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Abdominal Wall Hernia Repair

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What is an abdominal wall hernia?

An abdominal wall hernia is a defect (hole) that develops in the muscle and tissues of the abdominal wall, which allows abdominal contents such as the small intestine, colon, or fat to protrude through the defect.  Abdominal wall hernias can be congenital and present from birth, and these are often termed epigastric or ventral hernias.  Abdominal wall hernias can also result from a hole that develops at the site of a previous surgery, which are called incisional hernias.  The most common symptoms of an abdominal wall hernia are bulging, pressure, burning, and pain.  Factors that can cause a hernia to develop or worsen are weight gain, excessive straining, chronic coughing or sneezing, pregnancy, and heavy lifting.  While most abdominal wall hernias are not dangerous, they will never resolve without surgery and tend to worsen over time.  If left untreated, abdominal wall hernias can become incarcerated or strangulated — a term used for tissues or intestine that become trapped in the hernia with compromised blood flow as a result.  An incarcerated or strangulated abdominal wall hernia can be a life threatening condition that often requires emergency surgery.  To resolve patients' symptoms and prevent incarceration/strangulation, most surgeons recommend surgical repair for all healthy patients that have a symptomatic abdominal wall hernia.

How is an abdominal wall hernia repair performed?

Abdominal wall hernias have traditionally been repaired using an open technique by making a large incision on the patient's abdomen and using a piece of synthetic mesh placed beneath the defect to repair the hernia.  In the early 1990s, laparoscopic abdominal wall hernia repairs with mesh began to be commonly performed.  These repairs are performed using small abdominal incisions through which a small video camera and thin instruments are inserted. These instruments repair the abdominal wall hernia by placing mesh beneath the hernia defect.  Patients undergoing a laparoscopic abdominal wall hernia repair experience less pain and faster recovery times than patients undergoing an open abdominal wall hernia repair with mesh. Over the last decade, the benefits of robotic assisted surgery have been widely published, and the technology is now commonly used for general surgery cases, including abdominal wall hernia repairs.  A robotic assisted laparoscopic abdominal wall hernia repair is very similar to a standard laparoscopic abdominal wall hernia repair in terms of technology used. While the robot holds the thin instruments, the robot itself is always under complete control by the surgeon.  The advantages of a robotic assisted laparoscopic abdominal wall hernia repair over a standard laparoscopic abdominal wall hernia repair are the following: a three dimensional high definition view of the hernia and surrounding tissues, much more precise instruments that can rotate 360 degrees not just open and close, and the ability to place the mesh in a safer location to minimize complications and better secure the mesh in position. In addition, patients who undergo a robotic assisted laparoscopic abdominal wall hernia repair also experience a faster recovery, less pain after surgery, and require significantly less narcotic pain medication compared to those undergoing a standard laparoscopic abdominal wall hernia repair.  Dr. Mueller performs a high volume of robotic assisted laparoscopic abdominal wall hernia repairs at Northwestern Memorial Hospital and continues to observe excellent patient outcomes.

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