Hernia Repair

 

Dr. Zdankiewicz performs all inguinal hernia surgery on an outpatient, same day basis. This has proven safe and effective, regardless of whether the hernia is recurrent. But everyone has a unique situation and the hernia repair is tailored to each patient individually. There are at least a dozen methods for repairing hernias, and each may be right for a particular patient.

Nationwide, the preferred method for at least the last thirty years has been the use of synthetic mesh to repair a hernia. This avoids tension on the muscle layers in the repair and so it has been named the “Tension Free Mesh Repair”. First and incision is made over the site of the hernia. Next the bulging or protruding tissue is returned behind the muscle of the abdominal wall. Then specially designed mesh is laid behind the defect, repairing the hole or defect in the muscle that led to the bulge.

This method has been proven over many years to be the most effective way to repair a hernia and to prevent it from recurring. It is effective for inguinal hernias and other kinds of hernias. Although there are methods of hernia repair that do not require the use of mesh, these repairs add tension to the abdominal wall and tension is what causes hernias to begin with. As expected, the chance of hernia recurring is higher if mesh is not used.

The exception to this is the case of hernias in children, when mesh is not required. Using mesh in the repair of hernias lowers the chance of recurrence to about 0.5%, or one out of 200 cases. It also requires a shorter recovery period and greatly reduces postoperative pain. Some patients do not even require prescription pain medication after the Tension Free Mesh Repair.

 The Tension Free Mesh Repair uses sterile polypropylene mesh to reinforce and support the surrounding tissues. Polypropylene has been used in surgical implants for decades and has proven extremely safe. The mesh patch creates a framework for the bodies own tissues to grow. Within a few weeks the body’s tissues grow into the patch like the roots of a tree creating an extremely strong repair.

The Prolene Hernia System (PHS, shown above) is an innovative method of treating hernias. The mesh is made up of three elements. There is an underlay mesh, which slips behind the muscle, an onlay mesh which lays on top of the muscle, and a cylinder which connects the two layers. The cylinder fits through the hernia defect, and it is held in place primarily by its shape. Stitches may be used to hold it in position, but usually only a few are necessary and they do not have as much tension on them as stitches in the older types of repair. This means less pain in the postoperative period.

Dr. Zdankiewicz prefers to avoid the laparoscopic repair of inguinal hernias because that repair requires the use of a metal screws or coils that are placed through the mesh. The PHS repair gains its strength from the patients tissues healing into the patch, rather than relying on metal screws to hold it in place. 

The PHS mesh in place

Once the underlay is slipped beneath the muscle, and the cylinder runs through the hernia defect, there is very little chance that the mesh will move, making a very solid repair. The last layer is placed on top of the muscle, and the repair is complete.