" (clinical) [Ep 3 · 27:58](https://qa.library.globalcastmd.com/watch/groin-controversies-todd-ponsky-update-course-2014-661?t=1678)
- "Felix Schier's original laparoscopic hernia recurrence rate was 6%, more recent data 3%" (host_summary) [Ep 4 · 37:47](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2267)
- "Craig Albanese and Sanjeev Dutta reported 1.5% recurrence with the SEAL repair" (host_summary) [Ep 4 · 38:16](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2296)
- "CK Young has had one or two recurrences in over 2000 laparoscopic hernia repairs" (host_summary) [Ep 4 · 38:35](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2315)
- "In rabbit model at 2 weeks: suture alone stayed closed in 25% after suture removal; with anterior injury 87% stayed closed" (clinical) [Ep 4 · 63:35](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3815)
- "In rabbit model at 4 weeks: suture alone stayed closed in 17%; with anterior injury 100% stayed closed even at 36mmHg pressure" (clinical) [Ep 4 · 63:53](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3833)
- "Silk suture (braided) had better closure rates than Vicryl or Prolene (monofilament) in rabbit model without injury" (clinical) [Ep 4 · 65:23](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3923)
- "When adult hernia surgeons see pediatric recurrences, they are finding direct hernias not indirect" (host_summary) [Ep 4 · 30:23](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1823)
- "Mayo Clinic study and others show that direct hernias may be the most common cause of pediatric hernia recurrence" (host_summary) [Ep 4 · 29:59](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1799)
- "Grossfeld found 30% of recurrences are direct hernias" (host_summary) [Ep 4 · 30:26](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1826)
- "In 50-year Mayo Clinic follow-up study, 5% of hernia patients were infertile, similar to general population" (host_summary) [Ep 4 · 40:38](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2438)
- "Javetz study: 6% of 8500 fertility clinic patients had prior hernioplasty; those with hernia repair had markedly reduced semen quality" (host_summary) [Ep 4 · 41:07](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=2467)
- "In adolescent hernia series (13-18 years, 5-year follow-up), recurrence rate was 3% with open high ligation" (clinical) [Ep 4 · 104:16](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6256)
- "Adult hernia surgeons report 10-15% incidence of chronic pain with mesh repair; one study showed 30%" (host_summary) [Ep 4 · 105:16](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=6316)
- "Modified SEAL technique (two-pass suture ligature) has 1.4% recurrence rate in 210 repairs over 4 years" — Matthias Bruzzoni (clinical) [Ep 4 · 139:22](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8362)
- "Single-pass SEAL technique has 2-3% recurrence rate" — Matthias Bruzzoni (clinical) [Ep 4 · 139:37](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=8377)
- "In the UK, open hernia repair involves dividing the sac without ligation, with recurrence rates equivalent to traditional ligation" (host_summary) [Ep 4 · 59:56](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3596)
- "The speaker has had two preemies spit out the stitch without hernia recurrence, suggesting the suture may act as a seton" (clinical) [Ep 4 · 57:53](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=3473)
- "The speaker has had two stitch abscesses in preemies using braided suture; both hernias stayed closed" (clinical) [Ep 4 · 67:25](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4045)
- "The speaker has had two hydroceles form after laparoscopic repair, both on asymptomatic contralateral sides repaired with SEAL technique" (clinical) [Ep 4 · 77:36](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=4656)
- "Laparoscopic hernia repair in preemies rarely recurs; recurrences are more common in older children" (opinion) [Ep 4 · 23:26](https://qa.library.globalcastmd.com/watch/focus-on-technique-laparoscopic-pediatric-hernia-repair-2015-1046?t=1406)
- "Incision is placed in the lower abdominal crease for female neonatal inguinal hernia repair." — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:00](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=0)
- "Subcutaneous tissue and Scarpa's fascia are bluntly dissected in this approach." — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:20](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=20)
- "Palpating the hernial sac helps in its location and grasping." — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:35](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=35)
- "The sac and its coverings are bluntly dissected and exteriorized." — Tamer Ashraf Wafa (clinical) [Ep 8 · 0:45](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=45)
- "The coverings are peeled off the sac until the extraperitoneal fat is reached." — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:00](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=60)
- "The sac is opened to check for a sliding fallopian tube in female inguinal hernia repair." — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:25](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=85)
- "The round ligament is identified during female inguinal hernia dissection." — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:40](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=100)
- "In this case, no fallopian tube was found in the hernial sac." — Tamer Ashraf Wafa (clinical) [Ep 8 · 1:50](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=110)
- "The sac is twisted and transfixed at the proper neck using 4-0 absorbable suture." — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:00](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=120)
- "The external inguinal ring is closed using one or two absorbable stitches." — Tamer Ashraf Wafa (clinical) [Ep 8 · 2:25](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=145)
- "Scarpa's fascia is closed by inverted absorbable sutures." — Tamer Ashraf Wafa (clinical) [Ep 8 · 3:30](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=210)
- "The skin is closed by subcuticular sutures in this technique." — Tamer Ashraf Wafa (clinical) [Ep 8 · 3:50](https://qa.library.globalcastmd.com/watch/female-neonatal-inguinal-hernia-repair-dr-tamer-ashraf-wafa-4354?t=230)
- "Inguinal hernia repair is the second most common surgery performed by pediatric surgeons." — Meera Kotagal (epidemiological) [Ep 11 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=0)
- "The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns." — Meera Kotagal (epidemiological) [Ep 11 · 1:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=60)
- "The incidence of inguinal hernias increases to about 13% in premature infants who are less than 32 weeks of gestational age." — Meera Kotagal (epidemiological) [Ep 11 · 1:15](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=75)
- "Most inguinal hernias in children are largely indirect, over 90%." — Meera Kotagal (epidemiological) [Ep 11 · 1:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=90)
- "Direct hernias are pretty rare in children and are much more commonly found in adolescence." — Meera Kotagal (clinical) [Ep 11 · 1:40](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=100)
- "Femoral hernias are very rare in children, and as in adults, are more common in females." — Meera Kotagal (epidemiological) [Ep 11 · 1:50](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=110)
- "Indirect inguinal hernias in children are a congenital anomaly, meaning that they've occurred in development and are present at the time of birth." — Meera Kotagal (clinical) [Ep 11 · 2:10](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=130)
- "Indirect inguinal hernias occur as a result of the failure of the processus vaginalis to fuse." — Meera Kotagal (clinical) [Ep 11 · 2:25](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=145)
- "The right processus vaginalis usually obliterates after the left, which explains the higher prevalence of right-sided hernias." — Meera Kotagal (clinical) [Ep 11 · 2:45](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=165)
- "The number one risk factor for inguinal hernias in children is prematurity." — Meera Kotagal (clinical) [Ep 11 · 3:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=210)
- "More than half of the incarcerations that we see are in patients that are less than six months old." — Meera Kotagal (epidemiological) [Ep 11 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=420)
- "Two-thirds of incarcerations are in those patients that are less than a year." — Meera Kotagal (epidemiological) [Ep 11 · 7:15](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=435)
- "If the corrected gestational age is less than 60 weeks, premature patients are at a pretty increased risk of post-operative apnea, so you got to admit those patients after you do the repair." — Meera Kotagal (clinical) [Ep 11 · 7:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=450)
- "One of the most important things in being able to reduce an incarcerated hernia is helping to keep the patient calm, sometimes that means pain control and sedation." — Meera Kotagal (clinical) [Ep 11 · 9:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=570)
- "You have to keep applying pressure in a slow, gentle fashion and not just kind of come and go with your hands, because that gentle, slow pressure is what allows you to release the hernia." — Meera Kotagal (clinical) [Ep 11 · 10:20](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=620)
- "If you can reduce an incarcerated hernia, then you want to go to the OR within the first 24 to 72 hours after the reduction." — Meera Kotagal (clinical) [Ep 11 · 11:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=690)
- "Dr. Todd Ponsky states that with laparoscopy, you don't necessarily need to wait for bowel edema to come down because it's really not that much more difficult in a laparoscopic case if there's swelling, and sometimes the edema can help lift the peritoneum off." — Meera Kotagal (host_summary) [Ep 11 · 12:10](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=730)
- "Dr. Todd Ponsky suggests that if it's in the middle of the day and you have time availability and a patient has an incarcerated hernia, you could not even try to reduce it in the emergency room and just go straight to the operating room under laparoscopy." — Meera Kotagal (host_summary) [Ep 11 · 12:45](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=765)
- "The most important point in pediatric inguinal hernia repair is that you need to have high ligation of the processus vaginalis, whether you do it laparoscopically or open." — Meera Kotagal (clinical) [Ep 11 · 13:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=810)
