Abdominal Wall Hernia
Umbilical and abdominal hernias
In the case of an umbilical hernia, the gap (hernial orifice) lies below or around the navel. In most cases of umbilical hernia, the gap is present from birth (this is where the umbilical cord passes from) and later it grows in size.
In the case of an abdominal hernia, the hernial orifice lies in the anterior abdominal wall, without necessarily being located in the umbilical region. These types of hernias can become tight, and it is best to have surgery before they cause a problem.
The use or not of a mesh depends on the size of the hernia. Usually, a mesh is applied for hernias larger than 2-3 cm, since it has been scientifically proven to reduce hernia recurrence rates.
Abdominal hernias are repaired, either with minimally invasive methods (laparoscopic or robotic) or with conventional open surgery, along with plastic reconstructive surgery. The type of surgery is decided based on many factors, including on the size of the hernia, the patient’s body structure, as well as pathological factors of the patient.
What are the common symptoms of a hernia?
Symptoms usually depend on the location of the hernia, however pain is a common symptom for all, after vigorous exercise.
Removal of the contents of the hernia (omentum and in some cases small intestine coils) in the image above.
Covering of the hernial orifice with mesh from the inner side (inlay technique) in the image below, and stabilization with special clips and in some cases sutures”
What are epigastric hernias?
Epigastric hernias are located on the midline and above the navel. They are usually small and contain preperitoneal fat. It is extremely unlikely that these hernias contain part of the bowel or become strangulated (necrosis).
They usually coexist with diastasis recti (abdominal wall relaxation) and often occur in women who have had multiple or multifetal pregnancies as well as in obese individuals.
Open plastic repair, or laparoscopic mesh repair is the method of choice for these small epigastric hernias. A shorter recovery is expected with laparoscopic surgery.
What are incisional and large abdominal hernias?
Incisional hernias occur at the point of incisions due to an earlier surgery. Large abdominal hernias started small but because they were not treated in time become large with contents that cannot be pushed back to the abdomen.
Incisional hernias are category of their own can be a chronic and very difficult problem both for the patient and the surgeon.
Typically, in these cases there is a loss of muscle wall, and the abdominal wall lacks in functionality. As a result, patients find it difficult to make daily routine movements such as getting out of bed or from a seat and also and develop chronic problems with their waist.
In these cases, it is not enough to ‘patch’ the hernial orifice with a mesh. It is necessary to repair the normal anatomy of the muscle wall. Carefully planned reconstructive surgery of the abdominal wall, combining various techniques of either laparoscopic or reconstructive surgery, can lead to optimal results. It essential for the surgeon to restore the ‘continuity’ of the muscle wall, uniting the fascia with the “lips” of the hernia. For this purpose, we use specialized techniques such as component separation and Transversus Abdominis Release (TAR).
The treatment of these complex hernias has been revolutionized by the TAR method, which offers the lowest recurrence rates and the lowest morbidity rates in complex hernias. Dr. Chrysocheris has been trained in this type of hernia surgical treatment and has given many speeches at international conferences on hernia repair.
Spiegel hernia, hernia of the semilunar line. Hernias of the lateral abdominal wall
What is a Spigelian hernia?
A Spigelian hernia is located on the lateral abdominal wall, at the lateral border of the rectus abdominis.
It is usually accompanied with a non-specific pain and feeling of heaviness in the area. Most often there is no clear hernial opening and sac, but a projection of the peritoneum from a point where the wall is weak or relaxed (lateral abdominal wall hernia). These hernias can be idiopathic or caused by trauma, blunt or sharp. There is no risk of strangulation.
The best treatment method is the laparoscopic ‘reinforcement’ of the abdominal wall with the placement of a mesh.
Hernia and relaxation of the abdominal wall after pregnancy
Women after multiple or multifetal pregnancies have a high risk of herniation. In choosing the appropriate treatment we must take seriously into account whether the patient intends to conceive. If this is the case surgery should be avoided, unless the hernia gets strangulated, in which case urgent surgical treatment is a must.
Synthetic non-absorbable meshes are not suitable for this type of patients and should be avoided.
Combination of abdominal hernia and abdominoplasty
Patients who have decided to never again have children are presented with more options. In the case of a hernia, significant relaxation of the wall and excess skin and subcutaneous fat, and if the patient so wishes, the repair of the hernial gap with or without mesh can be combined with an abdominoplasty incision, which usually follows the track of the caesarean scar (if present).
If there is only “relaxation” of the muscle wall ( due to linea alba diastasis), without excess skin and fat, then we can correct it with laparoscopic or even robotic methods, without an incision and with excellent results!
How much does laparoscopic hernia repair cost?
Hernia surgery is individualized for each patient and many parameters are taken into account before the exact cost is determined.
Robotic hernia repair
In recent years, new minimally invasive techniques enable the surgeon to perform complex repair operations for large abdominal hernias by closing the hernia gap in conjunction with the use of mesh.
Robotic technology provides significant advantages in the treatment of intra-abdominal adhesions, minimizing the risk of intra-abdominal organ injury and converting the surgery to an open one.
It also allows for great flexibility in the endoscopic preparation and suturing of the abdominal wall in complex cases of hernia.
One such operation is the separation of layers with division of the transverse abdominal muscle (Component Separation with Transversus Abdominis Release – TAR). This technique is a reconstructive surgical technique that allows us to “lengthen” the muscular abdominal wall in order to achieve tension-free closing of the hernia gap.
With the help of robotic surgery, many limitations of laparoscopy are overcome and such delicate surgical maneuvers are possible with minimally invasive methods.
The team of Dr. Chrysocheris, at the 1st Surgical Clinic of the HYGEIA hospital, has been the first in Greece to perform robotic repair of a complex and complicated abdominal hernia using the Component Separation with Transversus Abdominis Release – TAR) technique at the beginning of 2019 and has since performed a series of similar robotic reconstructive procedures with absolute success.
Read a related article by Dr. Pericles S. Chrysocheris here
