Hernia Surgery

At the Hernia Center of Southern California, all hernia repairs are performed on an out-patient, same day basis safely and effectively, regardless of whether or not your hernia is recurrent or not. We realize each of you is coming to us with unique needs and situations, which is why the surgical procedures at the Hernia Center of Southern California are specifically tailored for each of you.

The Hernia Center of Southern California does not currently use the Laparoscopic method. Only about one in ten surgeons performs laparoscopic hernia repair as this method is still evolving. Teaching hospitals by far have the greatest experience in this method.

Tension Free Mesh Technique

The Tension Free Mesh Technique is the preferred method of hernia repair and has been in practice since the early 1970's. This technique utilizes specially designed "mesh", which can be altered to fit the exact needs of every patient. With the Tension Free Mesh Technique an incision is made directly over the site of the existing hernia. Any protruding tissue is returned to its proper position through the weakness or tear in the abdominal wall. At this time specially designed mesh is also placed on the inside of the tear or weakness, helping to repair the hernia from the inside.

Tension Free Hernia Repair Video

 

The safest, most effective way to repair a hernia is with the advanced Tension Free Mesh technique as practiced here at the Hernia Center of Southern California for over ten years. This advanced technique is ideal for repairing inguinal hernias in addition to many other
types of hernias.

"I just completed three ultras in two weeks (running an Angel 50 miler, Avalon 50 miler and the Calico 50K) and did well in all of them. I believe that I have become a better runner than ever since having my hernia surgery 3 months ago. These were just training runs. The big runs come in June and July."

- William H. Andrews, PhD
Founder & VP of Research
Sierra Sciences, Reno NV


As opposed to the "tension" method first used back in the 1800's, the highly advanced Tension Free Mesh technique reduces the chance of recurrence to only 1 in 200, or 0.5%, provides shorter recovery time and greatly reduces post-operative pain. Although some "tension" methods are still in use today, we at the Hernia Center of Southern California believe in, stand behind and practice only highly advanced Tension Free hernia repair. The Tension Free technique involves the placement of synthetic mesh in the inguinal area to repair and strengthen, where as the old "tension" method involved sewing the edges of the weakness or tear together with muscles.

With the Tension Free Mesh technique, we are able to tailor surgery more to the individual by selecting appropriate mesh for the shape, size and location of the individual hernia. As each of you is a unique individual, so is your hernia. We understand there is no such thing as "one size fits all" and your hernia shouldn't be handled by any type of less effective approach. The basis behind our "tension free" approach is not to create unnatural tension - where it so obviously failed before - by cutting and sewing muscles into new places, but rather to avoid tension entirely.

 

By making effective use of sterile, flexible polypropylene mesh to reinforce and support the surrounding tissue we are able to effectively repair primary and recurrent inguinal hernias as well as most other abdominal wall hernias. The mesh assists the new tissue growth, almost like a lattice assists flowers or plants in that it acts a stable platform for the new growth to come together and strengthen upon, as it incorporates itself safely and easily into your abdominal wall. Incredibly flexible and thin, you are unable to feel the mesh and it does not inhibit activity at all after surgery. Extending beyond the edges of the original weakness or tear, the mesh also supports the weak, thin tissue surrounding the hernia where it is most effective and will not lift or separate later with strenuous physical activity or excessive abdominal strain.

We have perfected our surgical techniques in such a way that we are even able to test and maximize the strength of the hernia before surgery is complete. Our proprietary methods enable you to return to everyday activity quicker.

 

Conventional Method

The Conventional Method has been widely used by surgeons and hernia specialists since the early 1900's and is still widely practiced today. With the Conventional Method, an incision is made directly over the site of the existing hernia. The tissue protruding through the opening is then returned to the abdominal cavity and any sac that may have formed is removed. The initial weakness or tear in the abdominal wall is then repaired with strong surrounding muscle, which is sewn over the weakness or tear. This method requires patients lift no more than 40 lbs. after surgery and is associated with a high rate of recurrence, a prolonged healing time of six to eight weeks and usually entails more post-operative pain.

 

Laparoscopic Method

The Hernia Center of Southern California does not currently use the Laparoscopic method. Only about one in ten surgeons performs laparoscopic hernia repair as this method is still evolving. Teaching hospitals by far have the greatest experience in this method.

