Friday, April 20, 2012


Groin hernia repair does not have the glamour of a Whipple or of a heart transplant, but in terms of preserving years of useful life, in sheer volume, is one of the most important surgical procedures - Dr. Jonathan E. Rhoades

Most Truths Start as Blasphemy-George Bernard Shaw


Surgeons have been trying to cure hernias for a long time. Bassini's results, published in 1888, were quite good but the problem of tension and poor tissues remained. The Lichenstein tension-free mesh repair came into vogue toward the end of my residency in 1991. When I first saw this type of repair, I immediately rethought that it was fantastic! No longer were we stitching bad tissues to worse tissues and expecting a good outcome. As a chief resident at the VA in Temple, TX, I decided that I would only do mesh repairs. Only one attending at the time was using mesh. Yikes-did this cause a controversy. I was bombarded by complaints. "Why do we have to order mesh for Camazine". "Its expensive". "No one else is using it". etc, etc, etc. I prevailed and have been doing mesh repairs ever since.

I have continued the practice of mesh repairs on my mission trips to the Nigerian Christian Hospital (NCH) as you can read in my other blog (Death By Strangulation, Loss of Domain, Surgical Mesh). Except at NCH, use of mesh is relatively rare in Nigeria. This is probably because of the high price of mesh and lack of training. I have been trying to reverse this trend by having Hernia Workshops  at NCH and distributing mesh to surgeons and residents who come to train with me. Mesh repair is critical in this setting since many of the hernias, both groin and ventral, are so advanced that they cannot be repaired adequately without mesh. 

In future posts I will discuss techniques of hernia repair, surgical mesh and case reports. Contact me with any questions at