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Surgical Solutions for Hernias

Today, surgeons are performing a variety of techniques to repair hernias. You should talk with your surgeon to determine what type of repair method is appropriate for you.

The Conventional Method. The surgeon makes an incision over the site of the hernia. The protruding tissue is returned to the abdominal cavity, and the sac that has formed is removed. The surgeon repairs the hole or weakness in the abdominal wall by sewing strong surrounding muscle over the defect. This is the most common method of hernia repair.

Tension-free Mesh Technique. For this technique, the surgeon makes an incision at the site of the hernia and a piece of mesh is inserted to cover the area of the abdominal wall defect without sewing together the surrounding muscles. Recovery is swift, and the likelihood of the hernia recurring is small. The body’s natural tissues generally accept this safe surgical mesh. However, be certain to discuss this procedure with your surgeon and understand how it will be done.

The Laparoscopic Method. A laparoscope is a long metal tube with a fiber optic light source and a telescopic eyepiece, which is connected to a TV monitor. The surgeon inserts the scope into the abdominal cavity through a small incision and uses it to view the hernia in the abdominal wall while he or she repairs the hernia through additional tubes that are inserted into the abdomen through separate incisions. A general anesthetic is required. Some surgeons are using this technique. Recent comparative studies have shown that laparoscopic inguinal hernia repairs have a  failure rate that is five-times that of conventional mesh repairs and higher rates of intestinal injury and blood transfusions.  Llaparoscopic ventral, incisional and umbilical repairs are safe and effective, but not for everyone. The following comparison shows why open repairs are sometimes preferred.

 


OPEN AND LAPAROSCOPIC VENTRAL HERNIA REPAIR

LAPAROSCOPIC

OPEN

  • Pain is higher and requires more pain medication for a longer duration.
  • Shorter duration, less overall pain medications.
  • With the laparoscopic approach larger mesh is typically used. 
  • Mesh is preferred over a simple sutured repair.
  • Lower infection rate, smaller incisions.
  • Higher infection rate, slower healing.
  • Pseudo recurrence common with visible bulge.
  • Pseudo recurrence and bulge is rare.
  • Seroma and hematoma common.
  • Seroma and hematoma uncommon unless hernia is very large.
  • Recurrence rate 4%.
  • Recurrence rate 10-12% depending on size of hernia.
  • Lower overall complications.
  • Less severe potential complications.
  • No feasible ability to remove excess skin.
  • Removal of excess skin common.
.Optimal patient for laparoscopic ventral hernia repair: overweight/obese, multiple health issues.

Optimal patient for open ventral hernia repair: the patient is frequently doing heavy lifting and using the abdomen in exercise on a regular basis.

 

 

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