HERNIA INSTITUTE OF PENNSYLVANIA
North Penn Hernia Institute
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FREQUENTLY ASKED QUESTIONS


and ANSWERS
About Hernia Surgery From The NORTH PENN HERNIA INSTITUTE




. . WHAT is a HERNIA?
A HERNIA, when related to the abdomen, is essentially a hole or defect in the abdominal wall muscle which normally acts to contain the abdominal organs. This defect can occur as a CONGENITAL defect in the muscle, or can be ACQUIRED from an acute or repetitive muscle stress or strain. As a result of the hole in the muscle, pressure in the abdomen tends to push the contents, or abdominal organs and surrounding tissue through the defect. This creates the characteristic "bulge" that is present in most hernias. A Hernia can be likened to an old "bubble in a tire" (for those old enough to remember these). The weakened and thinned out tire opens and allows the inner tube to push through.

. HOW SOON CAN I SCHEDULE SURGERY?
Surgery can be scheduled easily and quite rapidly at North Penn Hernia Institute at a date and time most convenient to you. Under many cases, surgery can be scheduled in about 1-2 weeks or less, and we can arrange for your surgery on any date (Monday through Friday) that is most convenient for you and your schedule. Appropriate forms can be printed off our site, completed, then Faxed or mailed to us, speeding the scheduling process.

VISIT our NEW PATIENT INFORMATION SITE

Hernia surgery is performed throughout the week. If you wish to arrange surgery via phone, or have specific arrangement or scheduling questions
CALL 215-368-1122
(Monday through Friday 9:00 AM to 4:00 PM)
If you have specific questions for our surgeons, and wish to speak to one of them personally before surgery, send us an E-MAIL
listing your name, phone number and best days/times to reach you. One of our surgeons will call you and speak to you personally about your hernia (free).

. WHAT DOES TENSION FREE HERNIA SURGERY?
Many older techniques for repairing hernias were performed by cutting and/or pulling the muscle together to close and repair the hernia defect. This creates a great deal of TENSION on the muscles, resulting in swelling, stiffness and pain. The swelling and pain can last for up to several months. In addition, the tension inhibits the healing process and therefore does not permit adequate healing of the sutured muscle edges. Under these circumstances, recurrent hernias are much more likely.

Our "TENSION FREE" technique eliminates this unnecessary swelling and pain by utilizing a specially designed surgical MESH, placed safely and securely beneath the hernia defect to accurately and effectively repair the hernia with minimal pain and a lower chance of recurrence.

. ARE ALL MESH REPAIRS "TENSION FREE"?
There are many uses for mesh in hernia repairs, but very few mesh repairs are true TENSION FREE repairs. Many surgeons still place tension on the muscles around the hernia defect by sewing them together, then apply mesh on top in an attempt to reinforce the repair. The tension on such a repair will heal poorly. Eventually, this type of repair will pull apart in a higher percentage of patients, lifting the mesh up and resulting in a recurrence of the hernia. In the TENSION FREE repair, mesh is safely placed beneath the muscle(not on top), extending broadly beyond the under edges of the hernia defect. The defect in the muscle is never sewn together under tension. It is not necessary to do so at all. While the mesh immediately and fully repairs the defect and the hernia, it also acts as a "growth-bed" ('rebar-like') for tissue in growth to essentially 'heal' the defect as the mesh becomes firmly, safely and comfortably incorporated in the abdominal muscle wall...WITHOUT PAINFUL TENSION !!!

. HOW IS THE MESH HELD IN PLACE ?
In our TENSION FREE TECHNIQUE, we do not suture muscle together under tension. The mesh is placed under the muscle defect to immediately, effectively and safely repair the defect. This mesh is positioned in a surgically created space identical is size and shape to the mesh being used. Like a hand in a well-fitting glove, once in place, the mesh has little or no tendency to move or migrate. We also place a few, loosely tied, 'tethering' and dissolvable sutures to orient the mesh in its proper location. These dissolve fully within weeks and place NO TENSION on muscle. As these sutures dissolve, the in-growth of tissue into and around the mesh continues to hold the mesh securely against the muscle without movement, in its effective position. This in-growth of tissue, which begins within hours of surgery, incorporates the mesh into the muscle wall as the defect uses the mesh as a scaffolding for healing.
RETURN TO TECHNIQUE


. CAN MESH BE REJECTED ?
The MESH used in hernia repairs is a synthetic plastic material (either Polypropylene or Gore Tex (PTFE)). Since it is plastic, it is totally inert or non-reactive in the body. Unlike materials made of foreign protein, plastic mesh cannot be rejected in the sense that a transplanted organ, composed of protein, can be rejected. In addition, allergy to the mesh material is virtually non-existent. Infection can very rarely develop but this occurs at an extremely low rate, and even then only rarely is repeat surgery necessary. Usually such an infection can be successfully treated with antibiotics.

