Beth Israel Hernia Center surgeons are hernia experts. We are vastly experienced at treating a wide range of hernia types, using a variety of repair materials and the latest techniques. We also work closely with other surgeons in a team effort, when necessary. For instance, with complex repairs, abdominal wall reconstruction is often necessary. Not only do our surgeons consult with plastic and reconstructive surgeons prior to surgery, but also work alongside them during surgery to minimize the number of operations needed to restore normal appearance. Here are some of the procedures we offer:
Standard open repair with mesh
The goal of this surgery is to close the hole in the muscle, in most cases with a synthetic mesh placed within the tissues to strengthen the abdominal wall and decrease the likelihood that the hernia will come back over time. The mesh acts as a scaffold to allow the body to produce natural scar tissue in and around it to keep the hole closed. The down side of mesh is that the patient has a larger incision, a longer recovery and some risk of the body rejecting the mesh.
Open mesh repairs are often done using laparoscopic surgery (using a small, inserted tube to view the area and small instruments to perform the repair), or with a single open incision just above the groin crease (inguinal hernia and femoral hernia), over the bulge (ventral hernia), or in the old scar (incisional hernia). This surgery is usually done as an ambulatory procedure (you go home the same day), though sometimes it may require a short hospital stay (typically only for incisional hernia).
For more complex hernias, such as giant abdominal wall hernias, the abdominal wall is under too much tension to be pulled back together once the intestines and organs have been returned to their proper location. Options to make up for this lack of original tissue are to use a large prosthetic or biologic mesh beneath the abdominal wall to bridge the gap. The skin is then closed over the top of mesh.
For parastomal hernias, mesh is used extending over and beyond the hernia to reinforce the whole weakened muscle wall. This serves to avoid future recurrences, commonly seen when these hernias were repaired with stitches alone. Parastomal hernia repairs can often be accomplished using either an open or laparoscopic technique.
Standard open repair without mesh
In some cases (femoral hernia, ventral hernia, umbilical hernia), stitches in the abdominal wall alone can close the hole and a mesh is not needed. This allows the patent to avoid some of the complications associated with mesh but they also face a greater risk of hernia recurrence. When it comes to determining which repair option (with mesh or without mesh) to choose, our surgeons make the decision based on the size of the hernia, the strength of muscle around the repair and the overall condition of the patient. Sometimes the decision is made before surgery, sometimes during.
Minimally invasive repair
Various minimally invasive techniques are used to repair some hernias whether mesh is used or not. Using a video monitor, surgeons can guide laparoscopic and/or robotic-assisted instruments into extremely small spaces using a camera.
As with all minimally invasive techniques, patients usually experience shorter recovery time, less scarring, less pain and less complications. Following surgery, patients are either discharged that same day or stay in the hospital for only one to two days.
This procedure is often necessary in a giant abdominal wall hernia where there is not enough original muscular wall to be pulled back together. This surgery separates and advances the abdominal wall muscle layers to lengthen the reach of each side towards the midline. In this way, defects of up to 20 cm at the waistline can be bridged. In many giant abdominal wall hernias, a combination of this technique and mesh repair is used. Component separation may require a hospital stay of up to a week or more.
To make an appointment with one of our surgeons at the Beth Israel Hernia Center, please call 212.844.1555.
If you have questions about the Hernia Center and our doctors please email them to firstname.lastname@example.org.
We are glad to answer your questions but please do not send pictures of your hernia to the center.