Hernia Treatment
with City Surgical Care

Surgical Hernia Repair

There are several hernia surgery options available to patients but, in our opinion, there is no “one size fits all approach”. In general, two major categories exist, mesh and no mesh hernia repair.

Mesh or No Mesh Hernia Surgery?

Our hernia surgeons are not advocates of mesh repairs. Data suggests over 50% of those implanted with mesh have significant issues resulting from the implant, such as chronic pain and infection or foreign body reaction to the mesh. In fact, a large part of our practice is based on the removal of previously implanted mesh and redo repairs by our hernia surgery specialists.

If we do implant mesh in our practice, we use what is called a biologic mesh. This is a specialized type of mesh that becomes part of your body, and infiltrated with your own tissue. Biological mesh is not widely used because it is far more expensive than conventional mesh. At City Surgical Care, we feel the benefits to our patients are worth the cost.

The primary benefits include much lower risk of chronic pain and foreign body reactions and lower risk of infection. These two issues are the leading cause of post-operative mesh complications and the main indications for mesh removal after implantation. Even when we use biologic meshes, we minimize the size of the implant to ensure the risk of complications is as low as possible in order perform the most stable and successful repair.

Laparoscopic vs Open Repairs

We feel laparoscopic repairs are best for older, high-risk patients who cannot tolerate abdominal incision. Patients who are sedentary and not particularly concerned with perfect alignment of their core muscles are also good candidates.

The vast majority of our patients do not fit into either of these categories. More commonly, we see patients after significant weight loss or multiple pregnancies, and are otherwise quite healthy and active.

Patients after weight loss and pregnancies often have more complex defects that require more intensive repairs. In addition, the excision of excess skin and loose tissue and realignment of their abdominal wall musculature are common factors.

For this reason, our hernia surgeons utilize 2 separate types of incisions for all or our hernia repairs.

1. Simple hernia repairs are performed through a small belly button incision. In groin hernias, the incision is made below the waistline.
2. Complex hernia repairs with multiple problems or excess skin and tissue are addressed through a lower abdominal “tummy tuck” incision. Tummy tuck incisions address all issues in the abdominal wall at once. It can be much more difficult to address the abdominal wall through this incision, however we have become quite adept at this approach and feel that the overall result is hugely beneficial to the patient. In addition, we can remove any excess skin and tissue at this time that is either bothersome to the patient in terms of skin irritation, or that may impair wound healing, or prevent full exposure at the time of operation. The overall result is a much more aesthetically pleasing, functional, and strong abdominal wall.

We focus deeply on specialized repair to encompass all functional issues while at the same time improving aesthetic ones.

Muscle Flap Repairs/Component Separation Repairs

In some instances, a component separation repair is necessary. There are specific indications for this procedure, such as large or complicated defects, the presence of infection, or in recurrent hernias.

Component separation repair is the gold standard hernia repair. It is a very specialized repair that we are adept at performing.

Risks of Hernia Repair Surgery

Any surgery or procedure has a theoretical risk of bleeding, infection, blood clots, and damage to adjacent structures. This is the same with hernia repair surgery. Prosthetic mesh complications confer a significant amount of risk, and for this reason we avoid them at all costs and use non mesh or biologic mesh repairs.

More complex, more chronic, and redo hernias always confer a higher risk due to variants in anatomy and scar tissue, as well as a poor blood supply, however our hernia specialists have a significant amount of experience with redo surgery at City Surgical Care, in even the most high risk patients.

Risks of Not Repairing a Hernia

In most cases, hernias are not an emergency and repair is elective. However, the longer you wait to repair your hernia, the greater the risk of more serious problems occurring.

In general, pain, tenderness, and bowel strangulation (in an emergency) are the risks. For these reasons, we believe almost all hernias should be repaired if identified.

If, for some reason, you must delay repair, we always inform patients on how to avoid an emergency. In general, most hernias can be “reduced” at home, meaning you can push whatever is stuck, back in. This typically avoids emergency operations, but should be discussed with your surgeon, as this is not a long-term solution.