Sep 12, 2026 · 56 min · 14 segments
This week, the topic of discussion was: - Giant Hernia - Incisional Hernia - Mesh - TAR Transversus Abdominis Release - Anterior Components Release - Risk Reduction - Weight Loss - Panniculectomy…
Jana SaccoGuest
Shirin TowfighHost
I was at M&M, which is our morbidity and mortality conference every week where we discuss complications.
And it's a very unique thing about our specialty that we sit around and we discuss complications because you learn from other people's mistakes or their situations where...
it was a big hernia surgery that one of the surgeons did and there was a complication.
And we always have, you know, an older surgeon that comes up and says, you should not have done this surgery because this patient was a patient dying, you know, and I got up there and I used Todd's words.
I said, you know, most of the time that we are operating on hernias, we're not saving lives.
We're not even really preventing a death, you know, we are improving their quality of life.
And these really giant hernias we know from really good data, the over nine centimeter patients, they do dramatically better than the under nine centimeter in terms of improvement in quality of life.
I think that kind of comment just kind of misses the point of the entire field of hernia and abdominal wall surgery, right? It is totally all about what the patient's quality of life is and what they want it to be.
And there's tons of people who, you know, I think we see and maybe it's not affecting their quality of life and maybe they don't need a hernia repair.
And, you know, all those examples I gave are just different patients from my practice because I really try to focus on, you know, one thing that like they really want to improve and like, can we actually get there? And what do the complications look like? Because yeah, these big cases are, I mean, sometimes when you have multiple meshes in your abdomen already, potentially fistulas, you know, bowel fistulas, kind of like when the bowel drains out and, you know, or you have an infected mesh that's draining, those things can be like absolutely terrible, right? People can be home-ridden because of it, right? on antibiotics for long periods of time that may also have side effects.
So it's really all about figuring out the balance, right? And I think we talk about that in surgery and everybody talks about it, the kind of risk benefit kind of balance or profile that we look at.
And you're right, like as elective hernia surgeons, like, you know, I don't do a lot of emergencies really.
And I tell people I'm not going to fix, like also fixing your hernia is not going to prevent saving your life.
I was at M&M, which is our morbidity and mortality conference every week where we discuss complications.
And it's a very unique thing about our specialty that we sit around and we discuss complications because you learn from other people's mistakes or their situations where...
it was a big hernia surgery that one of the surgeons did and there was a complication.
And we always have, you know, an older surgeon that comes up and says, you should not have done this surgery because this patient was a patient dying, you know, and I got up there and I used Todd's words.
I said, you know, most of the time that we are operating on hernias, we're not saving lives.
We're not even really preventing a death, you know, we are improving their quality of life.
And these really giant hernias we know from really good data, the over nine centimeter patients, they do dramatically better than the under nine centimeter in terms of improvement in quality of life.
I think that kind of comment just kind of misses the point of the entire field of hernia and abdominal wall surgery, right? It is totally all about what the patient's quality of life is and what they want it to be.
And there's tons of people who, you know, I think we see and maybe it's not affecting their quality of life and maybe they don't need a hernia repair.
And, you know, all those examples I gave are just different patients from my practice because I really try to focus on, you know, one thing that like they really want to improve and like, can we actually get there? And what do the complications look like? Because yeah, these big cases are, I mean, sometimes when you have multiple meshes in your abdomen already, potentially fistulas, you know, bowel fistulas, kind of like when the bowel drains out and, you know, or you have an infected mesh that's draining, those things can be like absolutely terrible, right? People can be home-ridden because of it, right? on antibiotics for long periods of time that may also have side effects.
So it's really all about figuring out the balance, right? And I think we talk about that in surgery and everybody talks about it, the kind of risk benefit kind of balance or profile that we look at.
And you're right, like as elective hernia surgeons, like, you know, I don't do a lot of emergencies really.
And I tell people I'm not going to fix, like also fixing your hernia is not going to prevent saving your life.
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