Hernia Repair – Advancements in Treatment

Hernia surgery is one of the most common non-emergent operations in the U.S. with over 1 million patients undergoing surgery annually. A hernia occurs when an organ pushes through a weak spot in the muscle or tissue that holds it in place. For patients who find out they have a hernia, surgery is not always needed right away unless significant discomfort and pain are present. If left untreated, a hernia will generally increase in size and pain and can lead to more life-threatening complications. If you decide to hold off on surgery, it is important to continue to monitor any pain or progress and notify your doctor of any significant changes.

Types of Hernias

Most commonly found in the abdomen, hernias may also appear in the upper thigh, belly button, or groin areas.

• Inguinal – occurs in the groin, most prevalent of all hernias
• Epigastric – occurs in the upper region of the abdominal wall and is the result of pregnancy and childbirth
• Umbilical – occurs at the site of the umbilical cord, the belly button, a naturally weakened area of the body, found in men and women
• Incisional – occurs at the site of a previous surgical incision and can develop weeks, months, or even years after surgery

What causes a hernia?

Hernias are caused by a combination of muscle weakness and strain. Depending on the cause, hernias can develop quickly or over a period of time. A hernia developed from muscle weakness could be caused by the failure of the abdominal wall to close properly in the womb, age, chronic coughing, or strain from injury. A hernia from strain could be the result of pregnancy, lifting heavy weight, or the site of a previous surgery.

Several factors could increase your risk for developing a hernia such as a family history of hernias, being overweight, smoking, chronic constipation, or chronic cough.

Signs and Symptoms

Initial signs of a hernia include a bulge or lump in the affected area. Bulges are more noticeable when standing up, bending down, or coughing. Other common symptoms include pain or discomfort in the affected area, weakness or a feeling of heaviness in the abdomen, or burning sensation at the site of the bulge.

Hernia Treatment

Surgery is the only way to treat a hernia. How soon you need treatment depends on the size and severity of your symptoms. If you decide to seek surgery down the road, your doctor may recommend lifestyle changes such as diet and exercise to improve symptoms and relieve discomfort. Regardless of lifestyle changes, the hernia will still be present. If left untreated, your hernia may grow in size and become more painful. Early intervention can minimize the effects of a hernia and avoid life-threatening complications.

Types of Hernia Surgery Techniques

There are several modes of treatment for repairing hernias, the needs of each specific case are crucial when determining surgical technique.

“Surgeons performing these repairs need to have all the resources,” said TPMG General Surgeon, Steven B. Hopson, MD, FACS. “You don’t want them to be pin holed into one treatment method.”

Traditional Hernia Repair

For a traditional hernia repair, an incision is made around the hernia and the protruding tissue is pushed back into place and the hernia is stitched closed. This approach typically requires a 1- to 3-day hospital stay and 4- to 6-week recovery.

Laparoscopic Hernia Repair

With a laparoscopic hernia repair, general anesthesia is used to put the patient to sleep and a camera (laparoscope) is inserted into the abdomen to visualize the hernia defect on a monitor. Long instruments are then inserted into the abdomen through small incisions to gain access to the area where the hernia is present. To create space to view the internal structures and to place the mesh used to close the hernia, the abdomen is inflated with carbon dioxide (CO2). The small incisions where the instruments were inserted are then closed with a few stitches.

Three-Dimensional Mesh Repair

With this approach, a one-piece mesh device with inner and outer patches cover the hernia on both sides of the abdominal wall. This type of hernia repair requires minimal sutures to secure the device and is considered a minimally invasive procedure.

Robotic Hernia Repair

A robotic hernia repair uses four robotic arms that are used as instruments in the repair. The arms are controlled by the surgeon’s feet and fingers which can articulate just as well as the dexterity of a hand, making the movements more precise and comfortable. This is a technical procedure and surgeons receive extensive training on the technology before completing a repair. This approach requires less CO2 than a laparoscopic approach.

Why Robotic Surgery for Hernia Repair?

The main difference between other modes of treatment and robotic surgery is in the repair. The hernia is fixed on the inside rather than the outside. Repairing from the inside is less painful because you’re not cutting into any muscle. This minimally invasive treatment method has the highest degree of precision compared to laparoscopic or traditional repair with the technology available.

At TPMG General Surgery and Hernia Center, Dr. Hopson primarily performs hernia repairs robotically, seeing the greatest success from this form of treatment. He finds that patients experience less pain, have a quicker recovery, and see better long-term results. Whether or not you choose to have robotic surgery, it is important to note that traditional open and laparoscopic techniques remain sound surgical options. Patients with complex hernias may not be ideal candidates for robotic hernia repair and benefit from an open surgery. If you’re considering surgery and are unsure which treatment is best for you, consult with a general surgeon and begin your journey to better health today.

TPMG Board Certified General Surgeon, Steven B. Hopson, MD, FACS has over 20 years of experience practicing in Hampton Roads and continues to bring important advancements in hernia care to the Tidewater area.