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June 2012 Hernia Newsletter >>
Surgical Options for Hernia Repair
Surgical hernia repair can be performed open or laparoscopically, using a variety of meshes. Component separation techniques (CST) are effective for repairing large ventral hernias; endoscopic CST often results in fewer wound complications than open CST.
Open vs. Laparoscopic Repair
Until the 1990s, an open surgical approach was used to repair all hernias. Over the past 20 years, laparoscopic hernia repair techniques have emerged. For many patients, these approaches may provide equally effective treatment with fewer wound complications (see related newsletter article, Outcomes of Laparoscopic vs. Open Hernia Repair, for more details).
The decision to use an open or a laparoscopic approach depends on the type and severity of the hernia, the patient’s medical history, and the surgeon’s experience. Surgeons at the UW Health Complex Hernia Clinic have substantial expertise in both open and laparoscopic approaches, and work with each patient to choose the most appropriate option based on medical need.
Types of Meshes
In both open and laparoscopic repair, the surgeon reduces the hernia and repairs the defect, usually using surgical mesh to reinforce the weak tissue. Unlike primary suture repair, the use of mesh provides a “tension-free” repair, which helps lower the risk of hernia recurrence.1
Meshes fall into one of two categories: synthetic or biologic. Synthetic meshes are usually made of polyester, polypropylene, or ePTFE (Gore-Tex®); biologic meshes are made of either human or porcine biomaterials. Meshes are available in a variety of weights, shapes, and porosities, and cut to size during surgery.
Our surgeons choose the most appropriate mesh for each individual case. Synthetic meshes are most commonly used, but no single mesh is appropriate for every type of hernia.
New Advances in Component Separation Techniques
Component separation techniques (CST) can be used to repair large ventral hernia defects (>4cm in the upper or lower abdomen, or >8 cm in the midabdomen) that cannot be closed primarily.
In CST, surgeons separate the fascia and muscular layers of the abdomen, and advance them to enlarge the surface of the abdominal wall. Mesh will likely still be used for additional reinforcement. This technique can be used to repair midline defects of up to 16cm.
Surgeons at the UW Complex Hernia Clinic perform both open and endoscopic CST for complex ventral hernias. Studies have shown that with appropriate patient selection, the endoscopic approach reduces the rates of wound healing complications by at least half.2, 3
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For More Information
Learn more about UW Health’s Complex Hernia Clinic here
1. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000 Aug 10;343(6):392-8.