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.
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.
A/Prof Brygel like all other surgeons requires accreditation at each hospital he operates at. He is also on the Medical Advisory Board of Masada Private Hospital and Sir John Monash Private Hospital.
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.
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.
Adjunct Associate Professor Maurice Brygel is a General Surgeon in Melbourne Australia. He has extensive experience in office and day surgery using Local Anaesthetic techniques.
He is a pioneer in day surgery hernia repair, having performed over 10,000 hernia operations mostly using local anaesthesia. He has become known as the “HERNIA KING” after establishing the first hernia clinics in Australia, the Melbourne Hernia Clinic and the Sydney Hernia Centre. He was one of the first to introduce the use of mesh routinely into hernia surgery.
His other main activity is teaching office surgical skills to GP’S. He is also a pioneer in this field developing and presenting “hands on” workshops long before surgical skills laboratories became fashionable.
He presents those workshop courses in association with academic bodies and private institutions throughout Australia and internationally.
A/Prof. Brygel practices at Masada Private Hospital and Cabrini Hospitals in Melbourne.
He teaches and / or examines at Monash University medical school campuses – Cabrini and Alfred hospitals, Notre Dame Medical School and The Royal Australian College of Surgeon skills laboratory. He teaches anywhere he is asked – often giving lunch time talks in local general practices
As well he has developed 2 teaching and public information websites www.hernia.net.au (Melbourne Hernia Clinic) and www.haemorrhoidclinic.com.au (Melbourne Haemorrhoid & Rectal Bleeding Clinic).
These sites also provide pre reading for the Continuing Medical Education (CME) category one accredited courses he conducts.
These presentations are also utilized in webinars he presents for rural and remote practitioners.
He has also published in the “on line” Middle East Journal of Family Medicine as contributor on topics ranging from femoral hernias to melanoma
Other publications in association with Dr. Gerry Ahern include the ground breaking Exploring Essential Series – EESurgery and EERadiology. These have been very successful within the online -MGraw Hill Access Surgery and Access Medicine subscription websites. These are widely subscribe to internationally as well as in most universities and medical schools throughout the U.S.A.
Other titles in the exploring essential series include general practice, fractures, emergency medicine, orthopedics, anatomy and embryology. These have also been produced as Apps iBooks.
His abstract paper on his hernia results and chronic hernia pain with Dr Luke Bonato won a first prize at the American Hernia Society meeting in Orlando U.S.A. He was able to show using a validated pain hernia questionnaire that with his technique on his patients in a 5 year follow up there was virtually a zero incidence of chronic pain following inguinal hernia repair.
He has an extensive multimedia collection of his own work first published under the title Video Book Of Surgery of which over 7000 copies were distributed throughout Australia .
His latest, soon to be released project is titled SurgiSkills. This is to be a series of comprehensive, online, interactive self-contained training courses for General Practitioners, Physicians and Medical Professional covering such topics as surgical and suturing techniques, local Anaesthesia, In growing toenails, lacerations, wound management-, –surgery for benign and malignant skin lesions as well as lumps and bumps .
The first course is on Ingrowing toenails, including the conservative management and the use of phenol and wedge resection. This course features a section on local anaesthesia and simple blocks such as a digital block which are used for, lacerations as well. There is an introductory component featuring a clinical approach to diagnoses, knot tying and surgical skills.
This and the following courses feature detailed video demonstrations of the differing procedures.