Greetings, I am Nick Kochylas, a general surgeon from Greece. I have a special interest in hernias and abdominal wall surgery. It’s amazing how such common operations with such an impact on everyday life can be so overlooked in everyday practice.
I met professor Yohann Renard at the EHS Advanced Cadaveric Hernia Masterclass of 2023, which was hosted at his anatomy unit in Reims. I asked him if I can apply for a fellowship at his unit and he just gave me his contact information. Just like that! Of course it’s never so easy. After a lot of planning and the unavoidable bureaucracy, 4 months later I was in Reims.
From then on, a new world opened in front of me. There are so many things that I saw and I learned! And so structured that it was as if someone took me by the hand and told me “You want to learn about hernia? Come this way…”
For start, consultations. Examining a hernia patient, optimization of weight and comorbitities is as important for the success of the operation as the surgical technique itself. The characteristics of the hernia and studying the scans yourself became very important, as the location and size of the abdominal wall defect, the loss of domain and the size and strength of the muscles. Every hernia case is unique and should be treated as such. This was doubly important in a center the handles only the hardest cases, lumbar, recurrences, loss of domain etc. Another major part of consultations was managing chronic pain. It’s as debilitating for the patients as it’s overlooked by physicians. DN4 questionnaire, mapping of the painful inguinal region, sportsman’s hernia, ACNES syndrome were only some of the concepts that seem obscure to most surgeons, but are everyday practice in the Reims hernia center.
And then, the OR. There I really understood the retrorectus and preperitoneal space. I saw Rives-Stoppa, TAR, anterior component separation, trans inguinal preperitoneal (TIPP) repair for inguinal hernia, all with explanations, many tips and tricks from a true master of the craft and much patience from Yohann for the endless questions I bombarded him with! And all on the hardest cases, huge hernias in the most amazing locations (in one case the sack was actually protruding between the 10th and 11th rib). And of course, I also saw the finesse of robotic hernia repair, and how to make a really big pocket in TAPP, always big enough for 17X12cm mesh.
I also saw all the adjuvant techniques that complement hernia surgery. Transversus Abdominis Plane (TAP) block, Dysport lateral muscle injections can be safely and routinely performed by a hernia surgeon after proper training. I saw Preoperative progressive pneumoperitoneum (PPP) in loss of domain cases performed as an outpatient, with the patients going home after a couple of hours. I had access to the anatomy lab too, observing lessons and hands on courses on the anatomy of the abdominal wall, as only Yohann Renard can deliver.
The structure of hernia surgery in France was also something to admire and try to imitate. I attended a congress totally dedicated to interns and junior surgeons trained in hernia surgery, where they were the speakers and after taking the exams, were awarded diplomas of proficiency in hernia and abdominal wall surgery, as a recognized subspecialty. I was also able to attend the MESH congress in Paris, as vibrant and full of lively debate as all hernia congresses tend to be, and I can say that I am now a proud member of the Société Française de Chirurgie Pariétale – Club Hernie!
But the most important part were the people that I met and the friends that I made. The heart of every unit is its people. My time spent with Yohann Renard showed me the great surgeon, professor and person he is. I had the privilege to see him at work, always smiling, and always on the move! It was exhausting to follow him around! He was everywhere, attending the patients, the OR, the university, with always time for a kind word, a joke with the staff or to answer the questions of an inquisitive Greek. A proud successor of an abdominal wall unit started by Rives himself. I met Fahad, another fellow from Kuwait, and we quickly became best buddies. I really miss teasing him! I met Alix, Annie, Jules, Agathe, all great people and doctors that we spent so much time talking about everything, medical or not. The EHS congress in Prague, that we attended, was one of the best in my life, due to, in no small part, these people.
All in Reims, a beautiful small city, filled with monuments, history and warm people. I would walk the streets, and the neighbors soon started to greet me, the stores quickly learned how I wanted my coffee, and the girls at the boulangerie had my baguette ready the moment I entered. It really became a home away from home.
As I write this, I realize how much I saw and I learned in just a few months. And I try to implement all these in my hernia practice… with one hand. With the other, I’m learning French!
