Complex Hernia Repair

Complex hernias are defined as hernias of the abdomen that have recurred despite multiple repairs, that are associated with infections, or have resulted in bowel perforations or fistulas.  Complex hernias, including incisional abdominal wall hernias, are a challenging surgical problem. Incisional hernias occur in 10 to 23 percent of open abdominal laparotomies, with recurrence rates reported between 18 and 50 percent

Until recently, many patients with complex hernias were discouraged from having surgery, and they present unique challenges and require specialized hernia surgeon. In the last ten years, the advent of new biological materials and the development of new surgical techniques have led to a revolution in hernia repair. As a result, the practice of hernia repair has become a specialty rather than one of many areas within mainstream general surgery.

Dr. Garcia has taken the challenge of the repairing hernias that were formerly considered unfixable, or hernias that have recurred many times, or hernias that have resulted in in in the loss of abdominal integrity. Dr Garcia has incorporated the robotic surgery in the creation of muscle flaps, done via robotic with very small incisions.

Nowadays Dr. Garcia has been able to repair complex hernias with a hybrid technique which combines open and robotic. With the newer robotic technique for complex hernias, patients experience less recovery time because the procedures are able to be done in an outpatient setting, and as a result the complication rates from seromas and large wounds have disappeared.

Complex hernias are particularly challenging to treat, as patients often have adhesions or mesh from prior surgical intervention and weakened abdominal wall tissues. The hernia repair must be substantially reinforced, generally with biological mesh. Flaps of muscles and aponeurotic need to be created to allow the midline to be approximated together. This is the component separation technique.

According to the most recent research, up to 53 percent of incisional hernias recur after their initial repair. Therefore, the most important repair is the first one and choosing the right surgeon is your first step to achieving the best possible results.