Hernia Repair Surgery: Typical vs. Complex

Insights from Dr. Cathryn Coleman

Hernias are a common health concern, often requiring surgical intervention. While most hernia repairs are straightforward, some cases are far more complex, requiring advanced techniques and specialized care.

Dr. Cathryn Coleman, a surgeon on the medical staff at USMD Hospital in Arlington, Texas, is a specialist in hernia repair surgery, including complex cases. She shares her expertise on the differences between typical and complex hernia repair surgery.

What is a Hernia?

“In its most simple form, a hernia is a hole in the abdominal wall where things can protrude, usually fat or intestine,” explains Dr. Coleman. “The most common places to get them are the belly button, the groin, or at a previous surgical incision.” These areas are naturally weaker points in the abdominal wall, making them more susceptible to hernias.

Understanding Routine Hernia Repair

Hernia repair surgery involves closing the opening created by the hernia and reinforcing the abdominal wall with a piece of mesh. Mesh provides support and reduces the risk of recurrence. In a typical, straightforward case, the procedure is minimally invasive, using robotic or laparoscopic techniques.

“For simple hernias, it’s often a day surgery with a fairly quick recovery time,” says Dr. Coleman. “Patients usually go home the same day. They are restricted from lifting anything over 20 pounds for about two to six weeks, depending on the hernia size and risk factors.”

When Does Hernia Surgery Become Complex?

Complex hernia repair surgery is necessary when the hernia is particularly large or when the patient has undergone multiple surgeries in the past.

“If a hernia is anywhere from 10 to 20 centimeters, that’s considered a large hernia, which presents some additional challenges for the surgeon,” Dr. Coleman notes.

Other factors that may make a hernia surgery more complex: “People who’ve had multiple hernia operations or other abdominal surgeries often have significant scar tissue, which complicates the repair,” Dr. Coleman said. Multiple hernia surgeries usually means layers of mesh which increases scar and complexity. Furthermore, a patient may have hernias in multiple locations and addressing all these hernias efficiently in a single operation can be a challenge. One major factor in complex repairs is the issue of tension.

“The biggest enemy of hernia surgery is tension. If the hole is too large, you can’t simply close it without causing strain on the abdominal wall,” she explains. To address this, surgeons may perform a procedure called component separation. This involves releasing or dividing abdominal muscles to reduce tension so that the hernia can close and heal

Surgical Approaches: Robotic vs. Open Surgery

When it comes to hernia repair, Dr. Coleman prefers using robotic surgery for its precision and efficiency. That’s especially valuable in complex cases.

“The robot gives you better flexibility, mobility, and optics,” she says. “Laparoscopic surgery with small incisions is better than traditional open surgery, but it still has limitations. Robotic surgery overcomes those, providing a superior repair.”

Although open surgery is rarely a first choice, it may be necessary in specific complex cases. “If a patient has extensive scar tissue or multiple layers of mesh from previous repairs, converting to open surgery may be the safest option,” she adds.

Recovery After Hernia Surgery

Recovery time is another factor that differentiates complex hernia repair from typical surgery.

“Everyone’s pain tolerance is different, but most patients describe the feeling after surgery as similar to what they’d feel after a really intense ab workout,” Dr. Coleman says. “Patients are sore for a couple of weeks, and some may experience twinges of pain for a few months as the body heals.”

However, for complex repairs, the recovery period is often longer, and patients are advised to follow strict lifting restrictions.

Choosing the Right Surgeon

Selecting a qualified surgeon is essential for successful hernia repair, especially if the case is complex.

In choosing a surgeon, Dr. Coleman recommends asking about the surgeon’s approach to the repair and their experience with robotic surgery.

“I see a lot of patients for recurrent hernias who had their initial surgery done using open surgery, which isn’t typically the best choice anymore,” she says. “Minimally invasive surgery has faster recovery, lower infection rates, and better outcomes.”

Dr. Coleman also highlights the importance of finding a high-volume center with specialized expertise.

“USMD is implementing protocols to optimize patient care, from preoperative assessments to postoperative follow-ups,” she said. “And we do a lot of hernia repair procedures, both simple and complex.

She adds that she gets many referrals from physicians in the area, joking that she’s become a “hernia guru” in Arlington. That accumulation of experience makes her a good choice for patients with complex cases.

“Volume and experience are especially important in complex cases,” she said.

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Final Thoughts

Hernia surgery can restore quality of life for many patients, whether the repair is typical or complex. With advancements in robotic surgery, even large and complicated hernias can be treated more safely and effectively.

“Patients deserve to know their options,” says Dr. Coleman. “Choosing a surgeon experienced in minimally invasive and robotic techniques can make all the difference in achieving the best outcome.”