cians should relay the pros and cons and discuss each of these areas:
• an open groin incision versus a laparoscopic approach;
• the chances of recurrence;
• expectations for recovery with each approach;
• expectations for pain; and
• patient concerns about mesh in the body.
A non-mesh open repair is an option for some patients who have
fears about mesh implants, but there's one key detail.
"That's a fine choice as long as everyone is understanding again the
pros and cons of those choices," says Dr. Ramshaw.
3. Know when to say no
You never know when a patient will ask you to take a novel approach,
particularly when they've found a paper online that appears to show
great promise. Many times, those studies have caveats and limitations.
During her presentation, Dr. Bachman told the story of a patient
with a large hernia who wanted her to perform a Desarda repair, a
non-mesh technique she had never done before. The patient even
handed her some papers to learn more about the procedure. She
declined to perform the operation.
"You always have an option of declining," she says. "Because what I
didn't want to do is try it out in this patient and not have it work. I
think it's better to educate yourself in other ways."
The lesson is clear. Doctors shouldn't try new procedures in real time.
If you want to add a new hernia repair to your menu of treatment
options, you need to do your homework and training.
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