A typical hernia is a weakness or tear in the abdominal wall which allows the inner lining of the abdomen to push through and form a sac. The hernia may fill with intestine or tissue which then may become incarcerated or obstructed, causing a potentially serious health risk.
Hernias can occur at birth or over time due to stress and strain. There are different types of hernias, but the overwhelming majority occur in the abdominal wall at the groin, the navel, or at the site of imperfectly healed surgical incisions. An easy way to envision a hernia is to think of old tires with inner tubes. When an abnormal opening occurs in such a tire, the inner tube protrudes from the opening. Similarly, a hernia occurs when an organ or tissue protrudes through an abnormal opening.
Hernias are usually easily recognized. You may feel pain when lifting heavy objects, coughing, or straining during urination or bowel movements. You may also feel a bulge under your skin.
Hernia repairs are one of the most commonly performed operations in the United States. Over 700,000 procedures are completed annually. This can only be accomplished by an operation performed to relieve the symptoms of pain and to prevent other more serious problems from occurring if the hernia is ignored. There are several operations available.
The most common hernia repair being performed today is the open "tension free" repair. This procedure is usually performed under local or regional anesthesia (however, you may be put to sleep) and requires a large muscle cutting surgical incision (two to four inches) to gain access to the hernia. The repair is made by securing a plastic mesh over the hernia defect. The technique is effective, but because the incision cuts through muscle a full recovery can take four to six weeks.
In the early 1990's, a minimally
invasive procedure to repair the hernia defect became available. This transabdominal approach usually is performed with general anesthesia (you are put to sleep). The surgeon gains access to the hernia internally through the abdomen making three small incisions (one half inch or less). The abdomen is then inflated with Carbon Dioxide gas.
Because these smaller incisions cause less trauma to stomach and groin muscle, post operative pain is usually less and full recovery is achieved much quicker (one week or less). However, one disadvantage of the transabdominal approach is that the laparoscope and other instrumentation needed to complete the repair must be inserted into the abdominal cavity exposing the patient to the risk of possible internal vessel or organ injury. Because of these risks and
the need to open the peritoneal cavity, Dr. Lydon's preferred approach
is the extra-peritoneal balloon repair.
The most up-to-date and advanced laparoscopic repair
of inguinal hernias is the extra-peritoneal balloon approach. Dr. Lydon
has been a regional leader and teacher of this repair since 1994. He
has been involved in over 1500 repairs. The laparoscopic repair is preferred for the recurrent or bilateral inguinal hernia.
The balloon dissection device . This procedure is considered safer for the patient since the surgeon does not have the potential risk of bowel or vessel perforation. The Bard 3D mesh is used in
most cases which eliminates the need for fixation of the mesh with
tacks in over 90% of cases.
Few or no tacks results in less post
operative pain and almost eliminates the risk of nerve entrapment.
Because the operative space created by the balloon approach requires inflation with carbon dioxide, general anesthesia is necessary. Full recovery can usually be expected within a week.
left inguinal pre-peritoneal space after dissection
deployment of lightweight polypropylene mesh in the preperitoneal space
This is the newest and most up-to-date "open" inguinal hernia repair. The PHS device combines an "underlay" patch that entirely covers the hernia prone area in the groin with an "overlay patch" that lies flat over the abdominal muscles. The two patches are connected which virtually eliminates the chance of mesh migrating, reduces discomfort, and greatly diminishes the risk of nerve damage.
This 3-dimensional mesh provides a strong posterior repair similar to that of a laparoscopic repair and can be performed under local anesthesia as an outpatient. This technique has become the preferred method of repair for many unilateral primary hernias. The next generation of the proven Prolene Hernia System (PHS)is now available in the ULTAPRO Hernia System (UHS). UHS offers all the benefits of the PROLENE Hernia System design:
3 points of protection, complete coverage of the myopectineal orifice, and a bilayer connected design. Plus:
- A reinforced underlay patch with absorbable MONOCRYL* (poliglecaprone 25) film for consistent deployment in the preperitoneal space
- Lightweight mesh construction utilizing ULTRAPRO mesh technology
- Thin filaments, large pore construction, absorbable component
- Large onlay patch
The ULTRAPRO mesh construction promotes a flexible scar that is compliant with the abdominal wall. The large pore construction can lead to less bridging of the scar formation and ultimately, patient comfort.