عملية الفتق: منظار ولا جراحة مفتوحة؟ الألم والتعافي واختيار التقنية المناسبة | Hernia Surgery: Laparoscopic or Open? Recovery, Pain and Choosing the Right Repair
بودكاست - الحلقة الأولى | Podcast: Episode 1
في أول حلقة من بودكاست «مع د. محمد حسام زيدان»، د. محمد بيرد على سؤال: إصلاح الفتق بالمنظار ولا بالجراحة المفتوحة؟ بيوضح إن المنظار مش الأسلوب الصح الوحيد، لكنه الاختيار المفضّل لأغلب المرضى لأنه بجروح أصغر وألم أقل ورجوع أسرع للحياة الطبيعية، وإن الجراحة المفتوحة بتفضل الأنسب لبعض المرضى، زي اللي حالتهم ما تسمحش بالتخدير الكلي. وبيشرح إن الألم بعد العملية بيعتمد على 3 حاجات: طبيعة المريض نفسه، وطريقة الجراح ودقة حركته أثناء العملية، والأدوات المستخدمة، زي الشبكة ثلاثية الأبعاد اللي بتقلل الحاجة للدبابيس والغرز. | In the first episode of the podcast "With Dr. Mohamed H. Zidan", Dr. Zidan answers a common question: should a hernia be repaired laparoscopically or with open surgery? He explains that laparoscopy is not the only right approach, but it is preferred for most patients because of smaller incisions, less pain and a faster return to normal life, while open surgery remains the better choice for some patients, such as those who cannot safely have general anesthesia. He also explains that pain after surgery depends on three things: the patient, the surgeon's technique and precision during the operation, and the tools used, such as 3D anatomical mesh that reduces the need for tackers and stitches.
Key Takeaways
Full Transcript
Host: How are you, doctor?
Dr. Zidan: Fine, thank God.
Host: How are things with you?
Dr. Zidan: All good.
Host: Doctor, I saw on your page that you strongly favor hernia repairs being done laparoscopically. Can you tell me why?
Dr. Zidan: Well, laparoscopic hernia repair isn't the only right approach; it's one of many approaches. The point is that the European Hernia Society, in its 2023 guidelines, said that laparoscopy is best, but if the center or the surgeon doesn't have the experience to operate laparoscopically, there's no problem in doing it as open surgery. I've never told a patient that open surgery is wrong or bad. On the contrary, I do open surgery for patients for whom only open surgery is suitable, for example someone with heart problems who can't have general anesthesia. For that patient, we choose open surgery. But laparoscopy is better because recovery is faster, so the patient can get back to normal life easily, because there's less pain after the operation, no big wounds, and most importantly, of course, the recurrence rate is much lower than with open surgery. So we always go for laparoscopy, but if laparoscopy isn't suitable, then we talk about open surgery.
Host: About getting back to normal life faster: I thought it could take weeks, a month, but I found people saying, "I finished the operation and walked out," or "I prayed without a chair." I saw reviews like that; it was simpler than I'd even imagined.
Dr. Zidan: That's true. It depends on how we use the instruments and how much traction we use during the operation. The causes of pain are very varied; pain depends on many factors. One, the surgeon; two, the patient; three, the instruments we use. Take the patient: pain tolerance varies from patient to patient. If I had an operation, my tolerance might be lower than yours, or the opposite. But that's just one factor. Number two is the surgeon himself: traction, or a lot of movement during the operation, translates into pain. That's why two surgeons can do the same operation with exactly the same technique, say open surgery, on the same patient, and the patient feels more pain with one surgeon than with the other. Why? Because movement during the operation makes a big difference to the patient. Number three: the instruments we use. Take laparoscopic hernia repair, for example. With laparoscopic hernia repair, it's as if we're eating with a fork and knife, compared with open surgery, where we're eating with our hands. If two people eat from a plate, one with his hands and the other with a fork and knife, which one will scratch the plate more? Definitely the one eating with his hands, because his movements are a bit rougher on the plate. It's a loose analogy, but it gives a sense of what can happen. With laparoscopy, our movements aren't slow, but they are very precise compared with our movements in open surgery, which translate into traction and pulling, and that translates into pain. Then there are the instruments we use. In laparoscopy, there are new instruments every day. Laparoscopy and the robot, which is similar to laparoscopy and unfortunately isn't widely available in Egypt, have very precise and very fine movements, and there's something new every day. For example, in laparoscopic hernia repair, we used to have no option other than using a standard mesh, placing it and fixing it with tackers, a stapling device we use to fix the mesh. Those staples are quite painful. Then they made absorbable tackers, which dissolve; there was still pain, but a bit less. Then they made glue, which caused a bit less pain. Then they made standard meshes that are self-gripping, so they stick; that caused less pain, but it was hard for the surgeon to handle. Then they made 3D meshes: pre-shaped meshes placed in the inguinal region that don't need any stitches, or at most a single stitch, whereas some surgeons use many stitches to fix a standard mesh. All of this makes a difference to the patient's pain after the operation. That's why, thank God, by the next day, and even the same day, the patient is almost free of pain. That's in addition, of course, to the anesthetic techniques we use to reduce pain.