Hernia repair with absorbable mesh

What are my hernia repair options?

Mesh Hernia Repair

Hernia mesh is a medical device that provides support to damaged tissue around hernias, by using mesh the chance of another hernia is lower.  Options include permanent and absorbable mesh. Absorbable mesh is made from natural material and works as a scaffold with your body to rebuild tissue. As you heal, the mesh dissolves, leaving good and  healthy strong tissue behind with no foreign material.

Non-mesh or dissolvable mesh hernia surgery

Even though mesh hernia repair is the medical standard, sometimes it is not always recommended and  the use of mesh depends on each case. In fact, non mesh hernia repair is an alternative that has become popular in recent years by closing the hernia defect only with sutures.

One of the problems is that hernia recurrence rate increases if  mesh is not used. In patients, that mesh is necessarily needed, a dissolvable mesh that offers all the benefits of mesh  is recommended. This mesh alternative can potentially benefit patients with high risk factors for post operative complications  and it can also be used in childbearing age patients with medium size hernias avoiding a permanent material that could impact future pregnancies.

Dr. Arevalo has extensive experience in alternatives to permanent mesh hernia repair in Texas and offers his patients the best technology available.

What to expect during & after a non mesh or absorbable Mesh hernia repair procedure

This will depend on the complexity of your procedure and the  hernia repair   technique that was utilized, either open repair, laparoscopic repair, or robotic repair. Robotic surgery is preferred for must hernias as it is much  kinder to the body and there will be less pain and a faster recovery; for small defects open surgery with no mesh is possible with excellent outcomes.

Hernia repair recovery time

Hernia repair recovery time may vary according to each case. You are encouraged to walk and climb stairs after surgery. If absorbable mesh was used during your repair, it  will not affect the post-operative recommendations.

What is an alternative to mesh for hernia?

With today's technology, there are more options for your hernia repair. Absorbable mesh, has proven to be a reliable choice for hernia repair with clinically proven benefits. 

Dr. Arevalo is performing no mesh or absorbable mesh hernia repair in Houston. If you still have any questions or want to know what type of repair is the most suitable for you, you can ask Dr. Arevalo through its website or by calling the number 281-351-5409.

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Absorbable Mesh FAQ

What Is a Hernia?

Nowadays, it is important to understand what is a hernia and why it appears because now it is more common. A Hernia can happen when fat, tissue, or part of an organ pushes through a weak spot or hole in the abdominal muscle. Depending on the type of hernia you have and how severe it is, the condition can range from slightly bothersome to life-threatening, according to  Hopkins Medicine.

In adults, hernia are very common, in the groin or abdomen. When a patient has a hernia, they may notice or feel a bulge in the area of pain. Also, they can experience pain during certain activities such as: Lifting or standing up for a very long period of time.

HOW CAN YOU DEVELOP A HERNIA?

A hernia can appear for different reasons, These causes can be the following: 

• If you have a chronic cough
• Lift heavy weights or  Heavy items
• Being born prematurely or having low birth weight
• Chronic constipation
• After pregnancy.

These are usually the most common causes for which a hernia develops, but there can be many more, and it also depends on the type of hernia. 

TYPES OF HERNIAS

There are two types of hernias, internal and external. The most common type of hernias are external, which means that the tissue is pushing through the abdominal wall toward the outside of the body. This often creates a bulge that you can feel or see, and an internal hernia refers to a hernia that happens inside the abdominal cavity. Internal hernia most commonly involve the intestinal bowel loops and cannot be visualized externally.

The most common types of hernias are the followings:

Inguinal hernia: 

An inguinal hernia occurs when the intestines or fat from the abdomen bulge through the lower abdominal wall into the inguinal, or groin, area.

Symptoms of an inguinal hernia:

• A bulge on one or both sides of the groin that disappears when lying down. 
• Pain in the groin, especially when lifting, coughing or exercising.
• A feeling of weakness, heaviness, or burning in the groin.
• A swollen scrotum.

Femoral hernia

Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear. 

Symptoms of an femoral hernia: 

• Groin discomfort that may worsen when standing, lifting, or straining.
• Abdominal pain.
• Nauseas.
• Vomiting.

Umbilical hernia:

An umbilical hernia occurs when a tissue bulges out through an umbilical hernia occurs when a tissue bulges out through an opening in the muscles of the abdomen near the navel or belly button (umbilicus). About 10% of abdominal hernias are umbilical hernias.

Symptoms of an umbilical hernia: 

A bulge in the belly button or surrounding region (often most visible when coughing or straining)

Pain at the hernia site

Constipation

Sharp abdominal pain and vomiting can mean the hernia is strangulated.

Incisional hernia:

An incisional hernia is very common in infants and young children, particularly it may happen in babies born prematurely. An umbilical hernia appears as a painless lump in or near the navel, better known as the belly button. 

Symptoms of a incisional hernia:

• Constipation, “narrow” or “thin” stool.
• Lump or protrusion in the abdomen at or near the site of a previous incision; the patient may be asked to stand and cough, which tends to make the hernia more pronounced.
• Nausea, vomiting, fever or rapid heart rate.
• Pain in the abdomen, especially around the protrusion.

