Advancements in Hernia Surgery

by Steve Holder on November 8, 2008

An abdominal hernia is an opening through the muscles of the abdomen that allows the intestines to poke through the muscle wall, forming a visible lump under the skin.  When further weakness in the muscle wall allows the opening to grow, more of the intestines are able to protrude and may eventually resist being pushed back into the abdomen. This becomes an incarcerated hernia and can lead to a medical emergency if the opening pinches off the blood supply to the protruding organs.  Surgical repair is the only cure for a hernia.

Surgery Before the Patch

Before the advent of the mesh patch, hernias were repaired by opening the abdomen where the muscles were separating and suturing them back together.

One disadvantage of this type of invasive surgery is it requires several weeks for recovery.  Because the recovery period is reputed to be long and painful, patients sometimes put off having the operation until living with the pain becomes worse than the fear of surgery and its possible complications. And because most surgeries were simply joining together the two sides of already weakened muscle tissues, the hernia would recur in approximately 10% to 20% of cases.

The First Mesh Patches

Because sewing the weakened muscle tissue back together was not a lasting repair in many cases, surgeons devised a mesh patch that they could attach inside the abdomen behind the weakened area. This resulted in a much sturdier and longer-lasting correction of the hernia.  The sterile mesh patch was designed to provide a latticework enabling new tissue to grow and strengthen the area.  This approach reduced the recurrence rate, but was still performed using open surgery.

Laparoscopic Surgery

With the increasing use of the laparoscope for abdominal procedures, it wasn’t long before doctors devised a way to place a patch behind a hernia using this minimally invasive method.  The laparoscope is a narrow tube with a camera, light, and tiny surgical instruments on one end that can be inserted in the abdomen through a small incision.  When the abdomen is slightly inflated using CO2 gas, the surgeon can perform surgical procedures by manipulating the instruments while observing his work on a television screen.

The laparoscopic hernia repair procedure combined all the advantages of a patch with the benefits of a minimally invasive surgery including reduced pain and a much shorter recovery period.

The Minimally Invasive Technique

Despite the benefits of laparoscopic surgery, it’s an expensive procedure because of the specialized equipment required. As a result, medical researchers devised a new minimally invasive approach for implanting a hernia patch. In this technique, the surgeon makes a small incision near the site of the hernia.  He inserts a rolled-up patch through the incision and spreads it out in place behind the abdominal wall. Then he adds a couple of sutures to hold the patch in place.

This procedure is typically performed as day-surgery with minimal post-operative pain, a recovery period of just a few days, and an extremely low recurrence rate of around 1% or less.

Advancements in Hernia Patches

With the minimally-invasive technique becoming the surgical method of choice, treatment advances began focusing on the nature of the patch itself. Various patents were granted for different compositions, structures and designs of the mesh fabric for hernia repair patches.

In the early 1990’s, one well-known surgeon, Dr. Robert Kugel, came up with the idea of placing an extremely thin plastic ring inside the patch, so it could be folded and inserted though a small incision, and would then unfold itself once released inside the abdomen. Moreover, the semi-rigid ring made it exceptionally easy to maneuver the patch into place, and his innovations in mesh fabric design created a patch that remained in position without sutures.

By 2001, Dr. Kugel had ten patents to his credit for the function, design, and method of placement of the Kugel Mesh Hernia Patch with the memory recoil ring.

Despite the recall of certain Kugel hernia patches that were defective because of a flaw in the manufacturing process, the Kugel patch and method remains among the state-of-the-art techniques in hernia repair surgery.

This article is featured at New Design World.

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