- "Unlike in adults, we don't generally use mesh in the repair of the pediatric inguinal hernia." — Meera Kotagal (clinical) [Ep 11 · 14:10](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=850)
- "The outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar, although there is some controversy on this topic." — Meera Kotagal (opinion) [Ep 11 · 14:25](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=865)
- "If you're considering that the child needs an orchidopexy in addition to their hernia repair, then most would approach that hernia in an open fashion." — Meera Kotagal (clinical) [Ep 11 · 14:55](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=895)
- "A floor repair should be considered in children who have long-standing or very large hernias, where you note that the floor might be blown out or unsupported." — Meera Kotagal (clinical) [Ep 11 · 15:35](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=935)
- "Superficial site infections occur in less than 1% of kids after inguinal hernia repair." — Meera Kotagal (epidemiological) [Ep 11 · 16:25](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=985)
- "The rates of recurrence after pediatric inguinal hernia repair vary from 1 to 5% depending on which studies you look at." — Meera Kotagal (epidemiological) [Ep 11 · 16:40](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1000)
- "In general, we don't try to limit activities in children after a hernia repair, and most children can return to normal activities within one to two days." — Meera Kotagal (clinical) [Ep 11 · 17:25](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1045)
- "If a patient does have an undescended testicle that's palpable in the inguinal canal, then you should plan to do an orchidopexy at the time of your inguinal hernia repair." — Meera Kotagal (clinical) [Ep 11 · 19:45](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1185)
- "Children with an absent vas deferens noted on hernia repair should be worked up for cystic fibrosis or for unilateral renal agenesis in the post-op period." — Meera Kotagal (clinical) [Ep 11 · 20:30](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1230)
- "If patients are having significant testicular pain after a hernia repair, the thing that concerns you most is testicular ischemia, and the best way to evaluate that is to get an ultrasound looking for Doppler flow." — Meera Kotagal (clinical) [Ep 11 · 21:10](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1270)
- "In general, patients with testicular ischemia after hernia repair are monitored and observed with pain control and we only frankly remove a necrotic testicle and not necessarily one that is partially ischemic." — Meera Kotagal (clinical) [Ep 11 · 21:40](https://qa.library.globalcastmd.com/watch/pediatric-inguinal-hernia-in-brief-presentation-workup-diagnosis-perioperative-considerations-4457?t=1300)
- "Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients." — Isabel Hageman (clinical) [Ep 12 · 0:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=33)
- "There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults." — Isabel Hageman (guideline) [Ep 12 · 0:40](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=40)
- "The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne." — Isabel Hageman (clinical) [Ep 12 · 0:52](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=52)
- "Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids." — Isabel Hageman (clinical) [Ep 12 · 0:58](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=58)
- "20% of patients received opioids intraoperatively, which was mostly fentanyl." — Isabel Hageman (clinical) [Ep 12 · 1:41](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=101)
- "Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter." — Isabel Hageman (clinical) [Ep 12 · 1:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=106)
- "33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids." — Isabel Hageman (clinical) [Ep 12 · 1:53](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=113)
- "No patients received an opiate prescription at discharge." — Isabel Hageman (clinical) [Ep 12 · 2:02](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=122)
- "Increasing age increased the risk for postoperative and total opiate use." — Isabel Hageman (clinical) [Ep 12 · 2:06](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "There was a significant association between female sex and total opioid use." — Isabel Hageman (clinical) [Ep 12 · 2:06](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids." — Isabel Hageman (clinical) [Ep 12 · 2:16](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=136)
- "Addition of regional blocks significantly lowered postoperative opiate use." — Isabel Hageman (clinical) [Ep 12 · 2:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "General anesthesia was found to be a risk for total, but not postoperative opioid use." — Isabel Hageman (clinical) [Ep 12 · 2:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world." — Isabel Hageman (opinion) [Ep 12 · 2:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=153)
- "There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients." — Isabel Hageman (opinion) [Ep 12 · 2:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=166)
- "Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional." — Isabel Hageman (clinical) [Ep 12 · 2:54](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=174)
- "Todd has seen a big change in practice over the last decade, from giving everybody narcotics after surgery to not prescribing narcotics at all." — Todd (opinion) [Ep 12 · 3:25](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=205)
- "The median length of stay was elevated due to premature infants and children already admitted to the hospital who had inguinal hernia surgery as one reason for admission." — Isabel Hageman (clinical) [Ep 12 · 5:07](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=307)
- "Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU." — Isabel Hageman (clinical) [Ep 12 · 5:33](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=333)
- "General anesthesia was a risk factor for opioid use in general." — Isabel Hageman (clinical) [Ep 12 · 6:19](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=379)
- "The institution is moving towards more spinals only for inguinal hernia repairs." — Isabel Hageman (opinion) [Ep 12 · 6:26](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=386)
- "Matthew Mitchell in Akron has been doing cases under spinal anesthesia where patients are wide awake, don't move during surgery, don't need PACU, and go home immediately." — Todd (clinical) [Ep 12 · 6:46](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=406)
- "In very young children, spinal anesthesia is easier to perform because they don't experience the potentially traumatic aspects of being in the OR as older children might." — Isabel Hageman (opinion) [Ep 12 · 7:05](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=425)
- "The median age of patients in the study was 3 months, making spinal anesthesia ideal, especially since caution with narcotics is important in young children." — Isabel Hageman (clinical) [Ep 12 · 7:27](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=447)
- "All patients in the study were open inguinal hernia patients, not laparoscopic." — Isabel Hageman (clinical) [Ep 12 · 8:23](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=503)
- "There was no association found between length of stay and opiate use, though this may be due to the small sample size of patients who received opioids." — Isabel Hageman (clinical) [Ep 12 · 8:25](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=505)
- "The study was a retrospective audit, so groups (general anesthesia only, spinal only, or both) were determined by looking back at what patients received, not selected beforehand." — Isabel Hageman (clinical) [Ep 12 · 8:55](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=535)
- "There was no institutional education around opioid prescription at the time of the study or before." — Isabel Hageman (clinical) [Ep 12 · 9:51](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=591)
- "Two or three years before the study, the warnings around opioids and their classification level were changed in Australia, which may have influenced opioid use at RCH." — Isabel Hageman (opinion) [Ep 12 · 9:51](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=591)
- "In older populations, the theory for gender differences in opioid requirements is that males are reluctant to report pain while females will ask for painkillers." — Isabel Hageman (opinion) [Ep 12 · 10:50](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=650)
- "In the very young study population where there is no verbal communication about pain, it is especially interesting that females have higher opioid requirements, and the reason is unclear." — Isabel Hageman (opinion) [Ep 12 · 11:12](https://qa.library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=672)
- "Over half a million opioid-related deaths occurred in the last 20 years" — Jeremy Warren (host_summary) [Ep 13 · 1:30](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=90)
- "Prescription opioid-related deaths increased by 17% in the last year" — Jeremy Warren (host_summary) [Ep 13 · 1:40](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=100)
- "Transition to synthetic opioids and heroin often begins with exposure to prescribed opioids" — Jeremy Warren (host_summary) [Ep 13 · 1:50](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=110)
- "A 2017 Dartmouth study demonstrated wide range of surgeon prescribing patterns for common procedures and that patients typically consume dramatically less opioid than prescribed" — Jeremy Warren (host_summary) [Ep 13 · 2:05](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=125)
- "Patients were prescribed between 15 and 120 opioid tablets after inguinal hernia repair, with an average of over 30 pills prescribed" — Jeremy Warren (host_summary) [Ep 13 · 2:35](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=155)
- "Patients reported taking only 15 to 30 percent of prescribed tablets after inguinal hernia repair" — Jeremy Warren (host_summary) [Ep 13 · 2:55](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=175)
- "More than 60 percent of inguinal hernia patients in a Greenville study required no opioid consumption" — Jeremy Warren (epidemiological) [Ep 13 · 3:10](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=190)
- "The ACHQC is a national hernia-specific registry containing over 100,000 patients" — Jeremy Warren (clinical) [Ep 13 · 3:40](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=220)