Epigastric hernia:

An epigastric hernia can occur when the tissues in the upper abdominal wall don’t close completely during development. Research continues to look for the specific causes of this type of hernia. Not as much is known about epigastric hernias, possibly because they aren’t reported many times due to a lack of symptoms.

Symptoms of an epigastric hernia:

• A bulge below the breastbone or upper abdomen.
• Pain, which can range from a dull ache to severe pain, especially when coughing, sneezing or lifting heavy objects.
• Bloating or constipation.

Hiatal hernia:

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

Symptoms of a hiatal hernia:

• Chest pain
• Acid reflux-Backflow of food or acid  from your stomach into your mouth
• Bloating
• Burping
• Trouble swallowing
• Bad taste in your mouth-An upset stomach and vomiting
• Shortness of breath

WHEN TO SEE A DOCTOR:

It is important to determine when you should consult your trusted doctor to prevent any type of these hernias becoming a danger to the patient. You should visit the doctor when you have these symptoms, (also everything depends on the type of hernia you have).

• When you have a lump in the navel that becomes very painful.
• When constipation  and vomiting occur along with the pain in the area of the hernia.
• Feeling a lot of sensitivity in the area.

It is extremely important to visit a trusted Doctor, like Dr. Gabriel Arévalo, who has several years of experience in hernias and surgery. He is currently chief of the surgery department at Houston Methodist, Willowbrook.

Dr. Gabriel Arévalo is a fellowship-certified Robotic and Laparo-endoscopic surgeon specializing in complex hernia repairs and advanced gastrointestinal surgery. He currently holds a national leadership role as a member of the HERNIA TASK FORCE of the Society of American Gastrointestinal Endoscopic Surgeons.

Also, Dr. Arévalo focuses on gastroesophageal reflux disease, gallbladder disease, and diaphragm dysfunction. He also does endoscopic treatments for achalasia and Gastroparesis.

In addition to operating, he has distinguished himself by his valuable contributions in research for improvements in hernia repair, gastroesophageal reflux disease, robotic surgery, and endoscopy. He has authored several publications and invited commentaries to some of the most influential gastrointestinal journals in the world. 

During pregnancy, the most common hernia that occurs is the umbilical hernia, which can pose a risk to your pregnancy.

It occurs mainly during the second half of pregnancy and is due to the increased abdominal girth, uterus enlargement, and the thinning of your abdominal wall muscles. But, it can also happen after pregnancy due to great abdominal strain when giving birth.

What is an umbilical hernia?

An umbilical hernia is a type of hernia that is located at the belly button. Umbilical hernias are more often acquired due to an increased intraabdominal pressure that causes a tear or hole in the abdominal wall at the belly button. 

The hernia has a sac that can contain part of the intestine, fat, or fluid. These tissues can stick out through an opening or a weak spot in the abdominal wall.

Umbilical hernias have been detected in up to 90% of pregnant women.

Generally speaking, this hernia should be repaired after the delivery. But, if the umbilical hernias are causing too much pain or become incarcerated with intestine or fat, it will require individualized treatment.

Factors to consider are no mesh surgery vs. mesh surgery. However, the latter can cause increased pain in future pregnancies and the risk of pregnancy loss related to surgery during pregnancy, the timing for surgery, gestational age (first second, or third trimester) type of surgical approach open or robotic and available resources including fetal monitoring are all very important.

You can make an appointment with Dr. Arevalo to find out the best treatment for you, both during and after pregnancy.

What is Umbilical Hernia?

An umbilical hernia is a type of hernia that is located at the belly button. Umbilical hernias in adults are more often acquired due to an increased intraabdominal pressure that causes a tear or hole in the abdominal wall at the belly button.

The hernia has a sac that can contain part of the intestine, fat, or fluid. These tissues can stick out through an opening or a weak spot in the abdominal wall.

Umbilical hernias are more common in women who have been pregnant more than one time, in people who are overweight, in people who do a lot of physical activity, and in people who have had an abdominal operation. 

What are the Symptoms?

They are characterized by a bulge around the belly button that can become enlarged when laughing or coughing. They are usually painless in babies and children, however, in adults who develop it the most common symptoms are  pain, pressure  and some gastrointestinal discomfort.

When to operate?

Repairing the hernia can relieve pain and discomfort and even make the bulge go away. It is important to remember that the hernia will not go away on its own. It’s bets that you have surgery if:

• Your bulge is very large
• Your hernia is bothering you 

With time and the persistent intraabdominal pressure, the hole between the muscles can enlarge, making a risk for the intestines to get incarcerated, “trapped” or even strangulated resulting in serious complications requiring emergency surgery.

What is the Procedure of an Umbilical Hernia Surgery?

Umbilical hernias can be repaired simply without the need for mesh if they are small. For wide umbilical hernias, robotic hernia surgery offers less pain and faster recovery. 

