Dr. Averbach and Dr. Hamdallah offer the most advanced, minimally invasive approach to surgically treat a variety of primary abdominal wall hernias (ventral, umbilical, inguinal or groin hernia) with laparoscopic procedures. A hernia is the protrusion of tissue or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. Hernias can be classified as internal or external and as abdominal or thoracic.
Abdominal wall hernias can occur spontaneously (presumably from congenital defects) or after surgery. When they occur after surgery, they are called incisional hernias, which can range from small to extremely large defects. Some defects are so large that contents are irreducible owing to an abdominal wall that is chronically injured and reduced. This is referred to as “loss of domain.”
Laparoscopic surgery allows more controlled repair of the hernia, because a defect in a strong layer of abdominal wall is more visible than with open surgery. Laparoscopic technology also allows detection of obscured multiple hernias, and allows for shorter post-surgery recovery.
Laparoscopic hernia repair involves the placement of a mesh inside the abdomen without abdominal wall reconstruction. The mesh is fixed with sutures, staples, or tacks. The recurrence rate of the laparoscopic repair is reported as equal or less than that done with the open approach.
Incisional hernia repair is considered a challenging procedure, especially in recurrent hernias, in which the chances of failure increase with each surgical attempt.
Open versus laparoscopic repair
As far as ventral incisional hernia is concerned, a laparoscopic approach is considered far superior to open repair and is associated with lowest risk of recurrence and complications.
The difference between open and laparoscopic approach is the access and exposure of the defect. In the open procedure, the abdominal wall is incised over the defect. The disruption of surrounding tissue can lead to devascularization. When large incisions are performed, a higher incidence of seromas, hematomas, and wound infections has been reported.