A/Prof. Maurice Brygel
Principal surgeons of the Haemorrhoid clinic are A/Prof. Maurice Brygel, Mr. Charles Leinkram, Mr. Peter Grossberg Mr. LP Cheah. All surgeons are Fellows of the Royal Australian College of Surgeons.
A/Prof. Maurice Brygel FRACS
A/Prof. 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.
A/Prof. Maurice 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. A/Prof. Maurice 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.
A/Prof. Maurice 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.
A/Prof. Maurice Brygel like all other surgeons requires accreditation at each hospital he operates at. He is also on the medical advisory board of Masada Private Hospital and Sir John Monash Private Hospital.
All surgeons need to obtain accreditation with The Royal Australian College of Surgeons annually, by submitting data about the work they do and the educational activities they undertake. Each year he presents an audit of the hernia results to the college.
A/Prof. Maurice Brygel classifies himself as a Hernia Specialist because
(a) The majority of his work is related to the diagnosis and treatment of hernias and related conditions.
(b) He provides reports for insurance companies regarding patients and work related hernia matters and their eligibility for work care and return to work post-operatively.
(c) He lectures to medical students, general practitioners, surgeons in training and surgical colleagues
He is an Honorary Senior Fellow in the Dept. of Anatomy & Cell Biology at the University of Melbourne, where he lectures on hernias and the anatomy of the groin. He tutors to medical students on hernias at the Royal Melbourne Hospital.
He also developed a teaching program, books and videos on hernias. There are 7 volumes and videos – titled The Video Book of Hernias. Including in this category are related areas of scrotal conditions and testicular tumours. For more information visit www.globalfamilydoctor.com
He had previously published the Video Book of Skin Surgery on the diagnosis and treatment of benign and cancerous skin conditions. For more information visitwww.globalfamilydoctor.com
Currently his practice is more then 60% hernia related. Mr Brygel believes it is advantageous to still have some practice in other areas of surgery. Any patient that presents with a hernia should be assessed as a whole and worked-up pre-operatively. This ensures other problems are not over looked and can be dealt with as appropriate. It is surprising how many patients present with a hernia and on further questioning have other undetected problems.
A/Prof. Maurice Brygelpractises in 3 hospitals under the Melbourne Hernia Clinic. He has several specialist anaesethetists who help on a regular basis. They include Dr George Sellton F.F.A.R.A.C.S., Dr David Pallot F.F.A.R.A.C.S and Dr Robert Cox F.F.A.R.A.C.S.
This Website and the concept of the Melbourne Haemorrhoid & Rectal Bleeding Clinic was developed in late 2006 and instituted in early 2007.
The Director – A/Prof. Maurice Brygel, is a General Surgeon whose main surgical interests are hernia repair under Local Anaesthetic and the diagnosis and treatment of haemorrhoids and related conditions.
He is on the Medical Advisory Board at Masada Hospital and Sir John Monash Private Hospitals.
He is accredited to perform gastroscopy and colonoscopy with the Gastroenterological Society of Australia.
He formed the Melbourne Hernia Clinic in 1980 and has extensive experience in that field – performing over 9000 hernia operations.
Over the last ten years apart from hernias his main surgical interest has been in management of benign anorectal conditions. He has decided to form the Melbourne Haemorrhoid & Rectal Bleeding Clinic based at Masada Hospital. Because of his commitments to the Melbourne Hernia Clinic his role in the Haemorrhoid Clinic will be more supervisory although he will still see problems and guide patients in the right direction as their particular needs require for example, towards a Physician if colonoscopy is required or other Surgeons on the roster.
The Melbourne Haemorrhoid & Rectal Bleeding Clinic has become established because surgery and medicine have become more and more specialised with many Physicians and Surgeons now practising and restricting their practice to special areas e.g.
- Breast Surgery
- Colorectal Surgery including haemorrhoids
- Abdominal Surgery
Some doctors decry this trend particularly where it affects the provision of emergency surgery in rural and remote areas and even at public hospitals. However, it is apparent that Surgeons are stretched to keep up with new developments.