- "Over 80 percent of patients reported taking less than 10 pills after inguinal hernia repair" — Jeremy Warren (epidemiological) [Ep 13 · 4:20](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=260)
- "Over 50 percent of patients reported taking no opioids at all after inguinal hernia repair" — Jeremy Warren (epidemiological) [Ep 13 · 4:30](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=270)
- "The study analyzed 1,937 patients undergoing elective, clean inguinal hernia repair with completed 30-day follow-up and complete opioid data" — Jeremy Warren (clinical) [Ep 13 · 4:45](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=285)
- "59 percent of cases were minimally invasive inguinal hernia repairs (lap and robotic), 35 percent open mesh repairs, and 6 percent open tissue repairs" — Jeremy Warren (epidemiological) [Ep 13 · 5:00](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=300)
- "Patients reported consuming zero narcotics in 50 percent of cases, with only 8 percent reporting more than 10 tablets consumed" — Jeremy Warren (epidemiological) [Ep 13 · 5:15](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=315)
- "Older age, ASA 1 or 2, use of local anesthetic, use of sedation versus general anesthetic, and shorter operative time all increased the chances that patients would use zero narcotics post-op" — Jeremy Warren (clinical) [Ep 13 · 5:30](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=330)
- "Patients with no opioid use prior to surgery or prescribed fewer than seven pills were the most likely to consume zero narcotics post-operatively" — Jeremy Warren (clinical) [Ep 13 · 5:50](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=350)
- "Younger age, smokers, ASA 3 or 4, preoperative opioid use, open mesh repairs, longer operative times, and worse baseline quality of life increased the risk of high opioid consumption post-op" — Jeremy Warren (clinical) [Ep 13 · 4:40](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=280)
- "Patients were at significantly higher risk of opioid consumption when prescribed a higher volume of pills" — Jeremy Warren (clinical) [Ep 13 · 5:00](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=300)
- "History of smoking increases the risk of opioid consumption after inguinal hernia repair" — Jeremy Warren (clinical) [Ep 13 · 5:10](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=310)
- "Patients with prior or recent opioid use are at higher risk of post-operative opioid consumption, supporting avoidance of prescribing opioids for hernia-related pain prior to surgery" — Jeremy Warren (clinical) [Ep 13 · 5:20](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=320)
- "Minimally invasive approach and use of local anesthetic are surgeon-modifiable factors that reduce opioid consumption" — Jeremy Warren (clinical) [Ep 13 · 5:35](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=335)
- "Patient-reported opioid use is significantly impacted by surgeon prescribing" — Jeremy Warren (clinical) [Ep 13 · 5:45](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=345)
- "Almost every state has reversed legislation to allow prescribing limited opioids without hand-off through EMRs" — Em Gootee (clinical) [Ep 13 · 7:50](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=470)
- "The rate of refill calls for inguinal hernias following these guidelines is 4%" — Em Gootee (host_summary) [Ep 13 · 8:40](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=520)
- "The number one predictor of how many opioid tablets a patient takes is how many they are prescribed" — Em Gootee (host_summary) [Ep 13 · 9:00](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=540)
- "A surgeon previously discharged every inguinal hernia patient with 50 oxycodones at $3 prescription cost plus $23 FedEx for refills" — Em Gootee (clinical) [Ep 13 · 9:20](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=560)
- "For laparoscopic inguinal hernias, a surgeon has discharged patients with zero narcotics for six months, using ice and scheduled Motrin and Tylenol, with only one refill request" — Em Gootee (clinical) [Ep 13 · 10:00](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=600)
- "Other specialties use drugs like gabapentin and Tylenol to achieve effective pain relief without narcotics" — Todd Ponsky (clinical) [Ep 13 · 10:40](https://qa.library.globalcastmd.com/watch/best-of-the-best-gen-surg-predictors-of-low-and-high-opioid-tablet-consumption-after-inguinal-hernia-repair-an-achqc-opioid-reduction-task-force-analysis-dr-warren-5864?t=640)
- "Inguinal hernia repairs are some of the most common pediatric surgical procedures and are traditionally performed under general anesthesia for open surgery." — Wendy (clinical) [Ep 14 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=0)
- "Many centers have recently started utilizing the minimally invasive approach with regional anesthesia instead of traditional general anesthesia with open surgery." — Wendy (clinical) [Ep 14 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=60)
- "Over the last five years at BC Children's Hospital, surgeons and anesthesiologists have utilized four different combinations of surgical and anesthetic techniques: general anesthesia with open surgery (GO), caudal anesthesia with open surgery (CO), general anesthesia with laparoscopy (GL), and caudal anesthesia with laparoscopy (CL)." — Wendy (clinical) [Ep 14 · 2:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=120)
- "Caudal anesthesia with laparoscopy (CL) is a newer combination that was recently adopted and its safety was demonstrated in a prior case study." — Wendy (clinical) [Ep 14 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=180)
- "The study was a retrospective cohort study including all infants less than one year old undergoing elective inguinal hernia repair from July 2016 to 2021 at a single tertiary care teaching center." — Wendy (clinical) [Ep 14 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=240)
- "All inguinal hernia repairs with concomitant procedures and emergent procedures from strangulated or incarcerated hernias were excluded from the study." — Wendy (clinical) [Ep 14 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=300)
- "Eight surgeons and 25 anesthesiologists contributed patients with approach dictated by practitioner preference." — Wendy (clinical) [Ep 14 · 6:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=360)
- "Of 465 infants initially assessed for eligibility, 338 patients were included in the final study analysis." — Wendy (epidemiological) [Ep 14 · 6:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=390)
- "Most patients underwent an open procedure with only 63 cases being laparoscopic, and there was a relatively even split between caudal anesthesia and general anesthesia." — Wendy (epidemiological) [Ep 14 · 7:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=420)
- "Of the 338 patients included, most were pre-term males and were followed for a median of 2.5 years." — Wendy (epidemiological) [Ep 14 · 7:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=450)
- "There were two crossovers: one conversion in the GL group to open surgery because the patient was unable to tolerate the pneumoperitoneum, and one case requiring conversion to general anesthesia in the caudal group because the patient did not tolerate the incision despite initially passing the pinch test." — Wendy (clinical) [Ep 14 · 8:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=480)
- "There was no statistical difference found between groups for the aggregate post-operative complication rates, including recurrence." — Wendy (clinical) [Ep 14 · 9:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=540)
- "Metachronous hernias occurred at a similar rate for open and laparoscopic approaches, albeit with a modest follow-up, irrespective of anesthetic choice." — Wendy (clinical) [Ep 14 · 9:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=570)
- "Total OR time was significantly different between groups with caudal anesthesia with open surgery being the shortest." — Wendy (clinical) [Ep 14 · 10:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=600)
- "Caudal anesthesia with open surgery was significantly shorter than caudal anesthesia with laparoscopy by 15 minutes and general anesthesia with open surgery by 9 minutes in total OR time." — Wendy (clinical) [Ep 14 · 10:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=630)
- "There was no difference between the groups in anesthetic preparation time or skin to skin time." — Wendy (clinical) [Ep 14 · 11:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=660)
- "Overall post procedure time was significantly shorter in patients receiving a caudal blockade than general anesthesia, with four minutes saved in the laparoscopic group and eight minutes in the open group." — Wendy (clinical) [Ep 14 · 11:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=690)
- "The use of laparoscopy with caudal anesthesia (CL) appears to be a safe and effective option in terms of post-operative complications compared to other groups." — Wendy (opinion) [Ep 14 · 12:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=720)
- "Caudal anesthesia with open surgery appeared to be the most resource efficient inguinal hernia repair method." — Wendy (opinion) [Ep 14 · 12:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=750)
- "Due to the retrospective nature of the project, it is subject to the normal bias of any retrospective review." — Wendy (clinical) [Ep 14 · 13:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=780)
- "Due to lack of cross hospital EMRs, the study follow-up was unable to capture post-operative complications managed at any other hospital or clinic." — Wendy (clinical) [Ep 14 · 13:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-song-caps-presentation-6352?t=810)
- "A systematic review and meta-analysis examined the optimal timing for operating inguinal hernias in preterm babies." — Cecilia Gigena (host_summary) [Ep 15 · 0:10](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=10)
- "The systematic review included 6 articles." — Cecilia Gigena (host_summary) [Ep 15 · 0:21](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=21)
- "Preterm patients operated before discharge in the first hospitalization had lower odds of incarceration." — Cecilia Gigena (host_summary) [Ep 15 · 0:21](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=21)
- "Preterm patients operated before discharge in the first hospitalization had higher risk of respiratory complications in the post-op." — Cecilia Gigena (host_summary) [Ep 15 · 0:21](https://qa.library.globalcastmd.com/watch/delayed-versus-early-repair-of-inguinal-hernia-in-preterm-infants-7705?t=21)
