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Alright, so welcome to another episode of Behind the Knife's Hurnia Series,

I'm Vahag Nakolian from OHSU, and I'm joined today by my partner, Dr. Sean Orinstein.

Today we're really excited to talk about mesh choices in the emergency setting, and to be completely clear, we've usually had this as a discussion.

But today we're going to run it more like a classic BTK interview, and Dr. Sean Orinstein is truly someone I consider a mesh master.

I joined OHSU's ABWAL team about two years ago after fellowship, and I thought I had a good fund of knowledge about mesh, mesh choices, and what to do in the various circumstances.

And I was completely blown away with Sean's ability to really put the data to good use and apply it in managing patients in very complex and diverse situations.

Today we're really going to focus on the mesh master, and learn from him as much as possible.

So with that said, Sean, welcome, and let's talk about mesh.

Well, Vahag, thank you for that kind introduction, and looking forward to talking about one of the big passions of mine.

Of course, that is a mesh, and it's various scenarios in what we do for Hurnia repair and abdominal wall reconstruction.

Awesome. So before we get going about decision making and emergency settings, why don't you like sort of tell us about your sort of how you developed your expertise and really became what many of us consider one of the international leaders in mesh.

Just literacy and knowing so much about it. How did it happen?

I certainly didn't start my career thinking I was going to be a mesh geek or know how this kind of fund of knowledge, but I was super excited to join Yuri Naviski in the lab during my residency program kind of midway through the residency and I spent two years.

We had a pretty productive lab. We had a basic science lab, clinical lab. We basically did a ton of in vitro and in vivo experiments, and basically try to get our hands on as much mesh product as we could synthetic, biologic, by resorbable.

We really went out there and did everything we could to study various aspects of it. A lot of it was on the inflammation and the inflammatory response and the foreign body response to implants that we did a bunch of rodent models where we could literally see what that tissue response on a cellular level was to a wide variety of products and be able to compare them to each other.

Biomechanical testing, even novel products from startup companies to figure out can we find the holy grail of the perfect mesh and certainly we're still seeking out that holy grail of mesh. We're not there yet, but maybe one of these days we'll get there.

So those two years really solidified my passion not only for mesh, but also a honey repair and it's really been an instrumental part of my fund of knowledge and just my excitement for our realm of honey repair.

Awesome. I have to admit you have taught me so much over the years about mesh. I've become a better surgeon because of it and watching the lectures at various conferences definitely makes me a better surgeon every time.

So with that said, let's get going. Let's talk about the emergency setting. Many of our listeners maybe aren't exclusively doing elective hernia or ab wall reconstruction, but a lot of people will be faced with like the emergency scenarios where they're having a patient present with hernia that's incarcerated or strangulated in those settings.

What are some of the considerations you think about when making decisions about the type of mesh or the type of repair you're going to do?

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