November 25-27, 2024 Guadalajara Mexico
Medical Center IMSS Centro Medico Naciona De Occidente (public hospital)
Hernia Help: Wolfgang Reinpold, David Lourie, David Chen, and Hector Valenzuela (local Cooordinator)
10 teaching cases, 2 days of lectures, over 100 surgeons participating via observation, training, and teleconference.
November 2024 Santiago Dominican Republic ILAC Trip
On November 3 – 7 at the Institute of Latin American Concerns (ILAC) in the Dominican Republic our hernia team operated upon 67 hernia patients. Two new surgeons, Dr. Nick Carter and Dr. Andy Yang, along with veterans to ILAC Dr. Michael Sarr and Dr. Bob Cusick operated. There were several challenging large inguinoscrotal sliding adult hernias and two rare cancers that surgically removed and eventually diagnosed. All patients did well during the week and in early follow-up. Dr. Alvaro Torres an ILAC employed physician provided 10 day follow-up and is available for long term follow-up as needed. The Lichtenstein tension free repair is the standardized technique at ILAC. Good anesthesia and team collaboration were evident throughout the week making the trip a very enjoyable experience.
September 24-28, 2024 Coron District Hospital Palawan, Philippines
Adult and Pediatric Hernia Surgeries including Training and Teaching in collaboration with Sui Generis Missions, the Philippine Hernia Society and Cebu Doctor Hospital.
Led By Dr. Henry Chua from Cebu Doctors Hospital, Wayne Huang from IRCAD Taiwan and David Chen from Hernia Repair for the Underserved.
Hernia Mission to Paraguay November 20-24, 2023
The hernia mission was planned and organized by:
Prof. Dr. Osmar Cuenca Torres, Director of the Department of Abdominal Wall Surgery del Hospital Universitario and Dean of the Faculty of Medical Sciences of the National University of Asunción. Prof. Cuenca is Paraguay´s leading expert for complex abdominal wall hernia repair. He has a vast experience of several hundred cases with preoperative Botox A infiltrations and preoperative progressive pneumoperitoneum. Apart from this he has established the MILOS technique in his department.
and
Dr. Wolfgang Reinpold, Director of the Hamburg Hernia Center and Department of Surgery, Reference Center of Abdominal Wall Surgery, Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg, Germany.
Visiting professor of the Faculty of Medical Sciences of the National University of Asunción.
All hernia operations were performed on poor and indigent patients who otherwise had no access to and were unable to afford necessary modern standard mesh repair of their hernias. Most of the patients suffered from their hernia for many years and some of them were no longer able to work at all, since many occupations, especially in rural areas require physical fitness.
Many of the patients came from the district of Santa Rosa del Aguaray, northern department of San Pedro which figures among the poorest regions of Paraguay with a rural population of 93%. About 40% of the people live in poverty and 15% in extreme poverty. Eighty percent of the population speak Guaraní and about 20% Yopara, a mixture of Guaraní and Spanish. Originally three operation days were planned in the General Hospital of Santa Rosa del Aguaray, which is located 250 km to the northeast of Asunción.
Several weeks before our mission the patients were all very well selected and prepared by Prof Cuenca, who drove two times six hours from Asuncíon to Santa Rosa del Aguaray to examine, select and prepare the patients.
Due to internal infrastructural problems in the Santa Rosa hospital the patients had to be transferred to Asunción for their operations. Many patients spoke only Guarani and hardly any Spanish. Since Spanish and Guaraní are the official Paraguayan languages the hospital staff and doctors were able to communicate with the patients and translate.
Hernia surgeries were performed in the following institutions:
Hospital of the National University of Asunción
The Hospital of the National University of Asunción is modern and well equipped including good laparoscopic facilities. In this institution all kinds of complex abdominal wall hernia operations can be performed. The facilities are appropriate for a hernia center of excellence.
Operations in the Military Hospital, Asunción
The Military Hospital of Asunción is set in an old building in the historic center of Asunción. Due to a scarcity of military patients and a specific need in the public health sector it was recently opened for the treatment of non-military patients. The hospital has good facilities for hernia repair. The operation rooms are spacious, basic but adequately equipped.
On November 20 we had the great honor to meet the Paraguayan Minister of Health Maria Teresa Barán Wasilchuk. She visited us in the operation section of the Military Hospital and thanked us for the HRFU project.
The staff of both, the Hospital of the National University of Asunción and Military Hospital were very professional, well trained, helpful, and friendly.
November 20 and 21, 2023: Military hospital of Asunción, two operating rooms (Prof. Dr. Osmar Cuenca (OC) Dr. Wolfgang Reinpold (WR))
November 22 and 24, 2023: University Hospital of Asunción, two operating rooms (OC and WR)
The operations were performed mainly under peridural or local anesthesia with sedation. The Paraguayan anesthesiologists were very well trained and did a great job. We operated on 40 patients (7 women and 33 men) with a total of 57 hernias (50 groin hernias, 7 umbilical hernias). Ten patients suffered from bilateral groin hernias and 15 patients had scrotal hernias of which 7 were very large. Nine of the scrotal hernias were not completely reducible (chronically incarcerated, 3 cases of reversible bowel strangulation, no bowel resction required). Four patients with scrotral hernias required partial omentum majus resection. There were no intra operative complications.
