Hernia Repair What is a hernia? A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions. Bariatric Surgery Weight Loss Surgery Laparoscopy Bariatric Surgery Weight Loss Surgery Laparoscopy Pleatman Surgical Bariatric Surgery Mark A. Pleatman M.D. weight loss surgery weight loss surgery Bloomfield Hills Michigan 248 334-5444 Why should hernias be repaired? Once a hernia has developed, it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore recommend that hernias be repaired when diagnosed, unless there is serious medical problem which makes it too risky. How are hernias repaired? The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures. Often a prosthetic material such as Gore- Tex, or another plastic material, is sutured in place to strengthen the area of weakness. Finally, the skin and other healthy tissues that were cut at the beginning are sutured back together to complete the repair. How does the laparoscopic method differ? In the laparoscopic repair, the defect in the abdominal wall is repaired from the inside of the abdominal cavity. Instead of closing or patching the repair from the outside, the patch is secured in place from the inside. This eliminates the necessity of cutting the skin and normal tissues to get down to and repair the hernia. How is this done? First a laparoscope, a surgical telescope, is inserted through a small puncture in the abdominal wall. Two additional narrow tubes are inserted through the abdominal wall to allow placement of surgical instruments. Under the guidance of a video camera attached to the laparoscope, the hernia is identified and repaired by stapling a patch over the defect in the abdominal wall. Is laparoscopic hernia repair experimental? Laparoscopic hernia repair has only been done for about ten years. The technique is still evolving. Methods originally tried have already been abandoned. In fact, there are several types of laparoscopic repair being done. Early studies have shown that laparoscopic hernia repair can be done safely and with recurrence rates which are acceptably low. Most insurance companies recognize laparoscopic hernia repair as being standard and not experimental; therefore it is covered by most policies. What are the advantages and disadvantages of the two types of repair? The standard repair has several advantages. It can be done under local anesthesia, which is safer that the general anesthesia. The standard repair has been done for many years, and is generally considered to be safe and effective. The laparoscopic repair has several disadvantages. It requires general anesthesia because of the inherent nature of the laparoscopic procedure. Some patients, such as the elderly, may be at increased risk for complications when given general anesthesia. There are also complications of which go along with laparoscopic procedures such as risk of puncturing the bowel or blood vessels, and formation of adhesions or scar tissue in the abdominal cavity. The laparoscopic repair may also be more difficult in patients who have had previous lower abdominal surgery. The laparoscopic repair also has some striking advantages. Because the incisions made for the repair are so small, recovery from the repair is extremely rapid; most patients have minimal pain and return to normal activities in less that a week. This difference is especially great for patients with bilateral hernias (both left and right sides). With the laparoscopic repair, both sides can be fixed at the same time with no additional incisions, and little if any additional discomfort. Patients with recurrent hernias are also good candidates for the laparoscopic repair, since the standard repair for recurrent hernias is known to have a much higher risk of complications such as re-recurrence, nerve injury, and injury to the blood supply of the testicle (in men). Finally, laparoscopy allows access to the abdominal cavity where other problems may be diagnosed and treated at the same time. Examples of procedures that could be done at the same time include removal of the gallbladder or voluntary sterilization (tubal ligation or vasectomy). What type of repair is best for me? Everyone is different, and each person must weigh the relative advantages of the two procedures. I would probably recommend the standard repair for an elderly retired person with a single-sided primary hernia. On the other hand, I would probably recommend the laparoscopic repair for a young man with bilateral or recurrent hernias who was anxious to get back to work as soon as possible. Your doctor can help you decide which repair is best for you. Mark A. Pleatman, M.D. 43494 Woodward Ave. #202, Bloomfield Hills, MI 48302 Office Hours: 9:00 a.m. to 5:00 p.m. Phone: 248-334-5444, Fax: 248-334-5484 email:  info@drpleatman.com