Dear Doctor: What is the Latest in Treatment Options for Large or Recurrent Abdominal Wall Hernias?
Abdominal wall hernias are caused by a defect in the muscle causing a bulge or swelling. They may be present at the site of a previous incision. Other common locations include at or above the belly button, groin, or on the lateral abdominal wall.
When considering repair of large hernias or hernias that have come back after a previous repair, it is first important to consider risk factors for recurrence. Two major risk factors for recurrence of hernias include smoking and obesity. We generally avoid performing elective hernia repair on patients who smoke. With increasing body weight, especially as the body mass index (BMI) increases to over 35-40, the risk of recurrence after repair increases exponentially. In this subgroup of patients, aggressive medical and/or surgical weight loss should be considered mandatory if there are no concerning signs for the intestine or other abdominal structures being compromised.
With regards to treatment options, it is increasingly being recognized that a durable hernia repair requires restoration of normal anatomy. In the case of large hernias, particularly in the midline, techniques to return the rectus muscles to the midline are utilized. This is traditionally done through a large midline incision. However, with advanced minimally invasive surgical techniques, this procedure (known as component separation) can be done through smaller incisions and in certain cases, can be done entirely through very small incisions in the lateral abdomen using robotic surgical techniques. This provides the advantage of decreasing pain and complications, particularly wound complications, which can be as high as 20-40 percent with traditional open surgery.
Dr. Peter Walker is a fellowship trained minimally invasive and robotic surgeon for the UT Health Science Center at Houston and provides patient care at UT Physicians at Cinco Ranch located at 23923 Cinco Ranch Blvd., Katy, TX 77494. To schedule an appointment, please call 713-486-5300.