24 Jun 2023 Who, Where and How Your Hernia is Repaired First Matters Most!

I always say this slogan: “Who, Where and How Your Hernia is Repaired First Matters Most!” Getting your first hernia surgery done by competent surgeons who are well-versed in hernia surgery and up-to-date with the latest practices makes a difference! In addition to where you get the hernia repair, factors such as preoperative preparation, the technique used, the type of mesh used, and postoperative follow-up influence the success. Let’s look deeper into the topic:

Who:

The most significant problem in the repair of the abdominal wall and inguinal hernias is recurrence after the operation. Although synthetic meshes have been used in hernia repair for nearly 60 years, and the recurrence rates have significantly decreased, ideal rates have yet to be achieved. Regarding inguinal hernias, the average global recurrence rates after the first surgery are around 7-13%. This is not acceptable. For inguinal hernias, this rate should be below 1%. In specialized individuals who focus on hernias (also known as Herniologists), the ideal rate is 0.5%. In abdominal wall hernias, the recurrence rates are even higher. In primary umbilical hernias, which are among the most common abdominal wall hernias, the recurrence rate without mesh repair ranges from 8% to 32%. This rate increases proportionally with weight. In mesh repairs, the recurrence rate is naturally lower, but global averages are not at ideal levels. Incisional hernias, which develop from surgical incisions, have high recurrence rates.

However, the success rates of surgeons who specialize in hernia surgery, prioritize these patients, and fill their daily practice with hernia surgery are significantly better than other surgeons. This is because hernia surgery requires excellent topographic and three-dimensional anatomy knowledge. It requires knowing different techniques and keeping up with advancements, as well as having a thorough understanding of meshes. Hernia surgeons excel in these areas. There are societies dedicated to the abdominal wall and hernia surgery that organize annual congresses, seminars, courses, and educational meetings. One of the goals of these societies is to reduce the difference in success between hernia surgeons and general surgeons in hernia repair.

Where:

Of course, a surgical procedure is performed in a fully equipped hospital. However, approaches categorized under Minimal Invasive Surgery, including laparoscopic and robotic surgeries, require the hospital to have a good infrastructure in this regard. While open hernia surgeries can be performed in almost any hospital, minimally invasive surgeries are technological. Due to simple issues such as technical malfunctions or insufficient equipment, the operation may unnecessarily convert to open surgery. Every necessary device and specialized material (mesh, fixation staples, laparoscopic tools, etc.) should be readily available as backups. Therefore, the right decision is to perform the surgery in a hospital with a good infrastructure. This is an important factor that affects success.

How:

This title includes quite detailed specifications. Firstly, the patient should enter the surgery under suitable conditions and in good health. For example, for complex abdominal wall hernia surgery, adequate preparation should be made. If the patient is overweight, they should lose weight, diabetes should be controlled, and chronic illnesses should be managed. Smoking should be discontinued at least one month before the surgery. The most appropriate technique should be selected for hernia repair. The surgeon should have excellent mastery of that technique. The synthetic mesh used should be of high quality. Mesh quality is a significant factor that determines success. Postoperative follow-up and care are also crucial. Although the first year is important, long-term follow-up becomes particularly important for incisional hernias.

Hernia Surgeons have deep knowledge of abdominal wall anatomy. They keep up with current congresses and meetings. They follow and implement guidelines published on hernia surgery. They stay updated on the latest developments in hernia surgery from various sources. They have a portfolio of various surgical techniques and are experienced in their application. They possess detailed knowledge of meshes and other materials. Lastly, they have detailed information about the most appropriate surgical approach for each patient, which we refer to as “Hernia Repair Tailored to the Patient.”