VOLUME IV · ISSUE 11
King's College London · April 2026
Mr Jan's
Surgical Diary
The Surgical Diary #11
Major Trauma, Colorectal & General Surgical Consultant. Special interests include XYZ
Consultant Clinical Editor of the Surgical Diary, published monthly on MedTech Scope.
11
ISSUE
THIS ISSUE · TOPICS · A Case Study & Editor's Recommendation
EDITOR'S NOTE · ISSUE 11
Welcome to Issue 11 of Mr Jan's Surgical Diary
Welcome to Issue 11 of Mr Jan's Surgical Diary. This month we open with a tribute to Professor Harold Ellis CBE FRCS FRCOG, one of surgery's most beloved teachers and anatomists, whose passing marks the end of a remarkable era in British surgical education. Our clinical focus turns to surgical meshes — an area of daily relevance across general surgery — with a practical breakdown of mesh selection, properties, and complication profiles. We also bring you the latest exam deadlines, upcoming conferences, and a curated selection of free training and prize opportunities. As always, the diary is here to keep you informed and your career moving forward.
CLINICAL FOCUS · ISSUE 11
Clinical Focus: Surgical Meshes
Require careful design making, and balancing choice long term
WHAT ARE SURGICAL MESHES?Surgical meshes are prosthetic implants used to support and reinforce weakened or damaged tissue. They are most commonly used in hernia repair, pelvic floor reconstruction, and abdominal wall surgery. Available in synthetic (polypropylene, PTFE) or biological forms, mesh selection requires careful consideration of the patient's anatomy, comorbidities, and intended repair technique.
TYPES OF MESH
Permanent Synthetic Mesh— Polypropylene, ePTFE, PolyesterPermanent, stiff, monofilament used in inguinal, incisional and ventral hernias & TEP/TAPP. Contraindicated in active infection, direct bowel contact & contaminated field
Absorbable Synthetic Mesh — Vicryl (PGA/PLA) Polyglycolic acidTIGR Matrix- Used in contaminated / infected field and as a bridge / temporary repair. Contraindicated in sole long-term repair. Large defects can form without additional support
Biological mesh —OviTex (Sheep stomach)Permacol (pig dermis)SurgiMend (cow dermis). Remodels into own tissue as provides scaffold for tissue ingrowth. Used in infected / contaminated field, Direct bowel contact & Complex abdominal wall reconstruction. Contraindicated in sole long-term repair. Large defects can form without additional support
CLINICAL CONSIDERATIONS
Infection risk — particularly relevant in contaminated or clean-contaminated fields
Chronic pain — shrinkage and nerve entrapment are recognised long-term sequelae
Recurrence — mesh overlap, fixation method, and abdominal pressure all influence outcomes
Patient counselling — mandatory pre-operatively, especially for pelvic mesh
Consider mesh material and patient cultural & religious beliefs
KEY LEARNING POINTS
Match mesh weight to the clinical context — lightweight for laparoscopic inguinal, heavier for complex abdominal wall
Avoid synthetic mesh in contaminated fields — opt for biological or delayed repair
Fixation method matters — tack fixation increases chronic pain risk vs. self-gripping mesh
Document consent thoroughly — medicolegal landscape around mesh continues to evolve
CASE STUDY · ISSUE 11
Case Study: Incarcerated Right Inguinal Hernia
The Patient
Mr T.K., a 67-year-old retired builder, presented to A&E at 22:00 with a 6-hour history of right groin pain, nausea, and a tense, non-reducible right inguinal lump. He had a long-standing hernia for which he had declined elective repair. On arrival: HR 96, BP 138/82, apyrexial. Examination revealed a firm, erythematous, irreducible hernia without cough impulse and reduced bowel sounds. Bloods: WCC 13.8, CRP 54, lactate 1.6 mmol/L. CT confirmed an incarcerated right indirect inguinal hernia containing small bowel with no pneumoperitoneum, free fluid, or frank ischaemia.
Operative Decision & Management
IV resuscitation and catheterisation. Emergency exploration via oblique incision. Approximately 15 cm of jejunum identified, congested but viable after reduction. No perforation or soiling. Lichtenstein repair performed with lightweight polypropylene mesh. Uneventful recovery.
Teaching Points
Learn to distinguish incarcerated from strangulated, this has the most impact on management
Mesh repair is typically avoided in contaminated fields, tissue repair or delayed mesh repair is preferred.
Assess bowel viability intraoperatively: colour, peristalsis, and mesenteric pulse. If in doubt, wrap in warm saline gauze and re-assess after 5 minutes.
Reference: Miserez M et al. EHS Guidelines on inguinal hernia management. Hernia 18, 151–163 (2014).
SURGICAL HISTORY · ISSUE 11
Surgical History/ Memorable
Photo of the day
DEVICE & TECHNOLOGY CORNER · ISSUE 11
Haptic feedback Systems
Technology continues to improve, with simulation designs aiming to refine hand-eye coordination, spatial awareness, depth perception and tactile feedback. For procedures such as laparoscopies, enhancing technology sing technology can help surgical trainees perception of magnitude of applied force during laparoscopies, allowing time in theatre to further enhance non-simulated complications and human factors.
TRAINEE PERSPECTIVEName, Grade — [Institution][Add trainee perspective, reflections on a device, technique or innovation here]