. WHO IS "RIGHT" FOR TENSION FREE HERNIA SURGERY?
Virtually all patients, of all ages can have their hernias repaired using a "TENSION FREE" surgery technique. This procedure repairs the hernia defect using mesh rather than pulling muscle together. Tension on the muscle associated with older repair surgery causes swelling and severe pain and slows recovery. Our technique, performed with local anesthesia and sedation avoids this tension. Recovery therefore is QUICK, and well tolerated by men and woman of all ages. Hernias in children are effectively repaired in a "Tension Free" fashion without mesh in most cases.

. WHICH HERNIA TYPES CAN BE REPAIRED USING THE 'OUTPATIENT', SAME DAY TECHNIQUE?
The principle of TENSION FREE hernia repair can be applied to the surgical correction of most all abdominal wall hernias. Most hernias can be safely and effectively repaired using our outpatient TENSION FREE technique, allowing return to normal activity in DAYS. This includes: Extremely Large Incision or Ventral Hernias and Hiatal (esophageal) Hernias do require hospital admission, and General Anesthesia.

. WHAT IS MEANT BE "LOCAL ANESTHESIA"?
At North Penn Hernia Institute, most hernia repairs do not require full General Anesthesia in which the patient is put to sleep. Rather, in over 95% of the cases, we administer a safe, short-acting sedative intravenously to allow our patients to be fully relaxed and calm. The skin at the area of the surgery is then gently injected with a local anesthetic (like Novocaine). Once the skin is fully anesthetized (frozen or made numb), the local anesthetic is carefully injected into deeper layers. Patients are hardly aware that this process is ongoing and remain fully calm, relaxed and pain-free. Once the region is fully anesthetized, surgery can be safely and effectively performed in a pain-free fashion, while the patient is awake, yet again they remain calm, relaxed and quite comfortable.
In addition to the safety benefit of avoiding general anesthesia, the use of local anesthesia allows us to have our patients cough, strain and press down during surgery. This allows us to examine the repair at surgery to assure its security, completeness and integrity under somewhat normal dynamic conditions. This is an important "check-point" that cannot be utilized while the patient is asleep or under spinal anesthesia.

NOTE-Large and/or complex or multiply recurrent hernias (such as large Incisional Hernias etc.) may require light general anesthesia on rare occasion. However, most of our hernia repairs are performed using local anesthesia with sedation as described above.


. WHAT ABOUT LARGE AND COMPLEX HERNIA?
Even large, recurrent and complex hernias can be successfully repaired using a TENSION FREE approach. While at times, some of these hernias require general anesthesia to be effectively repaired, most Inguinal Hernias and Umbilical Hernias as well as many Incisional Hernias can be repaired with sedation and local anesthesia, even if they are large or complex.



. HOW IS A HERNIA BEST DIAGNOSED?
A Hernia cannot be fully diagnosed or evaluated by Symptoms alone. The diagnosis is made on physical examination by a physician trained in the evaluation of hernias. They are found when a "bulge" is present coming through a hole or defect in the muscle. In difficult or complex cases, a HERNIA SPECIALIST examination and at times specific tests (scans) may be recommended.

. WHAT IS THE COST and WILL MY INSURANCE COVER THE SURGERY?
Most Health Insurance plans cover the costs of hernia surgery performed at the North Penn Hernia Institute, including many HMO plans with appropriate referral. Patients are responsible for any contractual CO PAYS or DEDUCTIBLES in their plans. For those with special needs, or who are not covered by health insurance, additional options are available. Full details can be obtained by calling the office of North Penn Hernia Institute during regular business hours (Eastern Time Zone).
Ask for the
"HERNIA SURGERY ADMINISTRATOR".
PHONE 215-368-1122


. WHAT IF I HAVE OTHER MEDICAL PROBLEMS?
Since our surgery is performed under local anesthesia, the risks associated with General Anesthesia (being put to sleep) are avoided. Most patients whose medical conditions (Heart Disease, Diabetes, High Blood Pressure etc.) are controlled, tolerate our hernia technique quite well, even being discharge on the "SAME DAY" in most cases. In few instances, Medical clearance from your personal physician may be requested. We will be happy to discuss this with you by telephone prior to your visit.

. WHAT ABOUT POST OPERATIVE VISITS?
For those traveling a distance for surgery, you will have a comprehensive post operative evaluation prior to leaving for home, either the day of surgery, or the next morning. Post operative care and expectations will be fully discussed with you at that time. Your sutures are 'dissolvable', so care of your small incision is minimal, and your instructions are quite straight forward. Follow up discussions by phone will also be arranged for you.




. HOW LONG IS THE RECOVERY?
Because there is no cutting nor sewing of muscle edges together and no placing the repair under tension, pain is minimal, restrictions after surgery are few and brief, and the recovery period is the most rapid of any surgical repair for hernias. There is actual return to normal activity, without restrictions, safely and comfortably in DAYS!

