Robotic ventral hernia repair with posterior Component Separation and transversus abdominis release (TAR)

Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) is an advanced, minimally invasive procedure used to repair complex ventral hernias. This technique combines robot-assisted surgery with posterior component separation and transversus abdominis release (TAR) to address large and complicated abdominal wall defects. Here are the key points of this procedure:

It uses a robotic surgical system to repair hernias through small incisions, enhancing the surgeon’s precision and control. Posterior component separation is a form of muscle release that involves dissection of the abdominal wall layers to be able to recruit muscle and close large abdominal wall defects. TAR releases the transverse abdominal muscle to allow for further medial advancement of the components of the abdominal wall. This approach enables the placement of a large mesh in a submuscular position, reinforcing the hernia repair.

Key Benefits of Robotic ventral hernia repair with posterior Component Separation and transversus abdominis release (TAR):

1. Minimally Invasive Surgery: Compared to open surgery, this procedure offers smaller incisions, reduced scarring, and a faster recovery.
2. Enhanced Visualization and Precision: Robotic surgery provides the surgeon with 3D visualization, enhancing control and precision during surgical dissection.
3. Shorter Length of Stay (LOS): Studies show patients undergoing robotic hernia repair experience shorter hospital stays, reducing costs.
4. Lower Risk of Infection: The minimally invasive nature of this procedure results in fewer wound complications and a lower rate of infection.
5. Effective for Large Hernias: It is ideal for incisional hernias and those over 10 cm, recurrent hernias, or those with loss of abdominal domain.
6. Better Postoperative Outcomes: Faster recovery times, fewer complications and recurrences, and quicker return to daily activities are commonly observed with this technique when done robotically.

Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) Procedure Steps

The robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) follows a structured set of key steps designed to repair complex ventral hernias effectively. Here’s a breakdown of the procedure:

1. Access and Trocar Placement: The procedure begins with the surgeon making small incisions in the abdomen to insert the robotic trocar ports, enabling the introduction of the robotic instruments and creating pneumoperitoneum (insufflation of the abdomen with CO₂ to create space for surgery). Typically after trocar placement any adhesions are released to expose the abdominal wall.
2. Posterior Component Separation (PCS): The surgeon divides the posterior rectus sheath along its entire length. This separation is done posteriorly to expose the rectus abdomens muscle.
3. Creation of Retrorectus Space: The retrorectus space is developed between the rectus abdominis muscle and the posterior rectus sheath up to larval of the semilunar line. Care is made to identify and preserve the neuromuscular bundles supplying the abdominal wall.
4. Transversus Abdominis Release (TAR): The next critical step is releasing the transversus abdominis muscle. By releasing this muscle, the surgeon can further mobilize the abdominal wall muscles, allowing them to be moved medially to close large abdominal wall defects. This step requires expert knowledge of the anatomy and the technique to avoid injuries and adverse outcomes.
5. Closure of Fascial Layers: The surgeon then closes the posterior and anterior fascial layers. The closure of the anterior layer effectively closes the hernia defect and the closure of the posterior layer excludes the bowels and intra-abdominal organs.
6. Mesh Placement: A large synthetic mesh is inserted into the retromuscular space between the rests muscle and posterior rectus sheath. The mesh is positioned to provide reinforcement for the weakened abdominal wall, minimizing the risk of recurrence. Mesh placement in the retromuscular space allows better mesh integration, and reduces mesh infections and mesh adhesions to the abdominal wall.
7. Bridging Techniques: In cases where primary fascial closure is not feasible due to the size of the defect, bridging with mesh may be necessary. This involves using the mesh to connect the separated fascial layers, ensuring stability even in the absence of full closure.

The robot-assisted surgery platform provides the surgeon with 3D visualization and precise control over each step of the procedure, enhancing the surgeon’s ability to navigate intricate anatomical terms of location while care is taken to avoid damage to surrounding structures such as the gastrointestinal tract while ensuring the creation of a stable flap of tissue to close the abdominal defect. The robotic system also allows for improved ergonomics, reducing surgeon fatigue during the operation.