- "Inguinal hernias are very common in preterm infants." (host_summary) [Ep 16 · 0:00](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=0)
- "The optimal timing for surgical repair of inguinal hernias in preterm infants is still debated due to associated risks." (host_summary) [Ep 16 · 0:00](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=0)
- "A recent European study showed 56% of surgeons recommend inguinal hernia surgery before discharge in preterm infants." (host_summary) [Ep 16 · 0:08](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=8)
- "The JAMA 2024 trial enrolled 338 preterm infants diagnosed with inguinal hernias before their initial hospital discharge." (host_summary) [Ep 16 · 0:39](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=39)
- "Infants were randomized to early repair (before NICU discharge) or late repair (after NICU discharge)." (host_summary) [Ep 16 · 0:47](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=47)
- "The primary outcome was occurrence of predefined serious adverse events over 10 months, including death, hernia complications, and respiratory and cardiovascular morbidity." (host_summary) [Ep 16 · 0:54](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=54)
- "Late repair reduced serious adverse events to 18% compared to 28% in the early repair group." (host_summary) [Ep 16 · 1:07](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=67)
- "The late repair group experienced a 3-day reduction in length of hospital stay." (host_summary) [Ep 16 · 1:19](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=79)
- "Delaying inguinal hernia repair until after NICU discharge might be safer for preterm infants, potentially reducing the risk of serious complications." (host_summary) [Ep 16 · 1:25](https://qa.library.globalcastmd.com/watch/effect-of-early-vs-late-inguinal-hernia-repair-on-serious-adverse-event-rates-in-preterm-infants-9401?t=85)
- "Preterm infants with inguinal hernia have a very high rate of incarceration" — Todd Ponsky (clinical) [Ep 17 · 1:17](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=77)
- "The younger the baby, the higher the risk of incarceration in inguinal hernia" — Jose Campos (clinical) [Ep 17 · 1:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=103)
- "In the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group" — Em Gootee (host_summary) [Ep 17 · 3:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=216)
- "Recurrence rate after inguinal hernia repair in the trial was less than 1%" — Em Gootee (host_summary) [Ep 17 · 4:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=247)
- "Incarceration rate in the late repair group was around 4%" — Em Gootee (host_summary) [Ep 17 · 4:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=247)
- "In the early repair group, 4% of hernias resolved spontaneously; in the late repair group, 11% resolved spontaneously" — Jose Campos (host_summary) [Ep 17 · 4:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=260)
- "One patient in the trial had a bowel injury during hernia repair" — Todd Ponsky (host_summary) [Ep 17 · 4:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=296)
- "There was zero incidence of bowel loss in the trial" — Todd Ponsky (host_summary) [Ep 17 · 4:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=296)
- "The trial showed more reintubations and more apnea in the early repair group" — Todd Ponsky (host_summary) [Ep 17 · 5:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=326)
- "The JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated" — Em Gootee (host_summary) [Ep 17 · 7:12](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=432)
- "In the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery" — Em Gootee (host_summary) [Ep 17 · 10:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=654)
- "Post-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study" — Em Gootee (host_summary) [Ep 17 · 10:59](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=659)
- "General satisfaction and inclusion of family were higher after one-stop surgery experience" — Em Gootee (host_summary) [Ep 17 · 11:05](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=665)
- "There was no diagnostic uncertainty in the one-stop surgery program" — Jose Campos (host_summary) [Ep 17 · 11:35](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=695)
- "A recent Surgery journal article found that routine post-operative visits alter management in less than 1% of cases for routine pediatric surgical conditions including circumcision, orchiopexy, and inguinal hernia" — Jose Campos (host_summary) [Ep 17 · 12:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=746)
- "When facing medical problems with low risk of complications, family satisfaction becomes a surrogate for quality" — Jose Campos (host_summary) [Ep 17 · 13:28](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=808)
- "In the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up" — Em Gootee (host_summary) [Ep 17 · 15:34](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=934)
- "Of the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs" — Em Gootee (host_summary) [Ep 17 · 15:49](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=949)
- "The presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up" — Em Gootee (host_summary) [Ep 17 · 16:13](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=973)
- "A Mayo Clinic study by Ben Zendejas showed contralateral hernia occurrence after a 50-year follow-up period" — Todd Ponsky (host_summary) [Ep 17 · 16:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=1003)
- "In laparoscopic surgery, the traditional airway approach is using endotracheal intubation." — Lizzie Lee (host_summary) [Ep 18 · 0:11](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=11)
- "A randomized trial studied 50 kids having laparoscopic hernia repair comparing LMA to endotracheal intubation." — Lizzie Lee (host_summary) [Ep 18 · 0:21](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=21)
- "There was no difference in oxygen saturation between LMA and endotracheal intubation groups in pediatric laparoscopic hernia repair." — Lizzie Lee (host_summary) [Ep 18 · 0:26](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=26)
- "There was no difference in tidal carbon dioxide levels between LMA and endotracheal intubation groups in pediatric laparoscopic hernia repair." — Lizzie Lee (host_summary) [Ep 18 · 0:26](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=26)
- "There was only one desaturation event in the LMA group and one in the endotracheal intubation group." — Lizzie Lee (host_summary) [Ep 18 · 0:33](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=33)
- "For certain laparoscopic surgeries in children, an LMA might be just as safe as a traditional endotracheal tube." — Lizzie Lee (host_summary) [Ep 18 · 0:37](https://qa.library.globalcastmd.com/watch/the-use-of-laryngeal-mask-airway-versus-endotracheal-intubation-in-pediatric-laparoscopic-inguinal-hernia-repair-a-randomized-controlled-trial-11030?t=37)
- "The study examined pediatric inguinal hernia repairs across 21 children's hospitals." — Lizzie Lee (host_summary) [Ep 19 · 0:09](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=9)
- "When surgeons who mostly do open repairs performed a laparoscopic repair, the hernia recurrence rate was 3.6%." — Lizzie Lee (host_summary) [Ep 19 · 0:15](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=15)
- "When laparoscopic repair was done by surgeons who primarily use that approach, the hernia recurrence rate was 1.7%." — Lizzie Lee (host_summary) [Ep 19 · 0:15](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=15)
- "Surgeons who primarily do laparoscopic repairs had similar low recurrence rates whether they operated laparoscopically or open." — Lizzie Lee (host_summary) [Ep 19 · 0:27](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=27)
- "Surgeons tend to get the best results with the technique they use most often." — Lizzie Lee (host_summary) [Ep 19 · 0:35](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=35)
- "If surgeons split their practice between open and laparoscopic hernia repairs, it is important to maintain strong skills in both so that outcomes can stay consistent." — Lizzie Lee (host_summary) [Ep 19 · 0:39](https://qa.library.globalcastmd.com/watch/effect-of-a-pediatric-surgeon-s-primarily-performed-technique-on-inguinal-hernia-recurrence-rates-a-multicenter-retrospective-cohort-study-11386?t=39)
- "A nationwide study examined over 53,000 children who had inguinal hernia repair across the United States." — Lizzie Lee (host_summary) [Ep 20 · 0:06](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=6)
- "Approximately 16% of pediatric inguinal hernia repairs in the study were performed laparoscopically." — Lizzie Lee (host_summary) [Ep 20 · 0:13](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=13)
- "The majority of pediatric inguinal hernia repairs in the study were open repairs." — Lizzie Lee (host_summary) [Ep 20 · 0:15](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=15)
- "Laparoscopic inguinal hernia repair had more than 3 times the risk of same-side recurrence compared to open surgery." — Lizzie Lee (host_summary) [Ep 20 · 0:23](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=23)
- "Laparoscopic inguinal hernia repair was linked to fewer future surgeries on the opposite side (metachronous hernias)." — Lizzie Lee (host_summary) [Ep 20 · 0:30](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=30)
- "The findings comparing laparoscopic and open inguinal hernia repair held up after adjusting for hospital differences and patient factors." — Lizzie Lee (host_summary) [Ep 20 · 0:36](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=36)
- "Open inguinal hernia repair has a lower risk of same-side recurrence compared to laparoscopic repair." — Lizzie Lee (host_summary) [Ep 20 · 0:40](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=40)
- "Laparoscopic inguinal hernia repair may reduce the chance of needing surgery on the contralateral side." — Lizzie Lee (host_summary) [Ep 20 · 0:40](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11460?t=40)
- "A nationwide study examined over 53,000 children who had inguinal hernia repair across the United States." — Lizzie Lee (host_summary) [Ep 21 · 0:06](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=6)
- "Approximately 16% of the pediatric inguinal hernia repairs in the study were performed laparoscopically." — Lizzie Lee (host_summary) [Ep 21 · 0:13](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=13)
- "The majority of pediatric inguinal hernia repairs in the study were open repairs." — Lizzie Lee (host_summary) [Ep 21 · 0:15](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=15)
