Surgical Group of Johnson City
Hernia Surgery
Hernias are openings in the abdominal wall or groin which can occur at birth or be acquired as a result of abnormally increased intrabdominal pressure. They can also occur as the result of previous surgery. This could potentially allow the intestines to become trapped in the opening resulting in a potential life threatening situation. This could result in emergency surgery. It is for this reason, all hernias should be repaired. The most common sites of hernias are inguinal, umbilical, and the abdominal wall. Our surgeons have been thought leaders in the region in minimally invasive hernia surgery and have taught and shared their experience with many other surgeons.

Inguinal Hernia

These are commonly referred to as groin hernias. They have been traditionally treated as an open procedure without the placement of mesh. This has been an uncomfortable procedure and resulted in a high recurrence rate. These hernias are now routinely repaired with mesh which has resulted in a less painful operation with a recurrence rate of 0.2%. Patients can expect to return to work in about 14 days.

Even better is the laparoscopic approach which can be done as an outpatient procedure as well. This is less painful and the recurrence rate is the same. However, one can expect to return to work with unrestricted activity much quicker (typically in 3-5 days). This requires only 3 small puncture sites and no sutures in the muscle. Results have been excellent

All of our surgeons perform laparoscopic inguinal hernia repairs.

Incisional/Ventral Hernia

Incisional hernias are common after previous abdominal surgery. They can be very uncomfortable and unsightly with a considerable bulge in the abdomen. They can also be dangerous if the intestines were to become stuck in the defect. Therefore, all of these hernias need to be repaired.

The recurrence rate approaches 25% so these are usually repaired with mesh. These also can be repaired with an open or laparoscopic approach.

The laparoscopic incisional hernia repair is done with only 3 or 4 puncture sites. Occasionally, this can be done on an outpatient basis. This results in a less painful procedure with a faster recovery time. Mesh is used for the repair and recurrence rates are similar to the open repair. Most patients can return to work with unrestricted activity in about 2 weeks instead of the 6 weeks typically required by open repairs.

Larger abdominal wall defects will require abdominal wall reconstruction. This is a more complex operation which requires releasing muscle attachments laterally in order to bring the abdominal muscles together in the midline to recreate the natural position and function of the abdominal wall. These also are reinforced with mesh and having excellent functional and long term results. Our surgeons have extensive training and experience in repairing these most difficult hernias.

Our surgeons perform laparoscopic incisional hernia repairs.

Umbilical Hernia

Umbilical hernias can be acquired as an adult or as a result of birth. While in children 85% of umbilical hernias resolve without surgical intervention, in adults these need to be repaired. They have a high incidence of entrapping the intestines and smaller ones carry a higher risk than larger ones. These are repaired on a outpatient basis with low recurrence rates. The incision is hidden in the navel and return to work usually occurs in about 2 weeks.

Hiatal/ Paraesophageal/ Diaphragmatic Hernia

Gastroesophageal reflux disease is common. 90% of it can be treated medically but the rest will remain symptomatic and require surgical intervention. Most patients have a hiatal hernia which can be repaired with minimally invasive techniques either laparoscopically or with the Da Vinci robot. Likewise, all paraesophageal and diaphragmatic hernias need repair and can also be done with minimally invasive techniques.