Expanded Benefits of the Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) Technique

The robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) offers several advantages over traditional open or laparoscopic hernia repair methods, particularly for complex and large ventral hernias. Here are the key benefits:

1. Minimally Invasive Approach: The robotic TAR technique involves smaller incisions compared to open surgery. This leads to reduced scarring, less postoperative pain, and a faster recovery for the patient. The smaller incisions also lower the risk of wound infection and other complications.
2. Enhanced Visualization and Precision: The robotic platform provides the surgeon with three-dimensional (3D) visualization, which allows for greater clarity when working in the extraperitoneal space and around delicate structures. This enhanced precision and control reduce the risk of injury to surrounding tissue, such as the rectus abdominis muscle and neurovascular bundles.
3. Improved Fascial Closure: The transversus abdominis release (TAR) technique allows for significant medial advancement of the abdominal wall components, reducing tension and facilitating closure of large abdominal wall defects. This improved closure contributes to better long-term outcomes in preventing hernia recurrence.
4. Shorter Hospital Stay (LOS): Patients who undergo robotic TAR often have a shorter length of stay (LOS) in the hospital compared to those undergoing open surgery. Faster recovery and reduced pain contribute to quicker discharge and fewer postoperative complications, such as seromas or hematomas.
5. Lower Risk of Infection and Complications: The minimally invasive nature of robotic surgery results in a lower rate of surgical site infections (SSI) and other wound-related complications as well as reduced perioperative mortality, making it a safer option for patients with underlying disease conditions. Studies have shown that robotic TAR is associated with a reduced risk of complications such as adhesion and wound dehiscence.
6. Faster Recovery: Patients generally experience a quicker return to normal activities and a reduced need for pain medication compared to those who undergo traditional open surgery. The reduced trauma to the abdominal muscles and subcutaneous tissue aids in the body’s natural healing process.
7. Effective for Large and Complex Hernias: The TAR technique is particularly effective for large ventral hernias, recurrent hernias, and hernias involving multiple defects or loss of domain. The ability to place a large synthetic mesh in the optimal retromuscular position reinforces the repair and reduces recurrence rates.
8. Better Cosmetic Results: The smaller incisions used in robotic TAR often result in less visible scars, providing better cosmetic outcomes compared to open surgery. This is especially important for patients concerned about postoperative appearance.
9. Potential Cost Savings: Despite the higher initial costs of robotic surgery due to equipment and operating time, the shorter hospital stay, reduced complication rates, and faster recovery may lead to overall cost savings for both patients and healthcare systems.

While these benefits are significant, the success of robotic TAR depends largely on surgeon experience, proper patient selection, and continued advances in data and research on long-term outcomes.

How does the Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) Technique improve postoperative outcomes?

The robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) significantly improves postoperative outcomes compared to traditional open surgery. One of the key benefits is a shorter hospital stay, with patients recovering faster due to the minimally invasive nature of the procedure. Studies show that robotic TAR often results in a reduced length of stay (LOS), with patients spending less time in the hospital than those who undergo open repairs. The technique also leads to lower complication rates, especially when it comes to systemic complications and surgical site infections (SSI). By minimizing creation of subcutaneous flaps, robotic TAR reduces the risk of wound complications such as seromas, hematomas, and infections.

Additionally, robotic TAR is associated with a reduced risk of surgical site occurrences (SSO), such as wound infections and adhesions. Patients who undergo this procedure also experience lower readmission rates, with studies showing significantly fewer readmissions within 90 days post-surgery compared to open repairs. This is a testament to the reduced complications and improved outcomes associated with robotic TAR.

Faster recovery times are another major benefit of the robotic approach. The smaller incisions and reduced trauma to the muscle and subcutaneous tissue layers lead to quicker healing, less postoperative pain, and a faster return to normal activities. The robotic system’s three-dimensional (3D) visualization and enhanced precision enable surgeons to perform complex repairs with greater control, reducing the risk of tissue injury and improving long-term outcomes. The platform also offers better ergonomics for surgeons, decreasing fatigue during lengthy procedures and allowing for more meticulous and controlled movements.

one of the criticisms of robotic TAR is increased operative times however this is easily offset by the imrovement in outcomes.. Additionally, the robotic approach tends to incur higher initial costs due to the use of advanced technology. However, the shorter hospital stays, reduced complications, and quicker recovery may offset these costs over time. Overall, robotic TAR is a promising option for hernia repair, providing significant improvements in patient outcomes, though continued research and data collection are necessary to fully assess its long-term effectiveness.