Most of the patients went home on operating day, all remaining patients were discharged on the next day. The early postoperative follow-up of patients from district of Santa Rosa del Aguaray was performed by local doctors or health professionals. To our knowledge there were no complications except for three minor hematomas. There were no reoperations. (OC: 20 patients, 26 groin hernias, 7 scrotal hernias, 4 umbilical hernias
WR: 20 patients, 24 groin hernias, 8 scrotal hernias 3 umbilical hernias)
Eight final year residents successfully participated in the HRFU-One day Lichtenstein training course:
Dra. Noelia Campuzano (OC)
Dra. Roun Kim (WR)
Dra. Maria del Mar González (WR)
Dra. Maria José González (OC)
Dr. Francisco Molas (OC)
Dr. Victor Samaniego (WR)
Dr. Oscar Solis (WR)
Dr. Diego Vera (OC)
Hernia mesh was donated by the German companies GFE Dynamesh and PFM, suture material and other operating room materials were provided by donations of Hamburg citizens, Germany. The donations were organized by Dr. Reinpold.
The 2023 mission to Paraguay was very successful. The operations were performed very professionally and in good spirit. We operated exclusively on indigent patients. The patients were very thankful.
I thank Prof. Dr. Osmar Cuenca and his team very much for their outstanding and dedicated organization and excellent surgeries.
Dr. Wolfgang Reinpold
November 2023 Santiago Dominican Republic ILAC Trip
Our first set back was encountered before the trip when it became apparent that the container would not clear customs in time. However, Mary Lou Collins, our equipment coordinator came to our rescue by reminding us that all sent in this year’s container was for next year. This year we did encounter a shortage of patients performing only 67 hernia operations as opposed to 100 more or less in past years. Much discussion ensued as to reasons for the shortage.
Chuck has decided to step down as the team leader and in his place will be a core group consisting of Pat Gude, – general logistics, Vinayak Kottoor – pre-op, Theresa Keefe – anesthesia and Mike Sarr – surgery. All agreed to assume responsibility and they will make decisions about future trips to ILAC.
The surgical mission went very well with plenty of staff including 6 wonderful Peace Corp volunteers for translation. In addition, Dr. Alvaro Torres, an ILAC employee, did an extremely good job in the pre-op area with patients that could not have surgery or needed surgery to be delayed. Mary Lou and Robin Vineyard were excellent OR leaders and the team in general functioned very well.
Sixty seven operations were performed with one take back for a scrotal hematoma. All patients made a good recovery including the take back patient. Team members afterward sent inspiring notes stating that the weeklong experience inspired them to pursue future humanitarian surgical work. Pat Gude said “I think the outstanding care we once again provided is a testament to the work of so many good people”. Please see the photos below.
We are proud to announce that in October 2023, HRFU’s Founder and long-standing President, Charles J. Filipi, MD, FACS, received the American College of Surgeons/Pfizer Surgical Humanitarian Award. Dr. Filipi was recognized for his 20 years of humanitarian service: providing hernia repair services and encouraging others to volunteer their services in underdeveloped nations.
Dr. Filipi is a pioneer in laparoscopic and endoscopic surgery, including hernia repair. In 2004, he used his knowledge of the gaps in global hernia care in the Dominican Republic, where surgical teams repaired adult and pediatric hernias. For 6 years, he took an average of three annual trips to provide operations and education in developing countries.
In 2010, Dr. Filipi and a colleague arranged for four surgical teams to visit Haiti, offering support after the country’s devastating earthquake and performing 776 acute operations. In 2011, Dr. Filipi took a leading role in creating Hernia Repair for the Underserved. Hernia Repair for the Underserved has directly through surgery and indirectly through the education of local surgeons, operated on thousands of hernia patients. Approximately 2,000 operations have been performed by trainees, and 5,000 have been performed by hernia experts in seven developing countries. There have been no mortalities and a morbidity rate of .07% in these procedures. Our organization is extremely proud of his vision and fortitude to ensure these lifesaving services to patients in need that would otherwise not receive quality care.
We thank Dr. Filipi for his continued service to HRFU and congratulate him on this well-deserved award!
We carried out a mission at the Carlos Chagas State Hospital in Rio de Janeiro, Brazil on May 12th and 13th, 2023. We operated on 23 adult patients with 30 hernias. We had no intra-operative complications nor in the follow-up until the postoperative thirtieth. We had six trainers and trained 6 local surgeons. The meshes were donated by a local distributor (E. Tamussino) of the BD-Bard company.
November 2022 Santo Domingo Dominican Republic Trip
This was our first trip to Santo Domingo. It was conducted with the Foundation for Peace, a well-established large non-profit based in the Dominican Republic and Haiti. They are focused primarily on health care, education and community partnerships. A small US team arrived but there were some authorization paperwork difficulties that delayed surgery for one and half days. This was rectified and one operating room was used in the Hospital Regional Doctor Marcelino Velez Santana. Dr. Michael Sarr and Dr. Alejandro Serrano were the operating surgeons and Dr. Jennifer Huerta, Dr. Serrano’s wife provided excellent anesthesia.
Twenty one operations were performed without complications. Many of the patients had a short recovery because local anesthesia and sedation was used. More work will be done to improve the logistics for next year.
November 2022 Santiago Dominican Republic ILAC Trip
This was our first trip back to ILAC since 2019. An entire team was recruited and all three operating rooms were used. One for pediatric hernia surgery, another for the more complicated adult patients requiring a general anesthetic and the third for hernia patients requiring only local anesthesia with intravenous sedation. Dr. Michael Sarr, Dr. David Chen, Dr. Robert Cusick, Dr. Alex Schroeder and Dr. Conrad Ballecer were all surgeons with several spending two days of the five. Dr. Chen also gave a hernia lecture one evening to the Northern Dominican Republic chapter of the American Board of Surgery.
Eighty one operations were performed and many large inguinoscrotal hernias were repaired. One patient experienced an intraoperative bradycardia during that was rectified pharmacologically. No other complications were encountered.
