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| Hernias: treatments |
| What are the types of procedures used to repair hernias? |
There are many ways to repair a hernia. The conventional
method: the hernia sac and defect are dissected out and the sac is
either removed or reduced. Next using suture material, the muscle
tissue surrounding the hernia defect is reapproximated. Tension free
repair
using mesh: This is our procedure of choice. Once again the hernia
defect and sac is dissected out and the sac either removed or reduced.
The mesh is then inserted and covers the abdominal wall defect. Since
the hernia is repaired without tension and minimal suturing used,
there is a less pain. The mesh is a synthetic substance that
has been
around for years and is well tested. It is well accepted by the body’s
natural tissues which grow into the mesh. Recovery is rapid and the
likelihood of a recurrence is low. The laparoscopic method: this
is a similar to the tension free repair. A laparoscope which is a
camera
and light source is inserted in the vicinity of the hernia. The surgeon
can then visualize the procedure on a television monitor. Surgical
instruments are then inserted through separate incisions. The hernia
defect and sac are dissected out and the hernia sac and its contents
reduced back through the defect. Mesh is then used to cover the defect
and is held in place with surgical staples.
|
| What is the best method for repairing a hernia? |
| Repairs are judged as good or bad depending on their recurrence rates. Obviously every surgeon strives to have a recurrence rate as close to 0% as possible. In reality however there is no such thing as a hernia repair that has a 0% recurrence rate. A tension free repair has a recurrence rate of approximately one half to 1%. A conventional repair, that is using suture material to close the hernia, can be associated with a recurrence rate as high as 10%. Recent studies have shown that a tension free repair using mesh as well as a laparoscopic repair have similar outcomes in terms of recurrence rates and complication rates. There are some patients that may be candidates for a laparoscopic repair depending on the type of work they do and their body habitus. Every patient is different and we try to tailor our recommendations based on the individual. |
| What about recurrent hernias? |
| Most hernias do not reoccur. However,
when they do, repair is usually done in the same manner as a primary
hernia. Usually a synthetic mesh is used and is tacked or sutured
in place. Some times a laparoscopic approach is used. It
just depends on the patient and how many repairs they have had in the
past. |
| What is component separation and
when is it used? |
| Component separation technique is used for
complex recurrent hernias when using mesh is not possible. This is
usually the case when infected mesh is removed. Synthetic mesh
cannot be replaced in an infected field so component separation is used
to close the abdomen by advancing muscle tissue. Sometimes a
porcine or bovine or cadaver mesh is used to augment this repair. |
