Hernia surgery is a very common and often routine procedure. General surgeons in the United States perform about 1 million hernia surgeries every year, 800,000 of which are inguinal or groin hernias. Hernias are most often performed in a minimally invasive procedure known as laparoscopy, which, depending on the location and size of the hernia, may also be performed with robotic assistance.
The advent of laparoscopy and robot-assisted surgery created immense opportunity for patients with hernias, especially those with bilateral inguinal hernias – a hernia on each side of the abdomen. Bilateral inguinal hernias required two surgical procedures when open surgery was the only option. However, laparoscopy has allowed us to repair both hernia defects in a single procedure. Laparoscopy has also significantly reduced the chances of hernia recurrence, while minimizing the possibility of an incisional hernia after surgery. With smaller incisions and advanced minimally invasive techniques, pain is also significantly decreased in the post-operative period. This translates into minimal need for analgesics post-operatively, in fact most of our patients only need ibuprofen and Tylenol thus, completely avoiding narcotics and their side effects. They are also able to resume their regular daily activities more rapidly and can return to work much faster.
The ultimate goal of hernia surgery is to repair the defects with minimal pain, disruption to daily activities and quickest possible recovery with minimal downtime. Also, the repair must be durable and allow the patient to return to previous activities with minimal limitations. We have found that the best repairs are the ones performed with mesh reinforcement of the defect.
Thus, creating a barrier through which abdominal contents can no longer protrude. There are two techniques for repairing hernias– primary repairs which are by definition under tension and tension free repair technique. A primary repair involves mechanically closing the hernia defect using sutures only. Unfortunately, this is not ideal in most hernia repair situations. Because the tissue is under tension from the sutures, and there is no reinforcement to take the tension away from the repair site and distribute it elsewhere and the fascia itself is weakened, the chances of recurrence are relatively high. This leads most surgeons to reinforce the hernia repair with a synthetic mesh. The mesh is placed over the hernia defect and creates a strengthened barrier; it also distributes forces away from the hernia defect and repair site. Mesh has sparked some controversy lately and we will discuss this further down the page.
Using laparoscopic or robotic surgical techniques, hernia surgery is performed with the patient under general anesthesia and usually in an outpatient setting – meaning that patients will be able to go home shortly after their procedure is complete. Three-to-four small incisions are made in the abdomen, the largest of which is in the umbilicus or belly button, to minimize visible scarring.
Specially-made, long-handled devices, or the robotic arms, pass through the abdomen and into the surgical field. The surgeon then reduces any abdominal contents from inside the hernia and carefully lays a self-adhering mesh onto the hernia defect. Special care is taken to ensure that the mesh is large enough to cover the defect as well as some extra coverage of the surrounding tissue.
Having a foreign body, such as mesh, in the abdomen creates inflammation. The inflammation allows scar tissue to build up around the mesh, which ultimately becomes an integral part of the strengthening of the abdominal structure. The mesh, combined with the newly formed scar tissue, creates a strong barrier to recurrence.
Significant advances have been made in the field of hernia surgery and synthetic mesh production. Most meshes used in laparoscopic surgery have a special barrier layer which separates the mesh from the intra-abdominal organs, including the large and small intestine.
In our practice we utilize other advanced techniques such as placing the mesh between muscle, fascia and/or peritoneum- all of these are natural tissues which can act as natural barriers. Almost completely eliminating the risk of adhesions to the intra-abdominal viscera.
Having a frank conversation with your surgeon is the best way to understand more about the risks associated with an untreated hernia versus having surgery to correct it. In most cases, patients can decide to have surgery right away or defer their surgery until later. However, waiting can create a larger, more complicated hernia repair.
Our surgeons are EXPERTS in hernia surgeries. Contact us for more information about our hernia repair program and to schedule a consultation with one of our doctors.