The tissue that  enters the hernia sac is pushed back into the abdomen. The muscles and tissues around the navel are repaired, and the cut is closed with stitches. This can be accomplished through a small incision at your bellybutton or far away from it when performing robotic hernia repair.

If the surgeon considers it, a mesh can be placed in the weak to buttress the area before closing to prevent the hernia from recurring.

Key points to remember

• Hernias do not go away on their own, on the contrary, they tend to grow overtime. 
• Many doctors recommend surgery because it prevents a rare but serious problem called strangulation. This occurs when a part of the intestine or a portion of fatty tissue becomes trapped within the hernia and the blood supply is interrupted.

Dr. Arevalo is one of the best surgeons in Houston, Texas that can repair different types of hernias by using robotic hernia surgery, offering faster recovery and less pain. You can schedule an appointment to learn what is the best treatment for you.

Watch Dr. Arevalo's video to learn more about the types and causes of an umbilical hernia:

One in five people will have a hernia in their lifetime, and the only treatment is surgery. Today, this intervention can be done with minimally invasive techniques. Benefits? Less hospital stay and faster recovery. Most patients tend to have many questions before and after surgery, and in this blog, I will be answering my top 8 questions asked for hernia surgeries.

1. What causes a hernia?

• Anyone can get a hernia at any age, but they are more common as we get older. Certain activities may increase the likelihood of a hernia, including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.
• An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, obesity, injury, or following an infection at that site following surgery. They can occur immediately following surgery or may not become apparent for years later following the procedure.

2. How are hernias treated?

Hernia repair can be done through two options: open surgery or minimally invasive surgery (laparoscopic, robotic, or hybrid). Open surgery involves making a larger incision to access the hernia and can take about 3 hours, while minimally invasive surgery involves making a smaller incision, and it only takes about 1 hour. The right surgery will depend on the size of your hernia, where the abdominal wall is, whether this is the first time it is getting repaired, and what your general health is like. Dr. Arevalo is a fellowship certified hernia expert and will determine which approach fits best for you.

3. What should I expect after hernia surgery?

• Patients are encouraged to engage in light activity while at home after surgery. Your surgeon will determine the extent of activity, including lifting and other forms of physical exertion. 
• Post-operative discomfort is usually mild to moderate. 
• If you begin to have fever, chills, vomiting, are unable to urinate, or experience drainage from your incisions, you should call your surgeon immediately.
• If you have prolonged soreness and are getting no relief from your prescribed pain medication, you should notify your surgeon.
• Most patients can get back to their normal activities in a short period. These activities include showering, driving, walking upstairs, work, and sexual intercourse.
• Occasionally, patients develop a lump or some swelling in the area where their hernia had been. Frequently this is due to fluid collecting within the previous space of the hernia. Most often this will disappear on its own with time. 
• You should ask your physician when you need to schedule a follow-up appointment. Typically, patients schedule follow-up appointments within 2-3 weeks after their operation.

4. How long will I be off work after a hernia operation?

After hernia surgery, you are likely to feel a little uncomfortable for a few days. But you should feel better after a few days. Dr. Arevalos' patients return to work quite fast due to the benefits of robotic surgery.

Most people who have open hernia repair surgery for large hernias  can go home in one or 2 days after surgery. For minimally invasive surgery, patients can go home the same day or next depending on the complexity of the surgery. Recovery time is approximately 2 weeks but starts on day one by walking and moving out of bed. You will most likely be able to resume light activities soon after surgery . But, there are still activity restrictions, such as lifting no more than 20 pounds for the first  2 weeks.

5. How do you get out of bed after hernia surgery?

Dr. Arevalos patients follow an enhanced recovery pathway after surgery, this means patients are encouraged to get out of bed and walk the same day of surgery among other instructions.

As long as there are no contrary guidelines, it will be advisable to get up 2 to 3 times to walk a little. To do this, there must be always a person next to you who helps you turn on your side. Then you should bend your knees so that they hang over the side of the bed, and with the help of your arms, lift your upper body.

6. How do you poop after hernia surgery?

Constipation can be very common after hernia surgery, which is why I will give you 5 tips to help you have a bowel movement. 

• Drink plenty of water
• Drink prune juice, 
• Eat foods that are richer in fiber, such as pears, apples, bananas, and nuts. 
• Take walks to help your digestive system to get going again. 
• Chewing gum to help your digestive system to get going again. 

7. Does the bulge go away after hernia surgery?

Yes. After surgery, the bulge should be gone. What you can see is fluid accumulation or  inflammation and swelling, giving the sense of a bulge. 

8. When to call your doctor?

Be sure to call your surgeon if you develop any of the following symptoms:

• Persistent fever over 101°F (39°C)
• Bleeding
• Increased abdominal swelling or pain
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Drainage from any incision
• Redness surrounding your incisions

Other questions...

Make sure to call your doctor for any other questions you may have. If you haven’t gone through surgery yet, but you are thinking about it, you can always make an appointment with Dr. Arevalo and feel free to ask as many questions you like.