Surgical Treatment Options for Hernias

Hernia repair is one of the most frequently performed surgical procedures worldwide. In fact, there are over 600,000 hernia repair surgeries performed each year in the U.S. alone. A hernia is a weakness or defect in the abdominal muscles which can lead to the protrusion of tissue through an opening in the outer layers of the abdominal wall. Hernias can develop at any part of the abdominal wall, but generally occur in areas that have a natural tendency to be weak. These areas include the groin (inguinal hernias), umbilicus (umbilical hernias), hiatus (hiatal hernias) and incisions from previous surgeries (incisional or ventral hernias). While hernias generally do not pose serious long-term health issues, they can cause severe pain and discomfort for those suffering from this illness.

Hernias may be present from birth, or can be caused by strain on the abdominal muscles. In any case, hernias don't go away by themselves and based on the amount of bulging or pain, generally require a surgical procedure to be repaired. Hernia repairs are usually done on an optional basis, which means that the patient and physician decide whether or when the process ought to be performed. Emergency procedures are just done for strangulated hernias, which are hernias that have become pinched to the point that the blood supply is cut off. These hernias need immediate medical attention as they can become infected and lead to a life threatening illness very fast.

Hernias are typically repaired via a surgical procedure called herniorrhaphy, where the surgeon repairs the hole in the abdominal wall by sewing surrounding muscle collectively or by placing a patch called"mesh" within the defect. Most surgeons make an incision at the site of the hernia so as to gain access to this defect, although some surgeons prefer to perform these procedures laparoscopically.

During a laparoscopic hernia repair, the surgeon makes very small incisions to pass through specialized instruments and an endoscope, a device that allows the surgeon to see the abdominal area without opening the patient up. Laparoscopic hernia repair generally results in less postoperative pain and recovery time than open surgery. There's still a great deal of controversy within the long-term advantages of laparoscopic hernia repair, however, and it's by no means an option for each patient.

Using surgical mesh to repair hernias is gaining in popularity with surgeons. Most meshes currently on the market are made from synthetic materials such as polypropylene, polyester, silicone or polytetrafluoroethylene (PTFE), commonly known by the DuPont brand name Teflon®. When these meshes have good strength characteristics, they remain in the body as permanent implants and occasionally can cause adverse reactions when the surrounding tissue identifies these materials as foreign bodies.

To be able to avoid adverse reactions to synthetic materials, some surgeons prefer to use meshes made from biomaterials that are gradually resorbed by the body over time and are then eliminated through biological processes. Since these meshes are not permanent implants, they generally only provide temporary repair of abdominal wall defects and additional surgical procedures are sometimes required to replace the absorbed mesh.

An alternative to artificial and absorbable mesh is human tissue. There are a handful of companies that are now marketing processed, freeze-dried human dermis for soft tissue repair and augmentation. This material is implanted with the same technique as other meshes and supplies for revascularization, cellular ingrowth and"remodeling" to the patients tissue. Although this option generally provides a permanent repair with few adverse reactions, the processing and distribution of human tissue isn't regulated by the Food and Drug Administration (FDA) as are many other goods that are implanted inside the human body. In fact, there have been a number of recent cases of serious infections and even deaths caused by the implantation of human cadaveric tissue during surgical procedures.

New technologies have recently been designed to address the issues associated with the use of artificial substances, absorbable materials and human tissue in hernia repair processes. Researchers in Europe have been conducting research and development into alternatives to those products within the past two decades and have made major breakthroughs in this area over the past several years. New ways of collecting and processing natural materials have contributed to a set of products that give the potency of synthetic compounds, the biocompatibility of biomaterials and the regenerative properties of human tissue.

What material can provide all the benefits of the earlier mentioned products minus the corresponding disadvantages? Porcine dermal collagen has an architectural structure very close to human tissue, and is therefore readily recognized as favorable by the human body. A leading medical technology company in Europe has developed a patented process by which a sheet of porcine dermis is converted into a safe and effective surgical implant for soft tissue repair and augmentation. The procedure, which takes several weeks to finish, removes all non collageneous material from the sheet except elastin, and stabilizes the material via a cross-linking procedure. The end result is an acellular, non reconstituted, non allergenic membrane that has excellent strength characteristics, is completely biocompatible and offers a permanent solution for the repair of abdominal wall defects. Considering that the material itself is a byproduct of the meat packaging industry, it's more readily available than human tissue. In addition, the harvesting and processing of this material is strictly regulated by local authorities, as well as international directives and quality standards.

This collagen surgical implant has been used in Europe for these kinds of processes for several years and there is strong clinical evidence of their safety and efficacy of the product. In fact, the implant has been approved for sale in the U.S. from the FDA and there have not been any adverse reactions reported after several thousand implantations in Europe. Not only is it safe, because the construction of the collagen is so similar to human tissue, once it's implanted the sheet provides the basis for cellular ingrowth and revascularization. This causes a permanent fix in the most troublesome cases. In addition to the favorable clinical outcomes, surgeons enjoy the fact that they don't have to change their surgical procedure to utilize this item. They can use the same exact same measures they would use for artificial or absorbable surgical mesh in both open and laparoscopic procedures.

Only physicians can diagnose and appropriately treat hernias. However, patients have the right to actively participate in decisions that affect their health or quality of life. Information about the various treatment options that are available can play an important part in the discussions between patients and their physicians regarding the best surgical treatment option for them.