- "The study compared two key outcomes: hernia recurrence on the same side and the need for a second hernia operation later on." — Lizzie Lee (host_summary) [Ep 21 · 0:17](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=17)
- "Laparoscopic inguinal hernia repair had more than 3 times the risk of same-side recurrence compared to open surgery." — Lizzie Lee (host_summary) [Ep 21 · 0:23](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=23)
- "Laparoscopic inguinal hernia repair was linked to fewer future surgeries on the opposite side (metachronous hernias)." — Lizzie Lee (host_summary) [Ep 21 · 0:30](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=30)
- "The findings comparing laparoscopic and open inguinal hernia repair held up even after adjusting for hospital differences and patient factors." — Lizzie Lee (host_summary) [Ep 21 · 0:36](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=36)
- "Open inguinal hernia repair has a lower risk of same-side recurrence compared to laparoscopic repair." — Lizzie Lee (host_summary) [Ep 21 · 0:40](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=40)
- "Laparoscopic inguinal hernia repair may reduce the chance of needing surgery on the contralateral side." — Lizzie Lee (host_summary) [Ep 21 · 0:40](https://qa.library.globalcastmd.com/watch/a-retrospective-nationwide-comparison-of-laparoscopic-vs-open-inguinal-hernia-repair-in-children-11527?t=40)
- "Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias." — Jill Knepprath (host_summary) [Ep 22 · 0:10](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=10)
- "Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence." — Jill Knepprath (host_summary) [Ep 22 · 0:22](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=22)
- "When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume." — Jill Knepprath (host_summary) [Ep 22 · 0:30](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=30)
- "Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence." — Jill Knepprath (host_summary) [Ep 22 · 0:35](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=35)
- "The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon." — Jill Knepprath (host_summary) [Ep 22 · 0:44](https://qa.library.globalcastmd.com/watch/surgeon-annual-volume-impacts-recurrence-rates-of-pediatric-inguinal-hernia-repairs-a-multi-institutional-study-11554?t=44)
- "The study was published in the International Journal of Surgery." — Jill Knepprath (host_summary) [Ep 23 · 0:08](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=8)
- "The study used the modified percutaneous internal ring suturing technique to evaluate whether a laparoscopic non-mesh repair works on indirect inguinal hernias in adults." — Jill Knepprath (host_summary) [Ep 23 · 0:12](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=12)
- "There were 20 patients in the study." — Jill Knepprath (host_summary) [Ep 23 · 0:23](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=23)
- "The majority of patients were male." — Jill Knepprath (host_summary) [Ep 23 · 0:25](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=25)
- "No patients had hernia recurrence on follow-up, with a median follow-up of 79 months." — Jill Knepprath (host_summary) [Ep 23 · 0:26](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=26)
- "Patients reported a decrease in pain and an improved activity post-operatively." — Jill Knepprath (host_summary) [Ep 23 · 0:31](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=31)
- "This is a small single-center study." — Jill Knepprath (opinion) [Ep 23 · 0:35](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=35)
- "The study shows success with the modified PIRS technique in adults." — Jill Knepprath (opinion) [Ep 23 · 0:35](https://qa.library.globalcastmd.com/watch/laparoscopic-modified-percutaneous-internal-ring-suturing-a-mesh-free-alternative-for-indirect-inguinal-hernia-repair-in-adults-a-pilot-prospective-cohort-study-11894?t=35)
- "Patent processus vaginalis may close spontaneously - Ponsky reports having a patient with documented PPV on initial laparoscopy that was absent on second laparoscopy for unrelated indication" — Todd Ponsky (clinical) [Ep 24 · 8:35](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=515)
- "Risk of anesthesia is now so low that bringing a child back for delayed hernia repair after PPV discovery is acceptable" — Todd Ponsky (opinion) [Ep 24 · 8:56](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=536)
- "Contralateral PPV is present 30-40% of the time according to Witt's 1994 paper" — Todd Ponsky (host_summary) [Ep 24 · 11:13](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=673)
- "Risk of metachronous hernia after unilateral repair is 3-11%" — Todd Ponsky (host_summary) [Ep 24 · 11:50](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=710)
- "In rabbit studies, grabbing the vas deferens in a preemie-sized vessel just once can obliterate it and cause scarring" — Todd Ponsky (host_summary) [Ep 24 · 18:19](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1099)
- "Risk of hernia incarceration is high in preemies but drops to 1-3% after 1 year of age and less than 1% each year thereafter" — Todd Ponsky (host_summary) [Ep 24 · 30:48](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1848)
- "Ben Zendejas' 50-year follow-up study at Mayo showed some evidence of infertility after childhood inguinal hernia repair" — Todd Ponsky (host_summary) [Ep 24 · 22:47](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1367)
- "In a study of 8500 patients at fertility clinic, 6% had prior inguinal hernioplasty and their semen quality was markedly reduced compared to fertile men" — Todd Ponsky (host_summary) [Ep 24 · 23:25](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1405)
- "The most common recurrence after indirect inguinal hernia repair is a direct hernia, not another indirect hernia" — Todd Ponsky (host_summary) [Ep 24 · 39:39](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2379)
- "Open preemie hernia repairs may be causing floor injuries leading to direct hernias that present in adulthood" — Todd Ponsky (opinion) [Ep 24 · 40:26](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2426)
- "Kaiser study of 1700 children showed recurrence rate of 0.9% for laparoscopic unilateral hernias, with 0.8% for open and 0.3% for laparoscopic" — Todd Ponsky (host_summary) [Ep 24 · 43:00](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2580)
- "Ponsky reports never having re-operated on a hernia recurrence in 20 years except for his first seal technique case" — Todd Ponsky (clinical) [Ep 24 · 44:12](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2652)
- "Montreal group published 10% recurrence rate with laparoscopic repair, significantly higher than other centers reporting less than 1%" — Todd Ponsky (host_summary) [Ep 24 · 45:23](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2723)
- "Laparoscopic hernia repair in adolescents may reduce pain compared to open repair because the groin is a very nerve-dense area" — Todd Ponsky (opinion) [Ep 24 · 22:02](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=1322)
- "In rabbit model, suture repair alone showed 25% remained closed at 2 weeks after suture removal, while injury plus suture showed 90% closed at 2 weeks and 100% at 4 weeks" — Todd Ponsky (clinical) [Ep 24 · 66:54](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4014)
- "In rabbit suture material study, Vicryl had 80% failure rate, Prolene 75% failure, and silk 10% failure after suture removal" — Todd Ponsky (clinical) [Ep 24 · 69:00](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4140)
- "Braided suture works better than monofilament for hernia repair based on rabbit studies" — Todd Ponsky (clinical) [Ep 24 · 69:25](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4165)
- "Felix Shear's studies showed no impediment to cord blood flow after laparoscopic hernia repair" — Todd Ponsky (host_summary) [Ep 24 · 82:14](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4934)
- "Ponsky reports having had maybe 2 hydroceles after laparoscopic repair in 20 years, both of which resolved spontaneously" — Todd Ponsky (clinical) [Ep 24 · 56:13](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=3373)
- "Study of adolescent high ligation (ages 13-18) showed 2% recurrence rate overall, only 0.9% confirmed recurrence at 2-year follow-up" — Todd Ponsky (epidemiological) [Ep 24 · 96:32](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5792)
- "Statistical analysis of adult and pediatric hernia types suggests age 40 may be inflection point where direct hernias become more common, though most remain indirect" — Todd Ponsky (epidemiological) [Ep 24 · 97:27](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5847)
- "Norwegian mentorship program for adult laparoscopic high ligation reported zero recurrences" — Todd Ponsky (host_summary) [Ep 24 · 98:52](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5932)
- "VA cooperative study showed chronic pain after mesh hernia repair as high as 30%" — Todd Ponsky (host_summary) [Ep 24 · 118:23](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7103)
- "Incidence of chronic pain after mesh repair is substantial, and mesh can migrate" — Todd Ponsky (host_summary) [Ep 24 · 118:35](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7115)
- "Recent adult surgery paper comparing huge scrotal hernias found no difference in complications between resecting versus abandoning the hernia sac" — Marcello Rombaldi (host_summary) [Ep 24 · 121:20](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7280)
- "Rombaldi reports no hydroceles or scrotal complications from leaving the sac in place during laparoscopic repair" — Marcello Rombaldi (clinical) [Ep 24 · 120:56](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=7256)
- "Direct inguinal hernias in children are rare findings, making it difficult for pediatric surgeons to maintain proficiency in their repair" — Todd Ponsky (opinion) [Ep 24 · 101:45](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=6105)
- "When insufflating a distended abdomen for bowel obstruction, waiting 5-10 minutes allows bowel loops to spread out and improve visualization" — Todd Ponsky (clinical) [Ep 24 · 36:57](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=2217)
- "Ponsky uses 3-0 Ethibond (braided non-absorbable suture) for the final hernia repair after threading with Prolene" — Todd Ponsky (clinical) [Ep 24 · 83:39](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=5019)
- "In neonates, Ponsky uses single ligation rather than double because of risk of suture granuloma and spitting due to short distance from skin to knot" — Todd Ponsky (clinical) [Ep 24 · 71:05](https://qa.library.globalcastmd.com/watch/2026-laparoscopic-pediatric-hernia-repair-12251?t=4265)
