What are the different types of hernia repairs?

Approaches usually fall into three categories which consist of Open Repairs, Laparoscopic repairs, and Robotic Repairs. 

 

Techniques are typically classified as "Primary" repair (also called "Tissue repair") and "Mesh repair."

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Approaches

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Open hernia repair surgery:

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• Open hernia repair is simply what you tend to think of in traditional surgery, where an incision (cut), is made over the site of the hernia (in the groin for example for an inguinal hernia). A “sac” consisting of the lining of the abdominal cavity and containing the tissues that have herniated through the "hernia defect"(fat, intestine, or other organs) is identified, dissected free of the surrounding tissues, and pushed back into the abdomen where it belongs. Sometimes the sac is excised (removed), sometimes it is ligated (tied off), and other times it is left as is and simply pushed back inside with all of its contents. If the surgery is being performed emergently, because the sac has been incarcerated (stuck outside), or there is concern for strangulation (blood supply cut off) to the intestines or organs that have herniated), then the sac must be opened, and the contents examined. If those tissues are dead or severely damaged by lack of oxygen, then that part of the intestine or organ must be surgically resected and reconstructed. Once the sac has been "reduced" (pushed back inside), the defect (hole) in the abdominal wall must be closed (repaired), either using simple sutures (stitches) or using a piece of "mesh" to reinforce the repair and/or strengthen the tissues of the abdominal wall in order to try and prevent the hernia from coming right back.

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• Some forms of open repair can be considered minimally invasive if a very small incision is used. We use a very small incision. This type of incision heals very nicely with an excellent cosmetic result. Most people will never see it after it heals completely.

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• Depending on the type of hernia, the size and complexity of the hernia, and the type of repair, most patients will go home a few hours after surgery, and return fairly back to normal within a few days. Activity restrictions for lifting heavy objects or strenuous activity are usually instructed by your surgeon for four to six weeks after surgery, again depending on the type of hernia, location, size, complexity of the hernia, and the type of surgical repair.

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Laparoscopic (minimally invasive) hernia repair:

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Laparoscopic (commonly called minimally invasive) hernia repair is performed through multiple tiny incisions (typically about 1 cm in length). The number of incisions is typically determined by the type of hernia, location, size, and complexity of the hernia, combined with the type of repair planned. The technique involves using a special telescope that is attached to a digital camera which transmits the live video images to a flat screen monitor positioned in front of the surgeon, either on a mobile stand, or suspended on mobile arms from the ceiling. That scope is placed through one of the tiny incisions and is used to view inside the abdominal cavity. The other tiny incisions are used to pass special laparoscopic instruments, which are long skinny instruments with handles like a scissor that the surgeon uses to manipulate different tips on the end of the instruments, such as graspers, needle holders, cautery (electric current used to stop bleeding), scissors, etc. Standard approaches usually employ three incisions, one for the scope, and one for each hand. Sometimes there are more incisions if assistance is needed for retraction and exposure of abdominal contents (fat, blood vessels, fat, etc.).

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Laparoscopic surgery requires General Anesthesia (completely unconscious, muscles completely relaxed, and breathing through a tube on a mechanical ventilator). It is critical that the patient's muscles be completely relaxed, because for laparoscopic surgery, the abdomen needs to be inflated with gas (CO2) to lift the abdominal wall away from the abdominal contents, otherwise there would be no space to see internal structures or to work in. The defect (hole) in the abdominal wall or groin is identified and if there are any herniated tissues from the inside through the defect, then they are reduced (carefully manipulated and dissected free and brought back into the abdominal cavity where they belong.

 

The defect is then repaired, either by suturing (stitching) the defect closed, or by placing mesh to cover the defect, and sometimes both. Again, it is most common today to place a sheet of mesh over the defect or closure to strengthen the abdominal wall tissues and reinforce the repair. Again, see the section on "Mesh vs Tissue (No Mesh)."  Once the repair is complete, the tiny incisions are closed with a single stitch or wound adhesive (glue).

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Benefits of laparoscopic (and especially robotic surgery) include tiny incisions that heal with a very cosmetically pleasing result, potentially less postoperative pain, and a potentially faster recovery time.

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Robotic hernia repair:

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Robotic hernia is simply a fancier way to perform a laparoscopic approach. The approach is very similar and uses tiny incisions and a scope. It's just that the surgeon uses a $2,000,000 piece of equipment that offers much better visualization with better optics (better scope) and 3-dimensional vision (as opposed to a 2D flat screen), as well as much finer dexterity with instruments that simulate a surgeon's own hand and wrist movements, rather than straight skinny sticks for instruments.  The device consists of a series of "robotic arms" that hold the very specialized robotic instruments. The robot DOES NOT operate by itself. The surgeon sits at a special and very sophisticated console to control the video scope, robotic arms and instruments. Again, the robotic instruments serve as extensions of the surgeon's hands as he manipulates the hand controls for the very fine movements of dissection/manipulation of the tissues.  

 

The robot actually makes it possible to repair some hernias that would not be possible using traditional minimally invasive laparoscopic instruments or techniques. The robot also allows for additional techniques not possible with traditional laparoscopic instruments. We at AHS believe that the better visualization, increased dexterity, and more precise dissection allows for a better repair and less post operative pain. 

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Having said all of that, there are some complex hernias that cannot be safely or effectively performed by minimally invasive techniques and still require open surgery as the only method of repair.

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At AHS, we have been using the da Vinci surgical system since 2014, and we have been employing it for hernia repair for many years. Robotic surgery has especially revolutionized repair of abdominal wall hernias, and we have been very successful in also applying it to inguinal (groin) hernias with excellent results and very happy patients.

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Take that next step:

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Call us for more information or schedule an appointment with us at Advanced Hernia Specialists. We are experts in the field of hernia surgery, and we are committed to delivering excellent care and the best patient outcomes possible. We offer the most advanced open, laparoscopic, and robotic surgical techniques for hernia repair.

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Call us at 904-808-5658, email us, use our online Contact Form, or Book Online. 

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