ROX Hernia Center approach to Hernia Surgery
ROX Hernia Center was created to provide nothing short of excellence in hernia surgery. This includes managing some of the most complex hernia problems, utilizing a multi-disciplinary approach. With extensive background in both general surgery and plastic surgery principles, our surgical team is skilled at repairing some of the toughest recurrent hernia surgery cases.
Reconstruction of recurrent abdominal wall hernias is a challenging problem. Greater than ten percent of patients who undergo abdominal surgery using a traditional open approach, will develop a hernia through that incision. Further, it has been widely shown that recurrence rates following failure of initial repairs can be as high as 55-65%. These operations can fail (sometimes repeatedly) due to technical errors on the part of the initial surgeon, problems intrinsic to the patient’s tissues, or both. Patients can develop problems with their tissues as a result of previous surgery or trauma, prior or ongoing infections, personal habits (i.e. smoking) or other systemic illnesses.
Our goals in abdominal wall reconstruction hernia surgery are several and include:
1) Definitive closure of the hernia defect
2) Primary closure of the abdominal wall connective tissue (fascia) when possible.
3) Restoration of “Abdominal Domain.”
4) Improved cosmesis of the abdominal wall tissues (when possible).
5) Preservation, or re-creation of the umbilical structures, as is indicated.
To this end, the ROX Hernia Center Surgeons have utilized a combination of repairs for very complex ventral abdominal hernias that includes the following procedures:
1) Debridement of old scars in the skin and connective tissues.
2) Primary closure of the abdominal wall fascia; faciliated with Components Separation when needed.
3) Laparoscopic placement of an inlay mesh graft to reenforce the abdominal repair from within.
4) Excision of redundant skin and fat.
Interestingly, a recent study confirmed our philosophy toward complex hernia repair (Satterwhite, et al., Outcomes of Complex Abdominal Herniorrhaphy, Annals of Plastic Surgery, Vol 68, Nomber 4, April 2012, p382.). In this study, the authors noted one major conclusion. Namely, that mesh reinforcement used at the same time as a components separation in a “sandwich” repair, may lead to reduced hernia recurrence rates providing the best possible type of complex hernia repair.
More specifically, here were some of their findings:
1) The risk factors that contributed to the development of complications included: obesity, diabetes, high blood pressure, presence of enterocutaneous fistula and multiple prior abdominal operations.
2) Intra-operative contamination contributed to the development of complications.
3) Having more than two prior ventral hernia repairs, or three prior abdominal operations increased the liklihood of wound necrosis.
4) Large hernia defects were strongly associated with postoperative skin necrosis.
5) Use of biologic mesh had a higher rate of infection than use of prosthetic mesh.
6) Use of human-derived allograft mesh had a higher incidence of complications compared with porcine-derived allograft, including a higher re-herniation rate.
7) The use of an overlay mesh repair had a 9 fold increased liklihood of recurrence compared with underlay mesh placement.
8) “Sandwich” repair resulted in a 5 fold decrease in hernia recurrence.
9) The use of a Components Separation technique reduced recurrence rates 5 fold.