- "The incidence of inguinal hernias overall ranges from about 1% to 5% in full-term newborns." — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "The incidence of inguinal hernias increases to about 13% in premature infants who are less than 32 weeks of gestational age." — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Most inguinal hernias in children are largely indirect, over 90%." — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Direct hernias are pretty rare in children and are much more commonly found in adolescents." — Meera Kotagal (clinical) [Ep 7 · 1:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Femoral hernias are very rare in children and, as in adults, are more common in females." — Meera Kotagal (epidemiological) [Ep 7 · 1:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=86)
- "Indirect inguinal hernias in children are a congenital anomaly, meaning that they've occurred in development and are present at the time of birth." — Meera Kotagal (clinical) [Ep 7 · 1:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "Inguinal hernias occur as a result of the failure of the processus vaginalis to fuse." — Meera Kotagal (clinical) [Ep 7 · 1:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "The right processus vaginalis usually obliterates after the left, which explains the higher prevalence of right-sided hernias." — Meera Kotagal (clinical) [Ep 7 · 1:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=119)
- "The number one risk factor for inguinal hernias in children is prematurity." — Meera Kotagal (clinical) [Ep 7 · 2:47](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=167)
- "Other factors associated with an increased risk of inguinal hernias in kids include male sex, family history of inguinal hernias, a history of undescended testicle or hydrocele, and a connective tissue disorder." — Meera Kotagal (clinical) [Ep 7 · 2:47](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=167)
- "More than half of incarcerations are in patients that are less than six months, and two-thirds of incarcerations are in patients who are less than a year." — Meera Kotagal (epidemiological) [Ep 7 · 4:31](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "If corrected gestational age is less than 60 weeks, patients have a high risk for premature apnea postoperatively and need to be admitted after surgery to monitor." — Meera Kotagal (clinical) [Ep 7 · 4:31](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=271)
- "One of the most important things in being able to reduce an incarcerated hernia is helping to keep the patient calm, sometimes requiring pain control and sedation." — Meera Kotagal (clinical) [Ep 7 · 5:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=359)
- "For hernia reduction, one hand guides the contents through the inguinal ring and the other hand applies gentle, steady pressure, which must be maintained in a slow, gentle fashion." — Meera Kotagal (clinical) [Ep 7 · 5:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=359)
- "During reduction of an incarcerated hernia, you have to squeeze the incarcerated bowel so that the edema gets pushed out, which can take several minutes." — Todd (clinical) [Ep 7 · 6:41](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=401)
- "If you can reduce an incarcerated inguinal hernia, you want to go to the OR within the first 24 to 72 hours after the reduction." — Meera Kotagal (clinical) [Ep 7 · 7:34](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=454)
- "With laparoscopy, you don't necessarily need to wait after reducing an incarcerated hernia because it's not that much more difficult in a laparoscopic case if there's swelling; in fact, sometimes the edema can help lift the peritoneum off." — Todd (opinion) [Ep 7 · 7:50](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=470)
- "The most important point in pediatric inguinal hernia repair is that you need to have high ligation of the processus vaginalis, whether you do it laparoscopically or open." — Meera Kotagal (clinical) [Ep 7 · 8:57](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=537)
- "Unlike in adults, we don't generally use mesh in the repair of the pediatric inguinal hernia." — Meera Kotagal (clinical) [Ep 7 · 8:57](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=537)
- "The outcomes between pediatric laparoscopic repairs and open repairs are thought to be similar, although there is some controversy on this topic." — Meera Kotagal (clinical) [Ep 7 · 9:31](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=571)
- "If a child needs an orchidopexy in addition to their hernia repair, most would approach that hernia in an open fashion." — Meera Kotagal (clinical) [Ep 7 · 9:44](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=584)
- "When people have been doing orchidopexies and don't stitch the hole closed, patients usually do not get a hernia afterward, suggesting that scar alone may be enough and you may not need to ligate anything." — Todd (opinion) [Ep 7 · 9:59](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=599)
- "A floor repair should be considered in children who have longstanding or very large hernias where the floor might be blown out or unsupported." — Meera Kotagal (clinical) [Ep 7 · 10:54](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=654)
- "The most common complications after inguinal hernia repair in children are superficial site infection, which occur in less than 1% of kids, and recurrence, with rates varying from 1% to 5%." — Meera Kotagal (epidemiological) [Ep 7 · 11:10](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Rare complications include testicular atrophy or damage to the vas deferens." — Meera Kotagal (clinical) [Ep 7 · 11:10](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=670)
- "Post-operative hydrocele can occur after laparoscopic repair, and all observed cases have resolved on their own." — Todd (clinical) [Ep 7 · 11:52](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=712)
- "In general, we don't try to limit activities in children after a hernia repair; most children can return to normal activities within one to two days." — Meera Kotagal (clinical) [Ep 7 · 12:19](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=739)
- "A lot of times, once the patient is put under anesthesia, an incarcerated hernia that was unable to be reduced in the emergency department may actually spontaneously reduce with the patient's relaxation." — Meera Kotagal (clinical) [Ep 7 · 13:26](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=806)
- "If a patient has an undescended testicle that's palpable in the inguinal canal, you should plan to do an orchiopexy at the time of your inguinal hernia repair." — Meera Kotagal (clinical) [Ep 7 · 13:49](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=829)
- "Children with an absent vas deferens noted on hernia repair should be worked up for cystic fibrosis or for unilateral renal agenesis in the post-op period." — Meera Kotagal (clinical) [Ep 7 · 14:18](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=858)
- "If patients are having significant testicular pain after a hernia repair, the main concern is testicular ischemia, best evaluated with ultrasound looking for Doppler flow." — Meera Kotagal (clinical) [Ep 7 · 14:35](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=875)
- "In cases of testicular ischemia after hernia repair, patients are monitored and observed with pain control, and surgeons only remove a necrotic testicle, not necessarily one that is partially ischemic." — Meera Kotagal (clinical) [Ep 7 · 14:35](https://qa.library.globalcastmd.com/watch/inguinal-hernias-diagnosis-and-management-3891?t=875)
- "In the Fitzgibbons VA study of minimally symptomatic to asymptomatic inguinal hernias in patients in their 70s-80s, the risk of presenting with an emergency problem (incarceration or strangulation) requiring operation was 0.3% over 2 years." — Michael Rosen (epidemiological) [Ep 6 · 3:30](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=210)
- "In the Fitzgibbons study, almost one-third of patients in the observation group developed symptoms requiring operation by 2 years." — Michael Rosen (epidemiological) [Ep 6 · 4:11](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=251)
- "In long-term follow-up of the Fitzgibbons study, almost three-fifths of patients in the observation group developed symptoms requiring operation by 5 years." — Michael Rosen (epidemiological) [Ep 6 · 4:21](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=261)
- "For an 89-year-old patient with an asymptomatic hernia, watchful waiting is acceptable because the odds are they may not develop symptoms over their remaining lifespan." — Michael Rosen (opinion) [Ep 6 · 4:33](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=273)
- "For younger patients with asymptomatic hernias, the odds are against them living the rest of their life without the hernia becoming symptomatic, so repair should be recommended when the time is right." — Michael Rosen (opinion) [Ep 6 · 4:36](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=276)
- "Inguinal hernia repairs can be performed under local anesthesia in high-risk patients." — Michael Rosen (clinical) [Ep 6 · 6:06](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=366)
- "For symptomatic hernias in high-risk patients, it is much worse for them to present with an emergency problem in the middle of the night, which could be life-threatening, so they should still be offered repair." — Michael Rosen (opinion) [Ep 6 · 6:06](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=366)
- "For unilateral primary inguinal hernias, tissue repair, open mesh repair, or laparoscopic mesh repair are all acceptable approaches with ample literature support." — Michael Rosen (clinical) [Ep 6 · 7:56](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=476)
- "The best approach for inguinal hernia repair is what the surgeon does best, and this is supported by literature." — Michael Rosen (opinion) [Ep 6 · 8:29](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=509)
- "The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200-250 cases required." — Michael Rosen (epidemiological) [Ep 6 · 9:04](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=544)
- "In laparoscopic inguinal hernia repair, the mesh is placed away from the nerves, and the risk of chronic pain is lower than in open inguinal hernia repair when done correctly." — Michael Rosen (clinical) [Ep 6 · 9:18](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=558)
- "Chronic pain after open inguinal hernia repair can occur due to technical problems or simply due to mesh laying on the nerves, and affected patients are absolutely miserable." — Michael Rosen (clinical) [Ep 6 · 9:51](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=591)
