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Frequently Asked Questions

 

Most patients are candidates for laparoscopic inguinal hernia repair. In rare instances, due to prior surgery in the lower abdomen such as radical prostatectomy, hysterectomy, or colon resection, the resultant scar tissue may prohibit a laparoscopic approach. In these instances, an open approach may be necessary.

Factors influencing the approach to hernia surgery include nature of surgery, patient characteristics, surgeon training, facility equipment, etc. Dr. Zaré believes the ideal approach for each procedure is the safest and the least invasive approach. For the most complex hernia repairs like repair of hiatal or para-esophageal hernias, robotic surgery has added advantages over laparoscopic and open surgery and is our preferred approach. For other procedures like repair of inguinal hernias, laparoscopic surgery with the totally extraperitoneal approach (TEP) is the gold standard approach. Since it can only be performed laparoscopically, that is our favored approach. For umbilical, peri-umbilical, ventral, and incisional hernias, open tension-free retro-rectus approach that can be performed through a single limited incision offers the least invasive approach, as one can avoid multiple incisions, intra-abdominal adhesions, and mesh exposure to the abdominal viscera.

Laparoscopic inguinal hernia repair usually takes 30 minutes to complete. Open umbilical or small ventral hernia repairs usually take 30 minutes, while larger ventral or incisional hernia repairs may take 45-60 minutes. Robotic hiatal or para-esophageal hernia repairs usually take 90-150 minutes to complete.

This depends on the type of surgery. Majority of abdominal wall hernia repairs are performed at ambulatory surgery centers and you are discharged home within an hour of completion of the procedure. Robotic hiatal or para-esophageal hernia repairs are performed at the hospital, and you are discharged home the day after surgery.

No. Because of anesthetic drugs and pain medications, you will not be able to drive immediately after surgery. A responsible adult will need to accompany you home.

This varies greatly by the type of surgery. For laparoscopic inguinal hernia repair, return to day-to-day activities takes only 1-2 days. Return to strenuous unlimited activities resumes only 7-10 days after surgery. For umbilical, ventral, and incisional hernia repairs, day-to-day activities resume 3-4 days after surgery, and strenuous activities 3-4 weeks after surgery. For repair of hiatal or para-esophageal hernias, day-to-day activities resume 1-2 days after surgery, and strenuous activities 2-3 weeks after surgery. Always consult with Dr. Zaré before resuming strenuous activities.

Day-to-day activities include getting in and out of the bed, walking, going to the bathroom, climbing stairs, etc. Strenuous activities include those that actively engage the core muscles or involve lifting more than 25 lbs.

Since most incisions receive surgical glue, shower can be resumed immediately after surgery. Bathing can resume after 3 weeks.

No. Incisions will have absorbable sutures underneath the skin, and surgical glue on the skin. The glue will stay for 2-3 weeks, after which it will start peeling off. At that time, the glue can be removed manually.

Yes. To understand why mesh is used in repair of hernias, one has to know the history of non-mesh repair of hernias. Beginning in the late 1880’s, surgeons began performing hernia repair using native muscles to bridge the hernia defect. This placed undue tension on the muscles and caused excessive pain. More importantly, it led to high rate of recurrence of hernia. In some series recurrence rates of over 20% were reported. Then, nearly one hundred years later, in 1980’s tension-free hernia repair using prosthetic mesh was introduced. This was a seismic change in concept. Because no tension was placed on the muscles around the hernia site, this approach led to decreased post-operative pain and significant reduction in recurrence rates.

Each year, more than one million hernia repairs are performed in the United States. Tension-free repair with prosthetic mesh is the standard of care and utilized in the majority of patients. Because of use of mesh, which is a medical device, the outcomes of these operations are monitored closely by the Food and Drug Administration (FDA). To date, there has been no advisory against the concept of tension-free repair of hernias with prosthetic mesh. There have been recalls against specific products with flaws, either in design or material. There have also been instances of mesh-related infections in procedures such as repair of prolapse of pelvic organs or transvaginal surgery, where use of mesh was not indicated by the FDA. Dr. Zaré follows a strict protocol when using mesh and utilizes the time-tested polypropylene mesh under stringent aseptic conditions. To date, in our practice with two decades of experience, there has been no indication to remove a mesh due to chronic nerve pain.