MOST RAPID and SAFE RETURN TO NORMAL ACTIVITY

  • RAPID RETURN TO WORK (DETAILS)

  • RAPID RETURN TO SPORTS and RECREATION (DETAILS)

  • HOW SOON CAN I TRAVEL AFTER SURGERY (DETAILS)
Note-The above recommendations are appropriate under most circumstances following Inguinal (Unilateral or Bi-lateral), Umbilical or Femoral Hernia repair. Recovery following Incisional and or more complex hernias may be somwhat longer depending on the nature and complexity of the hernia, and patient' over-all health status.


. WHEN CAN I RETURN TO WORK?
Under most circumstances following Inguinal (Unilateral or Bi-lateral), Umbilical or Femoral Hernia repair, patients are permitted to drive (if licensed) in about 2-3 days. People's job descriptions and duties do vary. With a more sedentary job (desk/office employment), patients may SAFELY return to work at any time they desire (2-3 days in most cases including driving to and from work). More physically active employment and light laborers can usually return to work, generally unrestricted in most cases, after only 10 days to 2 weeks(or less). Heavy laborers may, in some cases, require 3 weeks before returning to full job activity, but are quite active and may pursue more moderate activity and work much sooner. (See ADDITIONAL DETAILS)

. WHEN CAN I PLAY SPORTS AND RESUME RECREATIONAL ACTIVITY?
We allow and in fact encourage rapid resumption of physical and recreational activity under most circumstances following Inguinal (Unilateral or Bi-lateral), Umbilical or Femoral Hernia repair. FOR EXAMPLE:
  • IMMEDIATELY AFTER SURGERY
    Brisk walking, treadmill and stationary bike activity can usually be resumed immediately. Jogging can usually resume in 2-3 days, along with gentle swimming and light golf {Short Irons and Putt} activities.
  • 5 to 7 DAYS AFTER SURGERY
    Moderate aerobic exercise, and light to moderate free weights and exercise activity can start in 5-7 days(Golf, Light Tennis, Alpine Skiing {GREEN and Groomed BLUE Slopes Only Initially}
    , Skating, Bowling, Softball, Lap Swimming and Hiking).
  • 10 to 12 DAYS AFTER SURGERY
    By 10-12 days, most sports and recreational activities can be safely resumed in most cases(Full Tennis, Cycling & Mountain Biking).
  • 2 WEEKS POST OPERATIVELY
    Full and unlimited activity is permitted about 14 days after surgery. This includes competitive and contact sports(ie Baseball, Football, Soccer, Hockey, Skiing, Limited Weight Lifting etc).

  • IMPORTANT NOTICE**While these are average recommendations, each case may differ slightly, and specific instructions will be given to each patient based on his or her physical needs, ability, skill, and training level. **




. HOW SOON CAN I TRAVEL AFTER SURGERY?
A considerable number of our patients travel to the North Penn Hernia Institute from states outside of Pennsylvania. However, after a brief period of observation, we do allow patients to be discharged on the SAME DAY as surgery, and permit them to even travel for a several (3-4) hours. For those coming from a longer distance, we suggest Local Lodging in the area. After a brief examination by your surgeon the next morning, you are permitted to travel home by any mode of transportation, including air travel. We can assist with local lodging at special rates if you desire.

NOTE-For those patients with Incisional Hernias or Large and/or Complex Hernias, a longer stay for 2 or more days after surgery in the area may be requested. Please discuss this with your surgeon prior to making final arrangements.

. WHY SHOULD I CHOOSE A "HERNIA SPECIALIST"?
Many Surgeons perform hernia surgery as just a small portion of their practice, repairing, on average 30-40 hernias per year. But hernia surgery has changed recently and quite significantly. New research has shown that hernias differ significantly form patient to patient, and therefore, the type of surgery necessary must be specifically tailored to the patient. The old "standard" hernia operations are now known to be neither as safe nor as effective as was once thought. As "HERNIA SPECIALISTS" our experience with repairing hundreds and hundreds of varied hernias annually allows us to use our expertise to evaluate the physical forces and anatomy found in the hernia at the time of surgery. We then expertly select that proper method and technique of repair (always TENSION FREE at North Penn Hernia Institute) that is best suited for that particular patient, and that particular hernia. Unlike many so-called hernia centers, we do not feel that a single hernia operation is right for all patients and all hernias. We utilize a variety of different yet specific TENSION FREE repair methods to assure our patients that they will receive not only the SAFEST, but the MOST EFFECTIVE repair of their hernia available anywhere.

. WHAT ABOUT HIATAL HERNIAS?
Hiatal Hernias, unlike abdominal wall hernias, occur within the abdomen, and are hernias of the diaphragm. These hernias causes reflux of acid from the stomach into the esophagus leading to heartburn, pain and erosion or ulceration of the esophagus. While the treatment is predominantly medical, occasionally patients do require surgery. Surgery for this condition is performed through the Laparoscope (unlike our 'BENCHMARK' TENSION FREE approach for abdominal wall hernias).


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