- "For young, healthy patients with unilateral hernias who are not anesthetic risks, laparoscopic repair is preferred by Dr. Rosen if the surgeon is past the learning curve." — Michael Rosen (opinion) [Ep 6 · 9:04](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=544)
- "TAPP (transabdominal preperitoneal) and TEP (total extraperitoneal) approaches have not been studied well enough to provide level-one evidence distinguishing their outcomes." — Michael Rosen (epidemiological) [Ep 6 · 10:45](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=645)
- "TEP repair requires use of a balloon dissector, which is more expensive, and provides a smaller working space but perhaps easier angles to operate with." — Michael Rosen (clinical) [Ep 6 · 10:58](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=658)
- "TAPP repair provides a better view and larger working space, and makes it easier for surgeons early in their learning curve to look intraperitoneally and confirm hernia reduction." — Michael Rosen (clinical) [Ep 6 · 11:09](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=669)
- "TAPP and TEP ultimately work in the same anatomical space—one enters through the front door, one through the ceiling—and should result in the same operation." — Michael Rosen (clinical) [Ep 6 · 11:26](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=686)
- "Laparoscopic inguinal hernia repair offers approximately 1 week to 10 days earlier recovery compared to open repair." — Michael Rosen (clinical) [Ep 6 · 12:23](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=743)
- "Laparoscopic inguinal hernia repair carries a risk of intestinal injury and injury to major blood vessels because the operation is performed near these structures, but this risk should be incredibly low if the surgeon knows the planes and operates safely." — Michael Rosen (clinical) [Ep 6 · 12:45](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=765)
- "In elderly patients with any anesthetic risk or anyone on anticoagulation who needs to restart quickly, Dr. Rosen prefers open repair because he does not want to dissect the retroperitoneal space in these patients." — Michael Rosen (opinion) [Ep 6 · 13:28](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=808)
- "In a 78-year-old patient with a symptomatic hernia on one side and an asymptomatic hernia discovered laparoscopically on the other side, Dr. Rosen does not fix the asymptomatic side, citing concerns about doubling anesthetic time and increasing hematoma risk." — Michael Rosen (opinion) [Ep 6 · 14:10](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=850)
- "Pneumoperitoneum is rarely a problem in patients with reduced cardiac capacity as long as insufflation is done slowly, pressures are kept low, and the patient is positioned in Trendelenburg to help cardiac return." — Michael Rosen (clinical) [Ep 6 · 15:17](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=917)
- "The benefits of laparoscopy for inguinal hernia repair are small for the vast majority of patients, though still worthwhile." — Michael Rosen (opinion) [Ep 6 · 15:39](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=939)
- "Surgeons must check their minimally invasive ego at the door and ensure they can also perform open inguinal hernias or refer to someone who can, rather than pushing laparoscopy in sick comorbid patients simply because it is their go-to approach." — Michael Rosen (opinion) [Ep 6 · 15:55](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=955)
- "Previous lower abdominal surgery is a contraindication to laparoscopic inguinal hernia repair in Dr. Rosen's practice because it increases the risk of enterotomy and OR time." — Michael Rosen (opinion) [Ep 6 · 16:24](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=984)
- "Previous prostate surgery makes laparoscopic inguinal hernia repair unpredictable—sometimes straightforward, sometimes brutal—and Dr. Rosen now performs these as open repairs." — Michael Rosen (opinion) [Ep 6 · 16:42](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1002)
- "Basic tenets of laparoscopic inguinal hernia repair include achieving a wide dissection plane, with parietalization of the cord (stripping peritoneum off the cord inferiorly and posteriorly) being the most critical element." — Michael Rosen (clinical) [Ep 6 · 17:52](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1072)
- "Parietalization of the cord is a basic principle promoted by René Stoppa during open preperitoneal repairs." — Michael Rosen (clinical) [Ep 6 · 18:15](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1095)
- "The length of parietalization is critical because it prevents the peritoneum from coming under the mesh and going back out to the defect, which is the mechanism of recurrence." — Michael Rosen (clinical) [Ep 6 · 18:27](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1107)
- "The inferior dissection is the Achilles heel of any laparoscopic inguinal hernia repair because it is awkward to view, surgeons fear making holes in the peritoneum, and it requires dissection very close to the vessels." — Michael Rosen (clinical) [Ep 6 · 18:53](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1133)
- "When surgeons do not take the peritoneum far enough back inferiorly, they tend to use a smaller piece of mesh, which is problematic." — Michael Rosen (clinical) [Ep 6 · 19:03](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1143)
- "All mesh contracts to some degree and can move." — Michael Rosen (clinical) [Ep 6 · 19:30](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1170)
- "According to Stoppa's original descriptions, for a unilateral inguinal hernia, surgeons should never use less than a 15 by 15 centimeter (6 by 6 inch) piece of mesh, which is much bigger than the vast majority of laparoscopic pre-formed meshes being placed." — Michael Rosen (clinical) [Ep 6 · 19:40](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1180)
- "For large direct inguinal hernias, mesh choice should change and surgeons should use a heavier weight material." — Michael Rosen (opinion) [Ep 6 · 20:26](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1226)
- "Heavyweight mesh is approximately 90 grams per meter squared (e.g., Marlex or Prolene)." — Michael Rosen (clinical) [Ep 6 · 21:37](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1297)
- "Midweight mesh is between 40 to 50 grams per meter squared." — Michael Rosen (clinical) [Ep 6 · 21:57](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1317)
- "Lightweight mesh (Ultrapro) is less than 30 grams per meter squared, starting heavier but degrading over time to about 28 grams per meter squared." — Michael Rosen (clinical) [Ep 6 · 21:57](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1317)
- "Mesh weight categories (heavyweight, midweight, lightweight) were defined by marketing companies, not based on science." — Michael Rosen (clinical) [Ep 6 · 21:37](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1297)
- "Advantages of lighter weight mesh include less foreign body, less palpability, and potentially less contraction because it ingrows more." — Michael Rosen (clinical) [Ep 6 · 22:16](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1336)
- "Disadvantages of lightweight mesh include having half the material, and in direct hernias where the mesh bridges and muscles never come together, the mesh is at risk for fracturing, with reports now showing central mesh failures." — Michael Rosen (clinical) [Ep 6 · 22:23](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1343)
- "Heavier weight mesh rarely breaks, but patients sometimes feel it in their groin if there are wrinkles or buckles, which can cause issues." — Michael Rosen (clinical) [Ep 6 · 22:42](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1362)
- "Pre-formed meshes for inguinal hernia anatomy are technically easier to place but surgeons commonly downsize to a much smaller piece of mesh, which is problematic." — Michael Rosen (clinical) [Ep 6 · 22:51](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1371)
- "For laparoscopic inguinal hernia repair, surgeons should never use smaller than a large pre-formed mesh because the entire myopectineal orifice needs to be covered." — Michael Rosen (opinion) [Ep 6 · 23:08](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1388)
- "If the mesh is too big during laparoscopic inguinal hernia repair, the problem is not the mesh size but inadequate dissection of the space." — Michael Rosen (clinical) [Ep 6 · 23:24](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1404)
- "Dr. Rosen believes mesh should be fixed in laparoscopic inguinal hernia repair and uses ProTack, though some surgeons use glue or no fixation." — Michael Rosen (opinion) [Ep 6 · 23:53](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1433)
- "Even surgeons who advocate no fixation will selectively use fixation for large direct hernias." — Michael Rosen (clinical) [Ep 6 · 23:59](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1439)
- "There is no evidence that absorbable fixation causes reduction in pain, provides better fixation, or improves long-term outcomes compared to non-absorbable fixation." — Michael Rosen (epidemiological) [Ep 6 · 24:10](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1450)
- "If a tack is placed through a nerve, it is the neuroma that causes the problem, not the tack itself." — Michael Rosen (clinical) [Ep 6 · 24:22](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1462)
- "Dr. Rosen performs Lichtenstein repair as his preferred open inguinal hernia technique." — Michael Rosen (opinion) [Ep 6 · 24:30](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1470)
- "There is mounting evidence that medium weight polypropylene mesh can be placed in a contaminated field, with several series in ventral hernias supporting this." — Michael Rosen (epidemiological) [Ep 6 · 24:56](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1496)
- "Depending on the level of contamination and indication, it is also appropriate to perform a Bassini or McVay repair without mesh in contaminated fields." — Michael Rosen (opinion) [Ep 6 · 25:01](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1501)
- "For incarcerated femoral hernias with bowel compromise, Dr. Rosen makes a vertical incision (vascular exposure), dissects onto the hernia sac, and can resect compromised bowel infrainguinally without dividing the inguinal ligament." — Michael Rosen (opinion) [Ep 6 · 25:55](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1555)
