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July 16, 2008 > Hernia Surgery: Advanced, Minimally Invasive Technique Speeds Recovery

Hernia Surgery: Advanced, Minimally Invasive Technique Speeds Recovery

The National Center for Health Statistics estimates that 500,000 Americans undergo some type of hernia surgery each year, making it one of the most common operations performed in the United States.

"With traditional hernia repair surgery, patients generally require hospitalization and six to eight weeks of recovery time before resuming all their normal activities," says Dr. Ramsey Araj, Director of Washington Hospital's Institute for Minimally Invasive and Robotic Surgery. "In the past 10 years, however, we have developed minimally invasive laparoscopic hernia repair techniques that often can be performed at an outpatient clinic, and the patient can generally resume full activities within 14 days."

A hernia is a defect in the abdominal wall fascia - which is a thin layer of connective tissue that supports and connects the muscles. This defect allows the intestines or other body tissues to push through and form a bulge or balloon-like pouch. "It's somewhat like a plastic grocery bag with a hole in it, and the groceries start to fall out," Dr. Araj explains.

"People who develop a hernia may notice a bulge in their abdomen or groin," he says. "The bulge can be small or large, and it often appears suddenly after heavy lifting. Some patients may not notice a bulge and just experience pain in the abdomen or groin. Still other patients will have both pain and a bulge. Hernias are more common among men, but women certainly can get them, too."

There are several different types of hernias:
* Inguinal - The most common type of hernia, these appear in the groin.
* Umbilical - These hernias are located around the belly button.
* Ventral (or Incisional) - These hernias occur in the abdomen in the area of an old surgical scar, where weakened scar tissue has created a weakness in the abdominal wall.
* Hiatal (or Diaphragmatic) - This type of hernia forms at the opening in the diaphragm where the food pipe (esophagus) joins the stomach, with part of the stomach pushing through the opening.

Most surgeons perform hernia repairs as "open" surgeries, making a large incision over the hernia, pushing the protruding tissue (usually part of the intestines) back into place and inserting a plastic or nylon mesh patch to fortify the damaged muscles. After a few weeks, new tissue grows on and through the mesh, making the muscle in the area less likely to tear again.

"With laparoscopic hernia repair, we make two to three tiny incisions - about 1/4-inch long," Dr. Araj says. "Then we insert the mesh patch and a laparoscope, which is like a little video camera that magnifies the internal organs and allows us to view the hernia on a video monitor as we repair it. In addition to reducing the patient's recovery time dramatically, the laparoscopic hernia repair reduces the level of post-operative care by 50 percent. Patients generally need only oral pain medications following the surgery."

Currently, only about 10 percent of hernia repairs are done laparoscopically because most physicians are not trained in the procedure. Dr. Araj and his colleagues at Washington Hospital, in fact, were among the pioneers in performing the laparoscopic hernia repair. Dr. Araj personally has performed hundreds of these innovative surgeries, with many of them being performed at the Washington Outpatient Surgery Center, where he is on the board of directors.

Dr. Araj notes that surgeons continue to make advances in hernia repair. "The latest innovation is to use biological mesh grown from human or pig skin, instead of plastic or nylon mesh," he says. "This biological mesh dissolves in the body and re-creates the fascia. Because biological mesh is new and somewhat experimental, it currently is very expensive to use, but it is definitely the trend of the future."

For more information about minimally invasive laparoscopic hernia repair, please call the Institute for Minimally Invasive and Robotic Surgery at (510) 797-1770 or visit, click on "Services & Programs" and select "Institute for Minimally Invasive and Robotic Surgery" from the drop-down menu.

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