Sydney Hernia Centre - Kingsgrove

Mr Maurice Brygel graduated from Medicine at Melbourne University. Following this he trained in Anaesthesia in London where he had obtained a Diploma in Anaesthesia. He then became an anaesthetic registrar at the Royal Melbourne Hospital in Melbourne where he passed the first part of the anaesthetic degree. However his first interest was surgery. He then trained in surgery at the Royal Melbourne Hospital where he attained the Surgical Fellowship of the Royal Australian College of Surgeons. Initially he practised all types of surgical procedures, but was inspired to concentrate on hernia surgery, following visits to Australia by Dr Lichtenstein who advocated the use of Mesh and local anaesthesia. The Lichtenstein technique is now the benchmark for excellent results. Having practised anaesthesia Mr Brygel saw the advantages of local anaesthesia being much safer for patients, particularly where large number of cases were concerned. After visiting the Lichtenstein Clinic in Los Angeles and the Shouldice Clinic in Toronto where he witnessed patients walking out of the theatre immediately following surgery, he felt that this was the way to go. The local anaesthetic technique is safe for younger patients, and more so for older patients. The recurrences were rare with the Lichtenstein technique. But not only this, the hospital stay was very short, just a few hours in many cases. At that time the many Australian patients were in hospital for 4-5 days and there was a higher rate of recurrence. How some things have changed in Australia and indeed in the rest of the world. Mr Brygel started off using both techniques - the Shouldice and the Lichtenstein. The Shouldice technique was suturing technique only and in those days wire was used. The Lichtenstein technique advocated a tension free repair with Mesh reinforcement. Mr Brygel used both techniques and found the Mesh reinforcement better in his hands. Now in many countries - as presented recently in June 1993 in London at the second combined meeting of the European and American Hernia Societies - up to 90% of patients now have Mesh used for their hernia repair. Mr Brygel attended this conference and some key findings were: Patients who attended hernia centres or surgeons, who concentrated on hernia repair, had better results then patients audited from the general population. For example in Scotland, Sweden and Denmark over 95% of the registered in the government hernia register. These patients had higher recurrence rates and other problems.