Complex Hernia Center

Complex hernias have higher complications or recurrence rates that are difficult to manage. Often this is because of risk factors that include age, obesity, cancer, infections or complications from previous surgeries. These hernias include:

• Multiple recurrence. These are hernias that develop again, sometimes after an inadequate surgical repair. With each recurrence, chances diminish for an optimal outcome.
• Complex hernia. A basic hernia can be considered complex when repeated attempts to close the hole have failed.
• Large hernia. If left untreated, hernias (which start as a small bulge) can grow, measuring 10 cm or longer. This can lead to digestive issues, including nausea, vomiting and constipation.
• Infection of prosthetic mesh. Surgical mesh is commonly used in hernia repair. Sometimes this mesh can cause infections, creating the need for advanced surgical repairs.
• Parastomal hernia. This is a common occurrence for patients with a colostomy. It occurs when the intestines press out near the hole (stoma) created in the abdomen.
• Enterocutaneous fistula. An abnormal connection can develop between the stomach or intestinal tract and the skin. These often occur after bowel surgery.

Complex hernias require a multidisciplinary approach to achieve the best patient outcome. Our specialists work together to minimize risk factors before, during and after the hernia repair and abdominal wall reconstruction. This decreases your risk of recurrence and complications following surgery.

A hernia occurs when an internal organ pushes through muscle or tissue that normally keeps it in. These most commonly occur in the abdomen or groin. Complex hernias happen when previous repairs fail or become infected. They also can be caused when organs, including the appendix, ovaries or spleen, poke through the abdominal wall. Among the most common causes:

• Aging
• Excessive abdominal pressure after surgery
• History of chronic diarrhea or constipation
• Obesity
• Smoking
• Long-term coughing, sneezing or COPD
• Poor hernia repair
• Heavy lifting

• Abdominal pain
• Constipation
• Previous hernia repair
• Vomiting
• Redness, pain or hardness of the hernia

You might need abdominal reconstruction if you have a history of previously repaired hernias or have suffered abdominal trauma. Abdominal wall reconstruction also may be needed if you have a large hernia that results in abdominal deformity. These aren’t generally life threatening, but they can be very uncomfortable and damaging to quality of life. They will not go away without surgery.

Abdominal reconstruction procedures typically require repositioning the abdominal muscles and fascia and inserting mesh for support. Our highly trained specialists can accomplish this by using open or minimally invasive techniques.

These procedures take as little as two hours but can take four hours or longer, depending on your age, medical conditions, size of the hernia and any complications from previous surgeries. You may need to spend at least one night in the hospital after the procedure. Among the surgical options:

Robotic surgery. These minimally invasive procedures offer the best option to reduce scarring and pain. The surgeon uses a computer console to help guide the instruments, which are inserted into the body through small incisions.

Laparoscopic surgery. With this minimally invasive procedure, the surgeon uses a camera and tools inserted through small incisions. Advantages include quicker recovery time and fewer complications.

Open surgery. This traditional surgical option may be needed for more complicated or hard-to-access hernias.

You likely will have questions before your procedure, including:

• What is a hernia?
• What surgical approach is best for this type of hernia and why?
• What should I expect immediately after surgery?
• What should I expect in terms of pain after the procedure?
• How is pain managed?
• Is there a risk for chronic pain after the repair?
• Will there be physical limitations after surgery?
• Are there any long-term complications?
• Can my hernia be repaired without mesh?
• What are the risk and benefits of mesh?
• Are there possible complications with mesh?
• What signs and symptoms could indicate a potential complication with my repair?
• What is the rate of recurrence after repair of this type of hernia?
• How do complications and recurrence compare with a non-mesh repair?
• When should I call the surgeon?