Types of Hernia Repair

There are many different kinds of hernia repair, but the three major categories are:

• Tension repair
• Open tension-free repair
• Laparoscopic tension-free repair

Tension Repair

For a long time, tension repair was the only repair option available to people with hernias. In this procedure, the surgeon makes an incision in the abdomen over the hernia site, pushes any protruding tissue back into the correct position within the abdominal cavity, and then stitches it closed. This type of repair is called a tension repair because the stitches or sutures put tension on either side of the defect in order to keep it closed. For many reasons, including pain and patient discomfort, a long recovery period, and high recurrence rates, physicians began moving to tension-free repair techniques.

Tension-Free Repair

Tension-free repair techniques utilize a piece of mesh to bridge the hernia defect, and are the most common today. They are considered the gold standard of hernia repair by the American College of Surgeons. Today's mesh products are state-of-the-art in their ability to be strong yet lightweight.

Flat Mesh Repair

After making an incision over your hernia, your surgeon will use a patch made out of flat plastic - like (polypropylene) mesh and stitch it to the tissue surrounding your hernia. 

Advantages:

• Hernias recur in only 3 percent of flat mesh repair patients
• Patients experience a quick recovery
• Only minor discomfort following procedure
• Can be done under local anesthesia

Disadvantages:

• If the hernia is large, more stitches may be required to fasten the mesh, increasing the risk of nerve damage, which could result in pain
• Procedure can take between 40 and 60 minutes

Today's mesh products are state-of-the-art in their ability to be strong, yet lightweight.

Three-Dimensional Mesh Repair

Three-dimensional mesh devices such as PROLENE* polypropylene Hernia System and PROLENE* 3D Patch polypropylene Mesh ( both manufactured by ETHICON Products Worldwide, a Johnson & Johnson company ) - have revolutionized the repair of hernias by building upon the advantages of the earlier tension-free techniques and making them even more effective.

PROLENE hernia system a "3-in-1" design (meaning that it incorporates three of the most widely used and accepted repair techniques into one single device) consist of three components integrated into one device:

• An underlay patch that provides an effective posterior repair on the inside of the abdominal wall, much like laparoscopic repair.
• An onlay patch that lays over the abdominal wall, much like a flat mesh repair
• A low-profile connector that connects the underlay patch on the onlay patch. This connector virtually eliminates the possibility of the device from moving, or migrating, thus significantly reducing the potential for recurrence.

• Patient Comfort
• Virtually zero chance of migration
• Little suturing, reducing the risk of nerve damage that could lead to pain
• Can be done under local or regional anesthesia
• Takes typically about 20-40 minutes
• Quick recovery and return to normal activities
• Extremely low recurrence rates

Another breakthrough device, the PROLENE 3D Patch mesh, is a one-piece mesh device that affords surgeons secure, low profile repairs. It is typically used for small hernias. The device consists of an overlay patch with a three-dimensional diamond-shaped underlay. The underlay is inserted into the hernia "hole" or defect, and then the surgeon pulls a string attached to the bottom of the diamond to "deploy" it. When deployed, the underlay becomes flat and forms a secure layer of mesh on the underside of the muscle wall.

Laparoscopic Repair

Surgeons have been performing laparoscopic repairs for the past decade. Although these procedures have been less widely used in the past, more and more surgeons are learning and perfecting this minimally invasive technique. In laparoscopic surgery, your surgeon makes a small incision and creates a space under the muscle in your abdomen with a balloon device. They will then insert a cannula, or slender tube, into your abdomen, which acts as a channel to the inside. Through this space, the surgeon inserts the laparoscope, which is a thin telescope, and views the hernia and surrounding tissue on a video screen. The surgeon must then insert two to three additional cannulas through small abdominal incisions. The hernia sac is removed and a piece of surgical mesh inserted, which is held in place with small surgical staples. This surgery is called posterior hernia repair because the hernia is being repaired from behind the abdominal wall. It differs from traditional mesh repairs (discussed above), in which the mesh is placed on the outside of the abdominal wall.

During the procedure, the surgeon needs to clearly visualize the underlying anatomy in order to put a piece of mesh in the proper place. Some mesh products are designed to make this easier. For example, the new ULTRAPRO* Partially Absorbable Lightweight Mesh has highly visible blue stripes to aid the surgeon with orientation and placement of the mesh.

Advantages:

• Pressure from within the abdominal cavity helps to hold the mesh in place
• Minimally invasive repair, which may mean less pain and shorter recovery time
• Allows for visualization of undiagnosed hernias
• May have advantages in repair of bilateral and recurrent hernias

Disadvantages:

• Must be performed under general anesthesia, the riskiest part of any surgical procedure
• Can require an overnight stay in the hospital
• Procedure can take 60 minutes.
• There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.

This type of surgery may not be appropriate for patients who:

• Are pregnant
• Cannot tolerate general anesthesia
• Have a severe lung disease
• Have had multiple previous abdominal surgeries
• Have a bleeding disorder or are taking medications to prevent blood clots
• Are obese