While the complication rate and the amount of time needed to return to work are the same, laparoscopic surgery requires the use of general anesthesia as compared to the open method which uses local anesthesia or local anesthesia with sedation. Another major drawback of laparoscopic hernia repair is that patient's are more prone to develop permanent dehabilitating pain. On the other hand chonic pain after open hernia repair surgery usually responds to pain management. Lastly, due to the pelvic scarring that results from the laparoscopic method, patients can no longer undergo either laparoscopic prostate surgery or some of the peripheral vascular surgeries.

The Laparoscopic Method, which has been in practice since the 1980's, uses a light tube and video camera inserted into small incisions, each no more than one centimeter in length. The video camera, inserted into one of the incisions, allows the surgeon to find and view the hernia during the entire operation while the other incisions allow the surgeon internal access to the hernia to perform the surgery. Once the hernia is repaired using techniques similar to that of the Tension Free Mesh technique, the surgeon removes all instruments used during the surgery and uses a single stitch to close each of the small incisions. However, Laparoscopic surgery is not for everyone. If you have 1) a large or incarcerated hernia, 2) previous pelvic surgery (i.e. prostatectomy, etc.) or 3) if you cannot tolerate general anesthesia then laparoscopic surgery is not for you. In addition, laparoscopic surgery is more costly than more traditional methods of hernia repair and may require slightly more time to complete the procedure.

 

 

NEUROMA SURGERY

SURGERY FOR POST HERNIORRHAPHY PAIN SYNDROME

SURGERY FOR CHRONIC PAIN AFTER INGUINAL HERNIA SURGERY

Many general surgeons refer patients with chronic pain after hernia surgery to the Hernia Center of Southern California. These patients are suffering from a condition known as Post Herniorrhaphy Pain Syndrome. This condition affects approximately 3-5% of all inguinal hernia surgery patients. The cause of Post Herniorrhaphy Pain Syndrome cannot be determined without a thorough examination. In addition, radiological examinations may be required to determine the cause of the pain.

Below is a list of the more common causes of post herniorraphy pain syndrome:

•  A missed hernia. A patient may actually have two hernias, such as an inguinal hernia and a femoral hernia. If the surgeon misses one of the hernias during surgery then the remaining hernia may cause pain.
•  Recurrent hernia. A hernia may have reoccurred and be painful.
•  Post operative neuroma formation. The end of a cut nerve forms a painful nerve ending.
•  Nerve damage as a result pinching or crushing the nerve during surgery.
•  Nerve entrapment in scar tissue.
•  Misplaced mesh.
•  Contracted mesh or a contracted mesh plug can cause a meshoma, which may be exerting pressure on a nearby nerve.
•  Wound infection.
•  Constriction of the spermatic cord causing a painful testicle.
•  Periostitis from a suture placed in the pubic bone.
•  Unrelated pain caused by an organ near to the region of the hernia repair such as the genital organs, intestines, pelvic organs, or abdominal wall muscle.

The treatment of the pain is aimed at the cause. If there is a recurrent hernia, or a missed hernia, then surgery is required. For pain unrelated to the presence of a hernia, conservative management is instituted. The first line of conservative treatment is with oral medications. In addition, physical therapy may be required. After a trial of oral medications, if the pain is still persistent, then local injection treatments consisting of a combination of anesthetic medication and corticosteroids may be necessary. This medication may be injected in the region of the pain, or at times in the nerve root close to the spine. Once injection therapy is instituted, it is usually administered in a series of three injections given over three weeks. If relief is obtained then the patient has the option of continuing an additional series of pain injections.

The typical results of conservative treatment are as follows:

  • Partial relief of pain 33.3%
  • Complete relief of pain 33.3%
  • No relief of pain 33.3%

Patients who experience dehabilitating pain despite conservative therapy consisting of a combination of oral pain medication, physical therapy and injections may require additional surgery. Surgery is an option usually after a trail of conservative treatment and a waiting period of 6 to 12 months after surgery, at which time a repeat operation is preformed to correct the cause of the pain. However, the cause of the pain cannot always be determined prior to surgery. The operation preformed is a wound exploration and triple neuropathy, in which all three groin nerves are divided, the nerve endings are ligated and buried in the surrounding muscle tissue. The results of a repeat operation are not always successful in alleviating the pain. Since the nerves are cut intentionally during this operation all patients will experience an area of numbness that will be permanent. The recovery period after this operation is 4 to 6 weeks.

The typical results of surgical treatment are as follows:

  • Partial relief of pain 30%
  • Complete relief of pain 50%
  • No relief of pain 15%
  • Pain may be worse after surgery 5%

 

 
© 2006 Hernia Center of Southern California , Pasadena CA
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