There are multiple ways to effectively treat hernias. At the Stony Brook Center for Abdominal Core Health, our surgeons provide all of them for our patients.
Some of our procedures use a mesh patch — made of synthetic or natural material — to close the gap in the abdominal connective tissue where the hernia formed (see our FAQs page).
Suturing the patient’s own tissue back together with permanent sutures (no mesh or patch) is another option. This is called the Shouldice hernia repair (see our FAQs page and patient testimonials).
Repairs can be traditional “open” surgery with an incision or laparoscopic (a small hole, made with thin instruments guided by a tiny camera).
When it comes to post-operative results, each surgical approach has its own advantages. You and your surgeon will decide together which option is best for you, depending on the hernia and your medical history.
Traditional Repair
Most traditional open repairs use an incision that exposes the entire hernia defect/weakness to allow repair. In the groin, this involves a small, 3-inch skin incision that lies underneath the patient’s waistband. For hernias on the front of the abdomen, a vertical incision in the middle of the belly is usually made. Usually, the surgeon will attempt to close the hernia defect with sutures before placing a mesh to help strengthen the closure.
These open repairs have been performed for many years and, therefore, have the most research into them.
Laparoscopic Repairs
During a laparoscopic repair, the hernia is fixed from the inside of the abdomen using a slender lighted camera that allows the surgeon to work through small incisions. The incisions are usually less than half an inch in length each and are placed apart from the hernia itself. Almost all laparoscopic repairs use mesh to cover the hernia defect and seal the hole. Research has shown that laparoscopic repairs have lower wound complications, decreased postoperative pain, and faster return to normal activities.
Robotic Repairs
Robotic-assisted surgery has the same benefits of small incision surgery and laparoscopic procedures, but with more flexible and precise instruments. During a robotic-assisted surgery, the surgeon is sitting at a console in the same room but away from the patient, manipulating surgical instruments. Robotic instruments can move like your own wrists do, giving the surgeon increased precision and articulation.
Abdominal Wall Reconstruction
For extremely large or complex hernias, sometimes a simple mesh closure is not enough. In these cases, it may be necessary to bring the layers of the abdomen back together, one by one, with a mesh placed for strength and support. This is called Abdominal Wall Reconstruction, and is usually used for abdominal hernias larger than 3-4 inches in diameter. A technique call a “component separation” may also be needed to get the layers back together. These techniques are very technically demanding and should only be performed by experienced surgeons.