Hernia Repair Procedures

Surgery is the definitive treatment for a hernia.

Indications for hernia repair surgery include:

• Symptomatic Hernia – a hernia creating symptoms of discomfort, pain or interfering with activities of daily living.
• Incarcerated Hernia – a hernia trapped outside the abdominal wall and cannot be returned back inside the abdominal cavity.
• Bowel Obstruction – a hernia causing a blockage of the intestines requires surgical repair.
• Strangulated Hernia – a hernia that has compromised blood supply of the contents. There is a high risk of death of the tissues such as intestines that are contained in the strangulated hernia. This requires emergency surgery.

Laparoscopic Repair
The laparoscopic repair uses small incisions on the abdominal wall through which the instruments are placed into the abdominal cavity. The abdomen is filled with air and the repair is guided by use of a camera. The hernia contents are brought back into the abdominal cavity and a mesh is secured in place to cover the hernia defect from the inside. The mesh helps to prevent its recurrence.

The laparoscopic repair has the advantages of quicker recovery, less pain, and less risk of infection.

Open Repair
The open repair is the traditional approach to hernia repair surgery with an incision made over the area of the hernia. The contents are returned back into the abdominal cavity and the sac is removed. Depending on factors such as the location and the size of the hernia, a mesh is often used to cover the area of the hernia defect. Otherwise the defect is closed with sutures.

The open approach is commonly used for very large hernias or those that are complicated by factors such as bowel obstruction, infection, incarceration, strangulation, or recurrences.

Use of Mesh
A mesh is a supporting structure used to give strength to the hernia repair. It is used to cover the defect and reduce tension in the repair. Tension, otherwise, can lead to recurrence of the hernia.

The mesh is made of synthetic material such as polypropylene or polyester. Alternatively, the mesh may be a biologic graft derived from animal tissue. The biologic grafts are often used if there is great concern for an infection as they tend to be resistant to infections.

Choice of Repair
The decisions regarding the laparoscopic vs. open approach hernia repair surgery and regarding use of mesh vs. no mesh will be individualized based on the characteristics of the hernia and the discussion you have with your surgeon.