A/Prof. Maurice Brygel
A/Prof. 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, A/Prof Brygel saw the advantages of local anaesthesia being much safer for patients, particularly where large numbers 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 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.
A/Prof Brygel started off using both techniques – the Shouldice and the Lichtenstein. The Shouldice technique is a suturing technique only and in those days wire was used. The Lichtenstein technique advocated a tension free repair with a mesh reinforcement. A/Prof Brygel used both techniques and found the mesh reinforcement better in his hands.
Now in many countries – as presented in June 1993 in London and again in Edinburgh in May 2014 at International Hernia Society meetings – up to 90% of patients have mesh for their hernia repair.
A/Prof Brygel attended the European Hernia Society conference and some key findings were:
Patients who attended hernia centres, or surgeons who concentrated on hernia repair, had better results than patients from the general population. For example in Scotland, Sweden and Denmark, over 95% of all hernia repairs were registered in the government hernia register and followed up. These patients had a higher recurrence rate and complications than those of specialist hernia surgeons.
All surgeons need to obtain accreditation with The Royal Australian College of Surgeons annually, by submitting data about the work they do and the educational activities they undertake. Each year A/Prof Brygel presents an audit of the hernia results to the College.
A/Prof Brygel classifies himself as a Hernia Specialist because:
- The majority of his work is related to the diagnosis and treatment of hernias and related conditions.
- He provides reports for insurance companies regarding patients and work-related hernia matters and their eligibility for WorkCare and return to work post-operatively.
- He lectures to medical students, General Practitioners, surgeons in training and surgical colleagues.
He is an Honorary Senior Fellow in the Dept. of Anatomy & Cell Biology at the University of Melbourne, where he lectures on hernias and anatomy of the groin. He tutors to medical students on hernias at the Royal Melbourne Hospital.
He has also developed a teaching programme, books and videos on hernias. There are 7 volumes and videos – titled The Video Book of Hernias. Included in this category are related areas of scrotal conditions and testicular tumours. For more information visit www.globalfamilydoctor.com
He had previously published the Video Book of Skin Surgery on the diagnosis and treatment of benign and cancerous skin conditions. For more information visit www.globalfamilydoctor.com
A/Prof Brygel believes it is advantageous to still have some practise in other areas of surgery. Any patient that presents with a hernia should be assessed as a whole and worked-up pre-operatively. This ensures other problems are not overlooked and can be dealt with as appropriate. It is surprising how many patients present with a hernia and on further questioning have other undetected problems.