New techniques are constantly being introduced and Surgeons need to train in each development.
The advent of laparoscopic (“keyhole”) surgery, endoscopic surgery and endoscopy, gastroscopy and ERCP colonoscopy have all lead Specialists in abdominal surgery and Physicians to reappraise the way they work. For example endoscopic retrograde cholangiopancriotography is carried out through a gastroscopy for gallstones particularly in the bile duct. This is a very specialised technique. Only a few of the Specialists in this area actually carry out the procedure. This means they have a larger workload and more experience and become more skilled at the procedure.
It appears the ideal Surgeon is one who is experienced and set up to deal with a selected group of conditions. That Surgeon needs to be able to work with a team where ideas are shared and problems can be discussed – a unit isproposed with the Melbourne Haemorrhoid & Rectal Bleeding Clinic.
Now all Surgeons are compelled to undergo continuing education, to audit their work and report results.
This haemorrhoid, rectal bleeding and endoscopy Website has been developed because of the success of the Melbourne Hernia Clinic Website – www.hernia.net.au or just Google hernia.
Mr Brygel and other members of the hernia team found patients were attracted to the site for a variety and numerous reasons.
These are listed herewith but not necessarily in priority or frequency.
There are more and more patients seeking advice over the Web. Complex issues cannot be addressed over the Web. However patients can be pointed in the right direction, which is always to consult their General Practitioner and seek Specialist referral if required. A second opinion can be sought if required.
All attempts have been made on this Website to provide correct information. However we cannot take any responsibility for the information provided and symptoms or problems must be addressed to the appropriately trained Medical Practitioner.
REASONS WHY PATIENTS HAVE SOUGHT US OUT
1. Avoid delays in getting access to a Specialist
2. To seek a second opinion (for a variety of reasons)
3. To avoid long waiting lists for surgery, both in the public system and even privately in some regions
4. Wishing to see a Specialist who has expertise or interest in a specific area
5. Seeking a particular type of treatment not readily available (with hernias many patients prefer Local Anaesthesia to General Anaesthesia)
6. Affordable fees for the non-insured
With anal, haemorrhoidal or bleeding problems patients might delay presentation to their General Practitioner because of embarrassment and not know where to turn. The Website encourages patients to present with their symptoms to their own General Practitioner. Some of these patients may be referred to our clinic but not necessarily so. The Website with hernias gave many patients confidence to go ahead with their own General Practitioner and Surgeon and reassured them that the appropriate measures were being taken.
Whilst hernias are not usually a life threatening condition, many many lives can be saved by early presentation. With rectal bleeding or by the early detection and treatment of polyps, cancer by endoscopy.
In 2007 the Government has launched a screening program for bowel cancer.
The home of the Melbourne Haemorrhoid & Rectal Bleeding Clinic is Masada Hospital in East St Kilda.
The hospital is developing a specialised unit where you can ring and have your problem assessed and be guided to the most appropriate appointment.
A similar service was set up by Mr Grant Clarke in Brisbane. He is the Director of the Masada Hospital. He was relocated from Brisbane to work at both Masada and Waverley Private Hospital as the Chief Executive Officer.
Masada has designed a specific day unit set-up for these issues to be handled. A team of Specialists is in place including:
Gastroenterologist – Dr Ian Bejer and Dr Adam Gordon.
Surgeons – A/Prof. Maurice Brygel, Mr Peter Grossberg, Mr Charles Leinkram.
The members of the team work at a variety of leading institutes in Melbourne including private, public and day surgical.
This gives a degree of flexibility managing your specific problems depending on the urgency, complexibility and affordability.
We hope you find this Website of use.
Dr Ian Bejer, Specialist Gastroenterologist – Physician.
A member of the Gastroenterological Society Of Australasia.
Accredited in gastroscopy and colonoscopy by the Gastroenterological Society of Australia.
Member of the Advisory Board at Masada Hospital.
Staff member at Masada Hospital.
Consultant Gastroenterologist at Monash Medical Centre.