What types of hernias can be treated with the Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) Technique?

The robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) technique is highly effective for treating a wide range of complex hernias, especially those involving large abdominal wall defects. One of the primary applications of this approach is for large incisional hernias, particularly those with a width of 8-14 cm or greater. These hernias often occur after previous surgeries and can be difficult to repair using traditional methods, making the robotic TAR technique an ideal solution.

The procedure is also well-suited for complex ventral hernias, including recurrent hernias that have failed previous repairs. The precision and control offered by the robotic platform allow surgeons to address these difficult cases with improved outcomes. For smaller hernias or patients with a lower body mass index, less invasive methods are more appropriate, as TAR is generally reserved for larger, more complex hernias.

For hernias with loss of abdominal domain, where a significant portion of the abdominal contents has shifted outside of the abdominal cavity, robotic TAR provides an effective solution by allowing for abdominal wall reconstruction. This technique is particularly beneficial for patients with hernia defects that are difficult to close using other methods, as the transversus abdominis release allows for better advancement of the abdominal muscles. Adjuncts such as preoperative progressive pneumoperitoneum (PPP) and botox injections may be needed in those cases tom improve chances of closure.

In summary, the robotic TAR technique is highly versatile and can be used to treat a variety of complex ventral hernias, including large incisional hernias, recurrent hernias, lateral hernias, parastomal hernias, and hernias with loss of abdominal domain. Its minimally invasive approach, combined with the ability to reinforce the repair with mesh, makes it a powerful option for addressing challenging abdominal wall defects.

What types of hernias can the Robotic Ventral Hernia Repair with Posterior Component Separation and Transversus Abdominis Release (TAR) Technique not treat?

While the robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) technique is highly effective for treating complex and large hernias, there are certain situations where this approach may not be suitable.

Small hernias that measure less than 8 cm in width may not require the extensive dissection and repair offered by TAR. In these cases, simpler techniques are more appropriate, as TAR is generally reserved for larger, more complex abdominal wall defects.

Patients who have previously placed pre-peritoneal or retromuscular mesh may present challenges for TAR. The presence of prior mesh can make it difficult to create the necessary tissue planes for a successful repair, as the existing mesh may disrupt the normal anatomy of the abdominal wall. Similarly, patients who have undergone extensive resection of the posterior abdominal wall components (for example, during procedures like a radical cystectomy) may lack the necessary tissue structure for TAR to be performed effectively.

For patients who have undergone anterior component separation in the past, performing TAR may increase the risk of creating a lateral hernia. Although TAR is possible in these cases, surgeons must exercise caution, as this previous procedure may alter the normal anatomical planes.

Lastly, TAR is generally reserved for complex or large hernias. Small, straightforward hernias that can be repaired using less invasive methods may not warrant the more extensive dissection and mesh placement associated with TAR.

In summary, while robotic TAR is highly effective for treating large and complex ventral hernias, it is not the best option for small hernias, patients with previous mesh placement or certain anatomical alterations, or those with compromised tissue healing due to underlying health conditions. Careful patient selection is crucial to ensure optimal outcomes with this advanced technique.

Dr. Iskandar’s Thoughts on the Technique

Robotic TAR is one of the procedures that has revolutionized treatment of large hernias. It allowed treatment of larger hernias that typically required larger open surgeries to be done in a minimally invasive fashion. This lead to significant reduction in complication rates as well as recurrence rates. Although a relatively new procedure, interest in its adoption among surgeons is high given the potential benefits to patient with complex hernias. Expert knowledge of the anatomy of the abdominal wall and the nuances of the operation and its complicated steps is mandatory for successful completion of the operation and avoiding complications.

Conclusion

Robotic ventral hernia repair with posterior component separation and transversus abdominis release (TAR) is a highly advanced, minimally invasive surgical technique that offers significant benefits for patients with complex ventral hernias. This procedure combines the precision of robot-assisted surgery with innovative techniques like TAR, allowing for effective repair of large abdominal wall defects, faster recovery, and fewer complications. Although robotic TAR may not be suitable for all hernia types, particularly smaller or less complex hernias, it has proven to be a versatile and powerful option for cases that require enhanced control and mesh reinforcement. With continued advancements in data and surgeon experience, robotic TAR is poised to become a key approach for hernia repair, offering patients improved outcomes and faster returns to their daily lives.