- "To gain space for reducing femoral hernia contents without dividing the inguinal ligament, surgeons can release the lacunar ligament medially (which gives off from the inguinal ligament and goes to the pectineal line) to gain an extra 1 centimeter." — Michael Rosen (clinical) [Ep 6 · 26:36](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1596)
- "Dr. Rosen performs a 'reverse McVay' repair for femoral hernias from the infrainguinal approach, sewing the inferior border of the inguinal ligament down to Cooper's ligament starting medially to avoid impinging on the femoral vein." — Michael Rosen (opinion) [Ep 6 · 27:19](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1639)
- "Dr. Rosen does not use mesh plugs in femoral hernia repair because femoral hernias tend to occur in thin women and he has had a DVT occur due to irritation of the femoral vein from the plug." — Michael Rosen (opinion) [Ep 6 · 27:44](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1664)
- "For recurrent inguinal hernias, surgeons should approach from where nobody has been before, or if both spaces have been operated, go where they are most skilled." — Michael Rosen (opinion) [Ep 6 · 28:12](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1692)
- "For known bilateral inguinal hernias in a skilled laparoscopic surgeon's hands, laparoscopy is the preferred approach." — Michael Rosen (opinion) [Ep 6 · 28:31](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1711)
- "Surgeons learning laparoscopic inguinal hernia repair should avoid bilateral and recurrent hernias during their learning curve, even though these patients might benefit most from laparoscopy, because these cases are twice as hard." — Michael Rosen (opinion) [Ep 6 · 28:36](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1716)
- "For large inguinoscrotal hernias, Dr. Rosen now performs all repairs open, whereas when he was younger he did them laparoscopically." — Michael Rosen (opinion) [Ep 6 · 29:10](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1750)
- "For incarcerated hernias that are difficult to reduce, Dr. Rosen puts patients to sleep and reduces the hernia under general anesthesia, then can proceed with TAPP repair." — Michael Rosen (opinion) [Ep 6 · 29:23](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1763)
- "For truly incarcerated hernias, TEP repair is not a good idea because surgeons want the hernia contents out of the sac; TAPP is preferred." — Michael Rosen (opinion) [Ep 6 · 29:30](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1770)
- "Surgeons can laparoscopically cut the internal ring at the 2 o'clock position while watching the epigastric vessels to help reduce an incarcerated hernia." — Michael Rosen (clinical) [Ep 6 · 29:43](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1783)
- "If an incarcerated hernia cannot be reduced laparoscopically, it should be done open, because making holes in the bowel increases the morbidity of the operation unacceptably high." — Michael Rosen (opinion) [Ep 6 · 29:53](https://qa.library.globalcastmd.com/watch/inguinal-hernia-adult-3441?t=1793)
- "In Fitzgibbons' VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, the risk of presenting with an emergency problem requiring operation due to incarceration or strangulation was less than 1% (actually one-third of 1%)." — Michael Rosen (epidemiological) [Ep 25 · 3:22](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=202)
- "In Fitzgibbons' original two-year VA study, almost one-third of patients in the observation group went on to develop symptoms and need an operation." — Michael Rosen (epidemiological) [Ep 25 · 4:00](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=240)
- "In long-term follow-up of Fitzgibbons' VA study patients (approximately five years), almost three-quarters of patients developed symptoms requiring repair." — Michael Rosen (epidemiological) [Ep 25 · 4:20](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=260)
- "The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200 to 250 cases required." — Michael Rosen (clinical) [Ep 25 · 8:40](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=520)
- "In laparoscopic inguinal hernia repair, mesh is placed away from the nerves, and the risk of chronic pain when done correctly is lower than in open inguinal hernias." — Michael Rosen (clinical) [Ep 25 · 9:20](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=560)
- "Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair, not a month or three to four months." — Michael Rosen (clinical) [Ep 25 · 12:10](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=730)
- "The most important part of any laparoscopic repair is parietalization of the cord (stripping the peritoneum off the cord inferiorly and posteriorly), a principle promoted by Rene Stoppa during open preperitoneal repairs." — Michael Rosen (clinical) [Ep 25 · 18:20](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1100)
- "The risk of recurrence in laparoscopic repair is the peritoneum coming under the mesh and then going back out to the defect inferiorly." — Michael Rosen (clinical) [Ep 25 · 18:40](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1120)
- "According to Stoppa's original descriptions, for a unilateral inguinal hernia repair, one should never use less than a 15 by 15 centimeter piece of mesh (or 6 by 6 inch), which is much bigger than the vast majority of laparoscopic preformed meshes being placed." — Michael Rosen (clinical) [Ep 25 · 20:00](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1200)
- "Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene mesh), midweight mesh is 40-50 grams per meter squared, and lightweight mesh (Ultrapro) is less than 30 grams per meter squared." — Michael Rosen (clinical) [Ep 25 · 21:20](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1280)
- "The advantage of lighter weight mesh is less foreign body and potentially less contraction due to better ingrowth; the disadvantage is half the material, which in direct hernias where muscles never come back together puts the mesh at risk for fracturing." — Michael Rosen (clinical) [Ep 25 · 22:00](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1320)
- "There is no evidence that absorbable fixation causes reduction in pain, better fixation, or improved long-term outcomes compared to permanent fixation." — Michael Rosen (clinical) [Ep 25 · 24:09](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1449)
- "If absorbable fixation is put through a nerve, it is the neuroma that causes the problem, not the tack itself." — Michael Rosen (clinical) [Ep 25 · 24:20](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1460)
- "There is mounting evidence that medium-weight polypropylene mesh can be placed in a contaminated field, with several series demonstrating this in ventral hernias." — Michael Rosen (clinical) [Ep 25 · 24:56](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1496)
- "For incarcerated femoral hernias, the lacunar ligament can be released medially to gain an extra centimeter of space for reduction without destroying the inguinal floor or inguinal ligament." — Michael Rosen (clinical) [Ep 25 · 27:00](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1620)
- "For recurrent hernias, the surgeon should go where nobody has been before; if somebody has been in both places, go where you are best." — Michael Rosen (opinion) [Ep 25 · 28:12](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1692)
- "For bilateral hernias in a skilled laparoscopic surgeon, laparoscopy is the best approach." — Michael Rosen (opinion) [Ep 25 · 28:30](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1710)
- "Surgeons learning laparoscopic inguinal hernia repair should avoid bilateral and recurrent hernias during their learning curve, although these patients might benefit most, they have the highest risk." — Michael Rosen (opinion) [Ep 25 · 28:40](https://qa.library.globalcastmd.com/watch/inguinal-hernia-with-m-rosen-13756?t=1720)

## Common questions
### What are the types of hernia repair?
Three primary repair approaches exist for inguinal hernia: tissue repair, open mesh repair, and laparoscopic mesh repair. Within open repair, surgeons can perform repairs without mesh or with mesh using techniques such as Lichtenstein. Laparoscopic approaches include preperitoneal or extraperitoneal repairs. Literature supports all three approaches for unilateral primary hernias, with approach selection based on patient factors rather than one technique being substantially superior to others.
### What is Inguinal Hernia?
An inguinal hernia results from failure of the processus vaginalis to fuse. Indirect inguinal hernias, the most common type, occur through this anatomical defect. Risk factors in children include male sex, family history, undescended testicle, hydrocele, and connective tissue disorders. Inguinal hernia repair is the second most common surgery performed by pediatric surgeons. Diagnosis requires physical examination, though small hernias can be extremely difficult to detect clinically.
### What is Inguinal Hernia?
An inguinal hernia is a defect in the groin region resulting from failure of the processus vaginalis to fuse. Indirect inguinal hernias—the most common type—occur above the inguinal ligament and lateral to the epigastric vessels and represent a congenital anomaly present at birth. Inguinal hernias are very common, particularly in preterm infants, and inguinal hernia repair is the second most common surgery performed by pediatric surgeons. Risk factors include prematurity, male sex, family history, undescended testicle, hydrocele, and connective tissue disorders.
### What is Inguinal Hernia, in plain language?
An inguinal hernia occurs when a weakness in the abdominal wall allows tissue to push through into the groin area. In children, inguinal hernias are a congenital condition—present from birth—that happens when a normal passage fails to close properly during development. In adults, a different type of hernia can develop later in life, typically starting around age 29, when changes in the abdominal floor create weakness. Some people are at higher risk because of family history, male sex, or connective tissue disorders. Hernias can sometimes be hard to detect on physical exam, especially smaller ones. Your care team can confirm whether you have one and discuss the best next steps for you.

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 1 item hidden — never mention Inguinal Hernia; unhide from the owner view
- Aug 31: 21 doctors auto-found from episode dossiers
- Aug 30: 16 doctors auto-found from episode dossiers
- Aug 30: 10 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 12 doctors auto-found from episode dossiers
- Aug 29: 12 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 36 items, 15 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 15 dossiers, summaries for 1 audience(s)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai