217. Pros & Cons of Open Hernia Surgery

Is the question for the groin still or for ventrals?

Both.

Yeah.

Does that change what you offer them? Is there a benefit to open or laparoscopic surgery?

I would say for ventrals, that doesn't change.

My approach is mostly based on what they need.

And if I know I can give them a better repair open, like I can get wider mesh coverage, I can really safely take down scar tissue safely.

Like I just do it open.

Aspirin, I don't really ever stop aspirin.

I do hold anticoagulation regularly.

but I do keep aspirin going for groins though.

I think that the groin space, when you're developing it, they do.

If someone's on anticoagulation and you're going to consider an open approach versus minimally invasive, if they're a good candidate, I would prefer the minimally invasive because you're not making a big subcutaneous spot pocket where they could develop a hematoma.

So I think a minimally invasive approach is, is slightly better for someone on anticoagulation to decrease the risk of a hematoma.

We've all had some of those people on blood thinners that have had a big, you know, an open Lichtenstein approach for growing and they get a hematoma in their groin.

And it's not that they need another surgery, but it is kind of annoying to have to

It's an important question to review with the patient because there's so many people getting cardiac stents and other operations that require long-term care.

Blood thinners, Eloquist, Plavix, Xarelto.

What else is there? All those different, they're all these new drugs too that come out that, and my part of the world, they take a lot of supplements.

So whenever you have omega-3 fatty acids and vitamin E and all those, that really makes them bleed

more than aspirin.

Yeah, it's pretty impressive.

So we make sure we specifically ask about omega-3 fatty acids and vitamin E.

I'll have to start asking that.

Yeah.