 

source https://iskandarcenter.com/hernia-surgery/robotic-ventral-hernia-repair-with-posterior-component-separation-and-transversus-abdominis-release-tar/

Enhanced view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair

The Enhanced-view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair is an advanced surgical technique used primarily for the repair of ventral and incisional hernias. This approach combines the principles of the Rives-Stoppa procedure with the benefits of a minimally invasive, laparoscopic technique.

Key Features of eTEP Rives-Stoppa Repair

• Minimally Invasive Approach: The eTEP technique is performed laparoscopically, which allows for a minimally invasive procedure. This approach involves creating a large extraperitoneal space to work within, without entering the abdominal cavity, which reduces the risk of complications such as intestinal injury, postoperative ileus, and adhesions.
• Mesh Placement: In the eTEP Rives-Stoppa repair, a mesh is placed in the retromuscular space, behind the rectus abdominis muscles. This placement is intended to allow for maximum mesh integration and strengthening of the abdominal wall, reducing the likelihood of hernia recurrence. keeping the mesh outside the abdominal cavity reduces the chances if infection and adhesions. Polypropylene mesh is commonly used due to its balance of strength and flexibility.
• Enhanced Surgical View: The technique provides an enhanced view of the retromuscular space, which improves the ergonomics of the surgery and allows for precise dissection and repair of the hernia. This enhanced visualization is particularly beneficial in the identification and management of complex hernias.
• Component Separation: For large or complex hernias, the procedure may include a posterior component separation technique, such as Transversus Abdominis Release (TAR), to facilitate tension-free closure of the defect. This separation is crucial for addressing extensive hernia defects that cannot be closed primarily without undue tension.
• Advantages: The eTEP Rives-Stoppa repair offers several advantages, including reduced postoperative pain, fewer adhesions, and a quicker recovery compared to traditional open hernia repair methods. It also allows for the use of a less expensive mesh, as a composite mesh with an anti-adhesion barrier is not required. Additionally, the extraperitoneal nature of this approach significantly lowers the risk of complications associated with intraperitoneal mesh placement, such as mesh-related adhesions and erosion into the bowel.

Overall, the eTEP Rives-Stoppa repair is a sophisticated technique that requires a thorough understanding of abdominal wall anatomy and advanced laparoscopic skills. It is considered a safe and effective alternative to open hernia repair, with promising outcomes in terms of patient recovery and hernia recurrence rates.

The eTEP Rives-Stoppa Hernia Repair Technique Procedure Steps

The Enhanced-view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair is a sophisticated surgical procedure for ventral hernia repair. Here are the general steps involved in the procedure:

• Patient Preparation: The patient is positioned and prepped for surgery. The procedure is performed under general anesthesia. Proper positioning is crucial to ensure optimal access to the retromuscular space.
• Creation of Surgical Space: The eTEP technique involves creating a large extraperitoneal space. This is achieved by opening the retro-rectus spaces and connecting them with the preperitoneal spaces of Retzius and Bogros. The creation of this space is fundamental to the success of the procedure, as it provides the necessary room for safe mesh placement and hernia defect repair.
• Dissection: Careful dissection is performed to expose the retromuscular space. This step requires expert knowledge of the anatomy and precise handling of laparoscopic or robotic instruments to avoid injury to surrounding tissues. Meticulous dissection ensures the integrity of vital structures and the optimal placement of the mesh.
• Closure of Hernia Defect: The hernia defect is closed using sutures to restore the linea alba, which is the central tendon of the abdomen. This closure is critical for reestablishing the functional integrity of the abdominal wall.
• Mesh Placement: A polypropylene mesh is placed in the retromuscular space. The mesh is typically macroporous and medium-weight, providing support and augmentation to the abdominal wall. The retromuscular space is measured and the mesh is cut to the measured size and fits the entire dissected space creating wide mesh overlap and reinforcement of the abdominal wall.
• Mesh Fixation: Initially, mesh fixation may involve the use of glue or tackers, but with experience, surgeons often rely on the overlap of the mesh to prevent recurrence, minimizing the need for fixation. This technique reduces the risk of chronic pain associated with mesh fixation devices.
• Component Separation: In cases of large or complex hernias, a posterior component separation technique, such as Transversus Abdominis Release (TAR), which involves incising the transverse abdominal muscle, may be performed to facilitate tension-free closure of the defect. This step is crucial for achieving durable repair in challenging cases.
• Closure: The posterior layer, such as the posterior rectus sheaths or peritoneum, is closed using resorbable barbed sutures. This layer provides an additional barrier between the mesh and the abdominal contents, further reducing the risk of postoperative complications.
• Postoperative Care: Patients are typically ambulated on the first postoperative day and discharged within a few days, depending on their recovery. Early ambulation is encouraged to reduce the risk of deep vein thrombosis (DVT) and to promote faster recovery.

