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To Tack or Not to Tack
1. George S Ferzli, MD, FACS Giancarlo Cires, MD Courage and comfort, all shall yet go well” King John, Act ii, Scene 4 To Tack or Not to Tack
2. Disclosure George Ferzli, MD, FACS has been a consultant for: Baxter International, Inc. Covidien, Inc. To Tack or Not to Tack
3. Increase in hernia recurrence? Increase in post-operative pain and cost. Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt” Measure for Measure, Act i, Scene 5” Why is there a question?
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6. "Have patience, and endure "Much Ado About Nothing, Act iv, Scene 1 “ Above all, these studies frequently did not specify the dimensions of the hernial defect. The significance of the size of a hernial opening on the recurrence rate remains unknown.” Khajanchee YS, Urbach DR, Swanstrom LL,Hansen PD. Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc. 2001; 15: 1102-1107. “ In conclusion, mesh fixation in the TEP technique offers no clinical advantages and increases the cost of the process. Our results recommend limiting the use of mesh fixation in the laparoscopic approach to cases of direct bilateral hernias.” Randomized Clinical Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty Alfredo Moreno-Egea MD, Jose Antonio Torralba Martinez, MD, German Morales Cuenca MD, Jose Luis Aquavo Albasini, MD Arch Surg. 2004;139:1376-1379. Is stapling mesh necessary to contain an enlarged or bilateral hernia?
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15. Ferzli et al. J Am Coll Surg, Vol. 205, No. 2, Aug 2007 "There was never yet philosopher that could endure the toothache patiently” Much Ado About Nothing, Act v, Scene 1 Post Herniorrhaphic Groin Pain
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19. Taylor C et al. Surg Endosc . 2007 Sept 21 … there may be more groin pain and no difference in recurrence Why not tack?
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22. Ferzli et al. J Am Coll. Surg. Vol. 188, No. 5, May 1999 "Withold thine indignation, mighty heaven, and tempt us not to bear above our power” King John, Act v, Scene 6 … where to staple – and how many? Why not tack? Khajanchee et al. Surg Endosc (2001) 15: 1102–1107
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25. Lau H. Ann Surg . 2005; 242: 670-675 An Alternative-Bioglue
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31. "The elements be kind to thee, and make thy spirits all of comfort: fare thee well !” Antony & Cleopatra, Act iii, Scene 2