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.
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.
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.
Chronic Pain after Inguinal Hernia Surgery
Post Herniorrhaphy Pain Syndrome
General surgeons regularly refer patients with post-operative chronic pain to the Hernia Center of Southern California. These patients are suffering from a condition known as Ã¢ï¿½ï¿½post herniorrhaphy pain syndrome.Ã¢ï¿½ï¿½ This condition affects approximately 5-10% of all inguinal hernia surgery patients. Post herniorrhaphy pain syndrome cannot be determined without a thorough examination coupled with radiological examinations to determine the exact cause of the pain.
Causes of Post Herniorrhaphy Pain Syndrome
Missed hernia: A patient may actually have two hernias in close proximity. If the surgeon overlooks one of the hernias during surgery, the remaining hernia may cause pain.
Recurrent hernia: A hernia may have reoccurred after surgery.
Neuroma formation: The end of a cut nerve begins to form a painful nerve ending.
Nerve damage is caused by pinching or crushing a nerve during surgery.
Nerve entrapment in scar tissue.
Constriction of the spermatic cord will lead to a painful testicle.
Periostitis pubis from a suture placed in the pubic bone.
Treatment of Post Herniorrhaphy Pain Syndrome
Naturally, the treatment of the pain is aimed at the cause. If there is a recurrent hernia, or a missed hernia, surgery is required.
For pain unrelated to the presence of a hernia, conservative pain management is instituted. The first line of conservative treatment is oral medications. 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. Physical therapy may also be required.
The typical results of conservative treatment are as follows:
Partial relief of pain 33.3%
Complete relief of pain 33.3%
No pain relief 33.3%
Patients who experience debilitating pain for 6-to-12 months after surgery, despite conservative therapy, may require additional surgery 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 ligated (closed off) and buried within the surrounding muscle tissue. Due to the fact that nerves are intentionally cut 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. Ultimately, the result of a repeat operation is not always successful in completely alleviating pain.
The typical results of surgical treatment are as follows: