Hernia surgery

[Armitage]

Let me start off by saying that I have a call in to my primary care physician & surgeon on this question also - not really looking to ATOT for a diagnosis, but rather for personal experience/opinion or additional resources.

I have an umbilical hernia - I've had it for years, but it's getting worse to the point that I need to do something about it. So I'm scheduled for surgery next Tuesday. The recovery time described is more then I was initially expecting - out of work for 5+ days, no driving for 4-6 days, not back to 100% for 4-6 weeks Some quality neffing time though!

What my surgeon described is what I would now describe as the "traditional" repair - cut you open, stuff things back inside, and then stitch the muscles back together. This puts alot of strain on the surrounding muscle, which leads to alot of pain, and possibly weakening the surrounding muscle wall.

I did some googling this weekend and found some stuff about "tension free" hernia repair. The idea being that they just stick a piece of polypropylene surgical mesh behind the rupture to keep everything in place, but don't suture the muscle back together. Recovery time is advertised as about 1/4 that of traditional, and reoccurance rate about 1/2 that of traditional (although that study was on a different type of hernia).

I say advertised, as I've found this information primarily on websites for specific surgical clinics and medical equipment manufactures, and I'm uncomfortable with the potential bias.

So does anyone have any insight or experience with this issue? Any place to find papers or clinical studies and such?

Cliff's Notes: If you can't be bothered to read it, don't bother to reply

 

[Blastomyces]

Here's some quick info, ask your surgeron about what he prefers. Most fo the literature focuses on inguinal hernias, but the most improtant thing ins to close the wound so that there is no tension across the sutures so the the muscles can heal together. For small hernias this can be done directly, for larger ones mesh is required.


Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia.

Kurzer M, Belsham PA, Kark AE.

British Hernia Centre, 87 Watford Way, NW4 4RS, London, UK. surgeons@hernia.org

BACKGROUND: Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias. METHOD: Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect. RESULTS: Postoperative pain was graded as mild ( n=37) and moderate ( n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively-mean follow-up 43 months (28- 67). There were no recurrences. CONCLUSION: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.





A new tension-free technique for the repair of umbilical hernia, using the Prolene Hernia System--early results from 48 cases.

Perrakis E, Velimezis G, Vezakis A, Antoniades J, Savanis G, Patrikakos V.

Department of Surgery, Western Attica General Hospital, 1 Dodekanisou Street, 12351 Athens, Greece.

Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the umbilical ring. The median operating time was 35 min (range, 28-40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1-24). Our early results indicate that the described tension-free technique could become the standard treatment for umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure.


Umbilical and epigastric hernia repair.

Muschaweck U.

Department of Hernia Surgery, Arabella-Klinik, Arabellastrasse 5 81925, Munich, Germany. info@hernien.de

The repair of umbilical and epigastric hernias still represents a challenge to surgeons. Although a common and relatively simple procedure, there is no exact protocol today on how the repair should be done. The Mayo technique and its alterations could not stand the test of time: a recurrence rate of 20% and higher is not acceptable for any surgical procedure. Although there is no consensus opinion, one thing is clear: the importance of an anatomic repair without tension and without an artificial enlargement of the defect. In 1987 Lichtenstein reported on 6321 cases of herniorraphy with a tension free repair, and in 1994 Stuart reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato and coworkers in Italy also states the advantage of a tension-free prosthetic repair in 16 patients with epigastric hernia. We have gone even further and recommend a tailored-to-the-patient repair using a customized polypropylene mesh and a one-layer running suture. The advantages should be obvious: no artificial creation of an even bigger than original defect, a completely tension-free repair, and little to no recurrence of the hernia. Our results clearly prove that assumption. Moreover, the procedure is extremely safe and complications are very rare and minor. We conclude that using a mesh plug in a customized tension-free repair of umbilical and epigastric hernia shows many advantages over the commonly used methods. And we finally conclude with the words of Albert Einstein: "The only source of knowledge is experience."

 

[Armitage]

Wow, thanks!
As you say, most stuff I've seen referred to inguinal hernias ("turn your head & cough" ), and most of what I found for umbilical hernias refers to pediatric cases.

Where'd you find this stuff? I'm guessing some kind of for-fee medical database? Any chance to get the whole paper? Not that it would mean much to me, but the surgeon might be interested - though I'm not all that interested in being a guinea pig for his first try of a technique he just learned about from a paper brought to him by a patient!

Thanks again!

 

[Armitage]

Update - I just got off the phone with my surgeon. He says that he almost always uses this technique for inguinal hernias, but less often for umbilical. He doesn't think that mine is serious enough to warrant it, though he decides on a case-by-case basis once he gets in there. He also mentioned that there isn't much literature for using it in umbilical cases, so I may take him those references above anyway.

I guess I'm a bit more comfortable knowing that he's aware of it and considers it an option.