Hernia Institute of Louisiana

The repair of inguinal hernia is the most common hernia repair procedure in the world, and the most frequently performed surgical procedure among general surgeons. Unfortunately, most general surgeons in the US and around the world have not embraced the latest and most effective techniques for hernia surgery. At the Hernia Institute of Louisiana, we are dedicated to changing that, and are actively engaged in surgeon education in hopes of improving the quality of outcomes for patients not only in our region, but also across the country and worldwide. You can read about our commitment to surgeon education elsewhere on our site by clicking here. UltraPro Hernia System Methods for the repair of inguinal hernias have evolved over the last 20 years more so than in the previous 100 years. As a result of this evolution of thought, there are numerous new techniques and mesh devices designed to provide reconstructive opportunities for surgeons and patients. Dr. Treen has evaluated each of these techniques and devices, and has concluded that in the vast majority of cases, the most consistently reliable technique is the use of the Prolene Hernia System and the UltraPro Hernia System. Published results of the effectiveness of these techniques indicate that their reliability and durability is unsurpassed, the incidence of postoperative pain is the lowest, and patient satisfaction is among the highest. Skin Closure for most all hernia repairs is completed with DermaBond topical skin adhesive, which eliminates the need for bulky gauze dressings, and allows patients to bathe or shower within hours of their surgery. These procedures are nearly always performed as an outpatient, under general or local anesthesia, and typically require about 45 minutes to complete. Most patients are discharged from our facilities within 1-2 hours following their surgery. In general, follow-up visits are prearranged in our clinic in 1-2 weeks. Most patients are able to return to work at that time, or shortly thereafter. 100% Guarantee Since 1999, and after several thousand inguinal hernia repairs using these techniques, not a single patient has returned with a recurrence of their hernia. As a consequence of this outstanding performance with these methods, we offer a 100% guarantee of our repair. If your inguinal hernia repair fails, regardless of your age, weight, or occupation, provided you are not on chronic corticosteroid treatment, we will provide a second repair without cost to you or your insurance company. *Ethicon products Inguinal Hernia Repair Sports Hernia Femoral Hernia Repair Umbilical Hernia Repair Hiatal Hernia Repair Ventral and Incisional Hernia Repair

Over the last several years, more and more publicity has emerged around professional athletes undergoing surgery for a “Sports Hernia”. In fact, the condition is perhaps more accurately labeled as Athletic Pubalgia (pain in the pubic region), or any one of a number of other names. The condition is actually not a hernia at all, but is thought to involve a disruption of connective tissue in the pelvis, in or near the inguinal region, which is caused by an imbalance of muscular and tendinous forces focused in the groin. It occurs most commonly in athletic activities, which require certain motions of the hip, thigh, and abdominal muscles. Soccer and hockey players seem to be most at risk, but any activity that places stress in this area can produce symptoms of a sports hernia, especially when conditioning is somewhat out of balance Professional athletes are not the only ones at risk. In fact, it is likely that non-professional athletes and “weekend warriors” produce more injuries. Diagnosis can be challenging, as diagnostic imaging studies such as MRI, CT scan, and ultrasound are often normal or inconclusive. Careful evaluation including analysis of the athletic mechanisms which produced the pain, and targeted physical examination, is usually the only way to accurately diagnose this condition. Experts in the field argue about the appropriate treatment of this condition, and there is no clear-cut consensus as to which type of surgery is preferable. Our approach is to avoid application of the “one surgery fits all” mentality, and devise a treatment plan that is suitable for the patient, his condition, and the urgency of returning to similar athletic activity. Clearly, professional athletes need to be “back in the game” as soon as possible, but it is important to allow adequate healing, whether surgery is involved or not, before allowing resumption of a full level of participation. For some, surgery is not required. Quality physical therapy with a competent and knowledgeable therapist, combined with gradual strengthening exercises, can yield excellent results. Surgical options for sports hernia include minimally invasive laparoscopic repair with lightweight mesh, and minimal incision “open” bilayer mesh repair with the Prolene Hernia System or UltraPro Hernia System. Release of the adductor muscle tendon in the groin is occasionally advised, but is employed very judiciously. Professional athletes can usually be expected to return to the field of play in as little as two weeks, but 3-4 weeks is average. Others, depending on the level of conditioning and need for therapy after surgery, can require up to 6-8 weeks for adequate recovery.

This is actually a type of groin hernia very similar to an inguinal hernia. Unlike inguinal hernias, femoral hernias occur more commonly in women, and usually in older women. The repair of these hernias is essentially identical to that of inguinal hernias.

