Incisional (Ventral) Hernia Repair
Most incisional hernias, including recurrent incisional hernias, are safely repaired using our “Tension-Free” procedure. Under most circumstances, our incisions are very small, and located directly over the hernia. This mini-incision technique requires only mild sedation and local anesthesia in the majority of cases. Procedures to repair very large and/or complex incisional hernias may, however, require the use of general anesthesia and possibly an overnight stay at Abington - Lansdale Hospital.
This “Tension-Free” 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. This mesh extends well beyond the under-edges of the muscle to reduce pressure on the hernia defect opening and reinforces the entire area. The mesh is held in place without tension.
There is no need to place painful, tight sutures, staples or tacks to pull muscle unnaturally together. By utilizing mesh to reinforce the defect, suture-line tension used in other standard tissue-to-tissue repairs is eliminated and the normal anatomic structure and physiologic functions of the inguinal area is preserved. 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.
Tailored to the Patient
Our surgeons choose from several mesh systems to best match patients’ unique needs. Hernias differ from patient to patient, often quite significantly. One single tension-free operative approach or single mesh product system may not be suitable for all patients or all hernias. No 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 patient. Regardless of the mesh product selected, it is always placed beneath the muscle (retrofascial, preperitoneal) where it is most effective.
Surgeons at North Penn Surgical Associates perform various advanced Tension-Free repair techniques commonly in use today, and utilize many diverse mesh systems. We individually select the precise mesh product (selecting the precise size, shape, configuration and manufacturer) at the time of surgery that is best suited for each hernia. Our expertise in both routine and complex hernia surgery assures that all of our patients receive the most satisfactory, safest and importantly the most effective repair available.
Recovery is rapid, pain is minimal, since muscles are not cut and are neither pulled together nor sewn under tension. Post-operative restrictions are few, if any, and our patients can return to normal activity in a short period of time.
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 one to two hours.
The advanced techniques we utilize are associated with a lower risk of recurrence when compared to most other older surgical techniques that place extreme tension on the muscle and the repair by simply cutting and sewing muscle together.
Patients undergoing incisional hernia repair with this technique must be at or near their ideal body weight or have a Body Mass Index (BMI) below 28 to be considered a qualified candidate. 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.
Comparing Open Versus Laparoscopic Ventral/Incisional Hernia Repairs
Recurrent incision hernias, previously repaired using mesh, especially in individuals exceeding their ideal body weight or with a Body Mass Index (BMI) over 28 may not be amenable to being effectively repaired using this technique. Consultation and examination prior to arranging surgery is mandatory for patients with 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, effective operative approach.
Consultation by telephone or e-mail may be scheduled with one of our surgeons to determine the patient’s suitability and candidacy to avoid long-distance travel. Importantly, the patient must be at or very near ideal body weight or with a Body Mass Index (BMI) below 28, and generally healthy to be considered an acceptable candidate for an incisional hernia repair by North Penn Surgical Associates.
125 Medical Campus Drive
Lansdale, PA 19446