Tension Free Repair Method
Incisional (Ventral) Hernias
Surgical Repair of
Incisional Hernias can be SAFELY and EFFECTIVELY repaired, often as a "Same Day", out-patient ambulatory procedure. This includes many 'Recurrent Incisional Hernias as well. Very large and/or complex Incisional Hernias may, however require both General Anesthesia and/or and overnight hospital stay at Abington Health, Lansdale Hospital.
We utilize an advanced "Open" Technique (OVHR) for all Incisional or Ventral hernia repairs here at the North Penn Hernia Institute. Under most circumstances, our incisions are very small, and located directly over the hernia.
For the most common INCISIONAL HERNIA, we utilize a "Tension Free", "Rives-Stoppa" repair, recognized by Hernia Specialists worldwide as incorporating the critical posterior mesh placement (beneath the defect in the abdominal wall) necessary for an effective hernia repair. This technique is performed by carefully inserting a specially designed sterile "Mesh" safely and securely 'beneath' the hernia muscle defect to close and fully repair the hernia. Importantly, this mesh extends well beyond the under-edges of the muscle to reduce pressure on the hernia defect opening itself to thereby reinforce the entire area at the same time. The mesh is held in place without tension. No painfully tight sutures are placed to pull muscle unnaturally together, nor are staples or tacks utilized in this superior method. Although the mesh is placed beneath the muscle, a naturally occurring barrier, consisting of both the anatomic membrane lining of the abdomen (Peritoneum), and the Trans-abdominal (Transversalis) Fascia, is maintained between the mesh and the underlying intestine. This natural layer prevents problematic adhesions from forming to the intestines later on. Therefore, while the mesh is secure beneath the muscle, it is not fully within the abdominal cavity. It is positioned where it will be most effective, yet completely safe.
Several "Mesh Systems" are available. However, we feel that no two patients are alike and therefore no two hernias are alike either. All hernias differ from patient to patient, often quite significantly. We feel that no one single "Tension Free",operative approach nor one single mesh product system is suitable for all patients or all hernias. We may utilize one of the commercially prepared products, or, especially in larger incisional hernias, tailor a larger mesh to the specific needs, size and dimensions of the specific patient's needs. Regardless of the mesh product selected, we always place mesh in a Tension Free fashion, beneath the muscle (retrofascial, preperitoneal) where it is most effective.
In a published article in The New England Journal of Medicine -- August 10, 2000 -- Vol. 343, No. 6, entitled A Comparison of Suture Repair with Mesh Repair for Incisional Hernia, it was concluded that "in patients with incisional hernias, retrofascial preperitoneal repair with polypropylene mesh is superior to suture repair with regard to the recurrence of hernia, even in patients with small defects." We continue to support this conclusion and use this technique exclusively in all of Incisional Hernia repairs.
Surgery at NORTH PENN HERNIA INSTITUTE is tailored specifically to the individual needs of each and every patient, every time. We are highly experienced and expertly familiar with the various advanced Tension Free repair techniques commonly in use today. All of these mesh system methods and diverse products are fully available to us. Rather than utilizing the same mesh product for all hernias like a rubber stamp or assembly line approach, we individually tailor the precise mesh product (selecting the exact size, shape, configuration and manufacturerT necessary) at the time of surgery which is best suited for each hernia. This selection process, which is the foundation for what we call the "Benchmark" approach, is based on our extensive experience, developed by performing nearly one thousand various hernia repairs annually and "specializing" in hernia repairs for over 20 years. This expertise in both routine and complex Incisional Hernia surgery assures that all of our patients receive the most satisfactory, safest and importantly the most effective repair available.
Recovery is therefore more rapid! Pain is reduced, since muscles not cut and are neither pulled together nor sewn under tension. Post-operative restrictions are few, if any, and our patients can actually return to NORMAL activity in DAYS! This includes resumption of work and recreational activity when desired.
In smaller incisional hernias, with the patient awake, yet calm and sedated, comfortably free of pain, the risks of General Anesthesia are avoided. Our patients are walking shortly after surgery, and are discharged home within about 1-2 hours.
This fully effective contemporary repair technique allows for your comfortably rapid recovery. The advanced techniques we utilize are associated with the Lowest Risk of Recurrence when compared to most other older surgical techniques which place extreme tension on the muscle and the repair by simply cutting and sewing muscle together. Our Benchmark technique is equally safe and the fully effective for "Recurrent" Incisional Hernias as well.
In addition, and equally important, Hernia repair with this advanced "Benchmark" approach is:
- Safe and Fully Effective Surgical Repair
- Lowest Incidence of Recurrent Hernias in the Future (less than 1%)
- Minimal Post Operative Discomfort
- Few Restrictions on Activity
- RETURN TO NORMAL ACTIVITY IN DAYS!
Patients undergoing Incisional Hernia repair with this technique must be at or near Ideal Body Weight or with a Body Mass Index (BMI) not over 28 to achieve a safe and effective repair with this method, and to be considered a qualified candidate for Incisional Hernia surgery at North Penn Hernia Institute. CLinically significant studies have shown that the failure rate for Ventral/Incisional Hernia Repair is 400% higher in patients who are obese (regardless of the repair technique used). For any questions regarding this restriction, applicable to Incisional Hernia surgery only, please call us at 215-368-1122.
Comparison of Quality of Life in Open Versus Laparoscopic Ventral/Incisional Hernia Repairs
RECURRENT INCISIONAL HERNIAS, previously repaired elsewhere using mesh, especially in those individuals exceeding Ideal Body Weight or with a Body Mass Index (BMI) over 28 may not be amenable to a safe effective repair using this method. Consultation and examination prior to arranging surgery is mandatory in all situations of Recurrent Incisional Hernias (previously repaired with or without mesh and regardless of prior method) to determine a patient's candidacy for repair and to outline both a safe and an effective operative approach. While we are most happy to see such patients in consultation, it is strongly advised that a preliminary Telephone Consultation or E-mail Consultation be scheduled with one of our surgeons to determine you suitability and candidacy, so as to avoid unnecessary long-distance travel to the North Penn Hernia Institute. Importantly, the patient must be at or very near Ideal Body Weight or with a Body Mass Index (BMI) not greater than 28, and generally healthy medically to be considered an acceptible candidate for an INCISIONAL HERNIA repair procedure here at NPHI.
For Specific Questions on Incisional or other Hernia Repairs
or Call 215-368-1122
James A. Goodyear, M.D., F.A.C.S.
Surgeon and Director
Surgery is performed at
Abington Health, Lansdale Hospital
Outpatients Surgery Department
in Lansdale, Pennsylvania
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