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Managed Care Insurance companies and governmental agencies will have miniscule interest in details of perioperative care. The economic system does not integrate the value of the patient’s postoperative well-being and comfortable, rapid recovery into the formula for defining payment. Value to an insurance company or hospital is derived from their bottom line profit and appeal to shareholders. Different techniques of hernia repair have different overall value to each patient but are valued the same by these insuring agencies. The variable costs in time, equipment, training and experience for both the surgeon and the operating facility are not compensated. If a surgeon is required to perform a large number of procedures each day in order to earn his/her living, each operation will be done with time c...

How knowledgeable is the Primary Care Physician (PCP) who refers his patients to surgical specialists? Physicians trained before 1985 have minimal familiarity with contemporary techniques.  Some observed some surgery in medical school or a rotating internship. Now, younger physicians have had almost no exposure to surgery after medical school. Even the knowledge of anatomy has been sacrificed to the rapid expansion in pharmacology, biochemistry and bacteriology. Time constraints in training are unavoidable but still have ramifications. How can primary care physicians understand the options, risks, benefits, advantages and disadvantages or expectations postoperatively? During education most non-surgeons witness only a few hernia repairs and do not see the newer laparoscopic type. How can one expect...

When I completed my five years of surgical training in 1970 and became an “obligated volunteer” in the U.S.Army as Chief of General Surgery at the multinational NATO hospital, most surgeons in the world repaired hernias through an incision using a technique originating in Europe almost 100 years earlier. We dissected many layers; sutured together the tissues at the edge of the defect (or gap), sometimes with a healthy tug causing tension. A few minimally significant advances had occurred since 1888 when the German surgeon Bassini described that favored method. In 1962, a newly introduced plastic mesh proved to be problematic. Many hernias remained untreated and were allowed by primary care physicians and patients to reach impressive sizes. A classmate in medical school returned from Africa with a...

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About Panagiotis Manolas, MD FACS. 
Over 50 years of experience.




About 700,000 inguinal hernia operations are performed each year in the United States.  An estimated 5-10 times that number have untreated hernia.  Hernias can occur at any age from birth to old age.  Some people have a small unchanging weakness or bulge that has minimal impact except for the likelihood that the hernia will ultimately enlarge.  Of this group that decide to “ live with” their hernia, many independently limit exercise and change life style.  Some people allow the hernia to become large and ignore physical deformity.  With enlargement and containment of bowel serious risks may be unknowingly accepted.  This book is designed to help patients to understand how hernias develop and the rational behind treatment and to discuss the information, thinking and planning that need be incorporated into the process of successfully achieving  surgical repair of a hernia.

Inguinal hernias can be confused with their next-door neighbor, a less common variety, the femoral hernia that is more likely to cause problems when small.  Another common abdominal wall hernia is umbilical.  As children we point out our “inney” and “outey” naval.  “Outeys” are hernias.  Many do not change for a lifetime.  Others especially under the influence of weight gain and pregnancy enlarge.  Hernias can be acquired as a result of inadequate healing of an abdominal incision, an Incisional hernia.  Millions of Abdominal Operations are performed in the United States for many reasons and from 5-10% of these are followed by hernia formation.  Other  types of rare hernias include lumbar, obturator and sciatic.. 

The scientific surgical literature is replete with papers, data, symposia and anatomic studies.  Even surgeons can be confused by inconsistent anatomic descriptions, terms and results based on incomplete follow-up.  The attempt to convey important information to a concerned patient in the office at the time of consultation is oft times befuddled by misunderstandings.  If you are worried about having a hernia and how to deal with it, the following information will facilitate your participation in the decision-making process.  Your satisfaction will depend on knowledge of reasonable expectations of results and the orderly progression of your surgical experience.

Dr. Manolas (photo).
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