NAHI Technique:


Our surgeons at the National Ambulatory Hernia Institute have adopted Dr. Moran's principle of combining the Shouldice technique with the insertion of Ethicon© Polypropylene Mesh into the preperitoneal space to reinforce the transversalis fascia in an overlapping fashion for the repair of inguinal hernias.

As part of the effort to decrease the social and economic costs relative to herniorrhaphy, attention must be paid to the problem of recurrence. It is estimated that primary inguinal hernia repairs continues to result in a 10% to 12% failure rate. These surgical failures take an enormous toll, not only in health care dollars, but also in lost work time and human suffering and are another reason that the Institute's hernia program is so successful. We presented the results of our work at the American College of Surgeons meeting in New Orleans, LA USA in October of 1995; 1,282 inguinal hernia repairs performed with a mere 0.4% recurrence rate.

Another unique part of our procedure is that the Anesthesia is customized per your needs. This allows surgery on patients with major medical problems such as liver disease, emphysema, and other conditions which would be adversely affected. In addition, the economic benefit is significant to patients as well as the insurance carriers, reducing cost and time away from the job.

As a small number of surgeons in private practice, we have developed a special interest in hernias and operate them exclusive of other procedures. By dealing only with a single surgical condition, our "hernia specialists " who perform hundreds of hernia repairs annually, gained insight into the anatomy which a general surgeon cannot achieve and have provided the underpinnings of the methods taught by our Institute.

The Institute's method has been demonstrated for other surgeons at the American College of Surgeons annual meeting for the last four years. In addition, N.A.H.I. has gained international recognition and peer acceptance with invitations for Drs. Moran and Brauns to lecture and demonstrate technique in Switzerland, Germany, and Italy. Our international efforts have been published in an Italian and Japanese Medical Journal and our articles are included in a Canadian Medical Text Book and in the publication of the 1994 Switzerland Hernia Conference. Additionally, patients from all parts of the globe for the surgical expertise of our Institute.

The confidence in the Institute's hernia repair program enables us to issue a Lifetime Warranty for all primary hernia repairs.

Today, most repairs of inguinal hernias are still based on these century-old techniques with recurrence rates of 10 to 12%. However, in 1940, Dr. E.E. Shouldice developed the multi-layer closure based on the transversalis fascia with recurrence rates of 1-1/2 to 2%.

In 1959, Dr. F.C. Usher introduced the use of polypropylene mesh in the repair of primary and recurrent hernias. This was followed by various mesh techniques.
Twenty-five years ago, the original description of the Shouldice hernia repair was published by Dr. Moran in a national surgical journal, Surgery. It was recognized as an important contribution by the Yearbook of Surgery. In 1988, the surgeons of the Hernia Institute combined these two procedures for our current repair. The principles of our repair are local or light anesthesia, a standard Shouldice dissection, and insertion of the Ethicon© polypropylene mesh beneath the transversalis fascia with a documented recurrence rate of 0.4% and warranty for a lifetime. Excellence.

The advantages of our Moran Repair are both medical and economic.

ECONOMIC ADVANTAGES
Instead of dealing with many separate bills such as the surgeon, anesthesiologist, consulting physicians, hospital costs, costs related to lab and ECG testing, the insurance carrier receives only one bill. This provides a significant savings to the insurance company by reducing the in-house expense. One bill and one payment.

The repair carries a life-time warranty. The warranty for all repairs continues for the life of the patient while covered by the contracted insurance carrier.

WHAT CAN A PATIENT EXPECT?
In the office, the patient is examined. The diagnosis of the hernia is established. A detailed history of the injury is obtained along with a very meticulous health history of the patient. The information is used not only to diagnose the injury, but also to determine the industrial and insurance company's responsibility in the case. Within a few days, the complete report is prepared and submitted to the affiliated insurance carrier. More than a decade of experience and success with the Shouldice repair has produced a level of quality which is second to none in the area. We have served this community for over 28 years. We spend time to establish a friendly and supportive relationship with our patients. All our patients are treated as private patients. In addition, consolidation of all costs of the hernia repair into one bill along with our lifetime warranty will save the insurance company money, time, and provides a known fixed cost.

CONCLUSION
The hernia is an unavoidable element of the human condition. The efforts of such eminent surgeons over one hundred years ago have alleviated much of the hernia's debilitating effects upon the patient. Now, through the efforts of our hernia surgeons, the hernia repair has been further streamlined with costs being dramatically reduced, predictable and warranted.