Umbilical hernias can be the result of a congenital weakness, a pre-existing dilatation of the natural umbilical ring, occupational stress, obesity, collagen deficiency, or previous surgery in the area of the umbilicus. Certain lifestyle choices can contribute to the development of an umbilical hernia as well, such as smoking and over eating. The vast majority of umbilical hernias are limited in size, and are therefore repairable with a simple mesh patch device, the Proceed Ventral Patch. This device is constructed mostly of absorbable components, a permanent lightweight mesh foundation, and features attributes which make repair with this device simple, fast, and most importantly highly reliable with minimal residual scar tissue. Umbilical hernia repairs are usually performed as an outpatient, requiring about 30 minutes to complete. General or spinal anesthesia is the most common choice in these procedures. Patients are free to return to normal leisure and work activities as soon as the minimal postoperative discomfort dissipates. This can be in as little as a few days.

Patients who suffer from chronic heartburn or gastroesophageal reflux disease (GERD) may have a condition called hiatal hernia. This is a dilatation of the normally occurring teardrop shaped opening in the diaphragm through which the esophagus passes from the chest into the abdomen to reach the stomach. The degree of dilatation and the resultant herniation of stomach through the dilatation are variable, as are the symptoms and treatment required. Patients who are unsuccessful in controlling symptoms with lifestyle changes and/or medications may be candidates for surgical correction of the hernia. Studies have shown that hiatal hernia repairs without the use of mesh can have a recurrence rate of 25-30% despite the fact that most of these recurrences are not associated with return of symptoms. Synthetic mesh products for use in this setting have been fraught with complications, however, due to scar formation around the esophagus, leading in some cases to erosion of mesh into the esophagus. Recent data suggests that the use of biologic mesh for these repairs is much better tolerated and carries much reduced risks of significant complications. The repair of a hiatal hernia is performed laparoscopically, under general anesthesia, and usually requires only an overnight stay in the hospital. Patients are able to return to normal activities and work in 5-10 days. Some patients may be a candidate for an implanted device which has been shown to have similar results in controlling heartburn and reflux. The LINX device is a “bracelet” of small magnets which is placed around the esophagus immediately before the stomach. This surgery can be performed as an outpatient in most cases.

Hernias can occur in the abdominal wall with or without a previous surgical scar. Incisional hernias can occur anywhere there has been a previous abdominal incision, and can occur at any time following previous surgery. Ventral hernias can also occur in a variety of locations in the abdominal wall without previous surgical incision. Surgeons have learned that repairing such hernias without the use of some form of mesh device puts the patient at much higher risk of failure of the repair than if the repair had included the use of mesh. Furthermore, simply suturing mesh to the borders of the hernia defect has been shown to be inferior to placing mesh with considerable overlap of the mesh perimeter on the surrounding normal tissue. This can be done in a variety of methods depending on the patient’s circumstances. The approach to the repair of these hernias must be highly individualized and tailored to his or her unique situation. ventral and incisional hernia repairMost of these patients require a preoperative CAT scan evaluation in addition to careful physical examination. Many patients have had numerous previous attempts at repair of the hernia, and each failed repair results in an increased risk of future failure. It is for this reason that many patients require advanced and radical solutions to achieve lasting reconstruction of their abdominal wall hernia. Options for repair of ventral and incisional hernias include: Laparoscopic mesh placement Requires intraperitoneal tissue separating mesh and fixation with transfascial sutures and tacking devices. Ventral and Incisional Hernia RepairOpen preperitoneal mesh repair (modified Stoppa technique ) which may or may not require transfascial sutures or tacks. Open components separation reconstruction with underlay mesh placement (preperitoneal or intraperitoneal) Open components separation reconstruction with underlay and onlay mesh reinforcement (Sandwich technique ). Mesh Products Mesh options for ventral and incisional hernia repairs include: Biologic Mesh (i.e. Flex HD ) is one of the newest tools available for hernia repair, and is usually recommended for procedures where there is risk of bacterial contamination or known existing infection. Use of non-biologic synthetic mesh in settings such as these can lead to infection involving the mesh, which often requires removal of the synthetic mesh. The use of biologic mesh in these cases greatly reduces both the risk of infection and the requirement of removal of the mesh. Tissue separating mesh Tissue separating mesh(i.e. Proceed® Mesh) is used when the mesh must be placed into the abdominal cavity in contact with the intestine and other internal organs. These mesh products are constructed of a lightweight mesh foundation, and feature surface qualities which vastly reduce and inhibit the formation of scar adhesions to these internal tissues, while providing strong in-growth into the abdominal wall. Lightweight mesh Lightweight mesh(i.e. UltraPro or Prolene® Soft Mesh) without tissue separating features is useful in circumstances where the mesh can be placed between two layers of, or on top of the abdominal wall. Recovery from ventral and incisional hernias is dependent on numerous factors, all of which are patient-specific. Nevertheless, while some patients are able to have repair of these hernias as an outpatient, the majority of larger, or more complex abdominal wall reconstructive procedures require at least a few days in the hospital, and as expected, a few weeks to a month or more before returning to active life and work obligations. Inguinal Hernia Repair Sports Hernia Femoral Hernia Repair Umbilical Hernia Repair Hiatal Hernia Repair Ventral and Incisional Hernia Repair