Sydney Hernia Centre - Ashfield

Dr. Adam Rapaport is a Consultant Surgeon, Graduate of Sydney University. He has important overseas postgraduate training in a university department in Texas. He has been in a private surgical consulting practice for over twenty years. He is a Consultant Surgeon for the Australian Defence Forces and has been in this position for over five years. He consults for the Services and he operated on many young Service men and women who develop hernia problems. In addition to his interest in hernia surgery he has special expertise in laparoscopic procedures and trauma surgery. The majority of his hernia patients are treated as a day case or overnight stay. They receive injection of Local Anaesthetic into the operative site, which reduces the post-operative pain. He realises the importance of an efficient return to full activities for army personnel, elite sportsmen and construction workers. The use of the mesh in all the types of hernia surgery facilitates this. This same principle applies however to sedentary workers and the elderly patient. In addition Mr Rapaport has long-standing extensive experience in treating children’s’ hernias. Mesh is not generally used. The main consulting rooms are in Bondi Junction. However most of the major metropolitan areas in Sydney are catered for on a regular or request basis.

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.

Mr Leinkram has been a Fellow of the Royal Australasian College of Surgeons for 25 years. He trained at the Austin and Repatriation Hospitals in Melbourne. After obtaining his Fellowship in General Surgery, he worked in England for two years, firstly at the Hammersmith Hospital in London and then at the Royal Victoria Hospital in Bournemouth. Since commencing private practice in 1982, he has developed a great deal of expertise in short-stay surgery. More and more types of operations now fall into this category, i.e., day-surgery or overnight-stay surgery. With careful preoperative assessment, sound surgical technique and the use of effective postoperative analgesia, operations as diverse as hernia repair, gallstone surgery and thyroid surgery can be done as short-stay cases. Mr Leinkram’s adoption of this type of surgical practice evolved at the same time as Mr Brygel was independently developing his technique of day-case hernia repair. They have now joined forces at the Melbourne Hernia Clinic where they both perform the same type of operation- the tension-free mesh hernioplasty, under local anaesthesia with sedation. In recent years, Mr Leinkram has also taken a special interest in the treatment of incisional hernia. This is a difficult and challenging problem because the patient often presents with a large abdominal swelling which might already have had one or more unsuccessfull attempts at being repaired, and the swelling is also quite often associated with an unsightly overhang of abdominal skin and subcutaneous fat. Mr Leinkram has developed an extensive experience in repairing these incisional hernias and at times combines this with an abdominoplasty (tummy-tuck). He has been performing abdominoplasties for over 20 years.