This procedure requires a thorough understanding of abdominal wall anatomy and advanced laparoscopic skills. It offers the benefits of a minimally invasive approach with reduced postoperative pain and quicker recovery compared to traditional open repair methods.

Benefits of the eTEP Rives-Stoppa Hernia Repair Technique

The Enhanced-view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair offers several advantages, particularly in the context of ventral and inguinal hernia surgery:

• Reduced Risk of Complications: The eTEP approach may minimize the risk of intestinal injury and reduces the frequency of postoperative ileus. It also results in fewer intraperitoneal adhesions and associated complications compared to intraperitoneal approaches. The extraperitoneal placement of the mesh avoids direct contact with the bowel, thus reducing the risk of mesh-related complications.
• Minimally Invasive: As a laparoscopic or robotic technique, eTEP approach is less invasive than traditional open surgery, leading to quicker recovery times and less postoperative pain. It provides an enhanced view of the surgical field, facilitating precise dissection and repair. The minimally invasive nature also reduces scarring and the overall physical trauma of surgery.
• Effective Mesh Placement: The procedure allows for the placement of a large piece of mesh in the retromuscular space, which provides extensive prosthetic reinforcement of the visceral sac. This placement reduces complications associated with mesh exposure to intra-abdominal contents and improves mesh integration. The use of a medium-weight, macroporous mesh enhances tissue ingrowth and long-term durability of the repair.
• Cost-Effectiveness: The use of a conventional mesh without the need for an anti-adhesion barrier reduces costs while still providing effective reinforcement. This cost-effectiveness makes the procedure more accessible to a broader patient population.
• Versatility: The eTEP approach is suitable for various types of hernias, including ventral, inguinal, and lumbar hernias.This versatility allows the eTEP technique to be applied in a wide range of clinical scenarios, offering a tailored approach to each patient’s needs.

Overall, the eTEP Rives-Stoppa Repair is a safe and effective technique with significant advantages over traditional open hernia repair methods, offering improved patient outcomes and reduced recurrence rates.

How does the eTEP Rives-Stoppa Hernia Repair Technique improve postoperative outcomes?

The Enhanced-view Totally Extraperitoneal (eTEP) technique improves postoperative outcomes in several ways:

• Reduced Postoperative Pain: The eTEP technique is associated with significantly less postoperative pain compared to other methods such as the intraperitoneal onlay mesh (IPOM) technique. This reduction in pain is particularly notable in the immediate postoperative period and contributes to better patient comfort and quicker recovery. The minimal use of fixation devices also reduces chronic pain risks.
• Lower Complication Rates: Studies have shown that the eTEP approach results in very low rates of surgical site infections, seromas, and major complications. For example, a meta-analysis reported a <1% rate of surgical site infections and a 1% rate of major complications. The extraperitoneal dissection and mesh placement contribute to these low complication rates.
• Improved Functional Recovery: Patients undergoing the eTEP procedure experience less restriction in normal activities shortly after surgery. This is attributed to the minimally invasive nature of the procedure and the avoidance of traumatic mesh fixation methods. Patients often return to normal activities and work sooner compared to traditional open surgery.
• Shorter Hospital Stay: The eTEP technique often results in a shorter hospital stay which is beneficial for both patient recovery and healthcare resource utilization. In most cases patient are discharged home the same day. This shorter stay is a direct result of reduced pain, lower complication rates, and quicker recovery.
• Low Recurrence Rates: The technique has demonstrated low recurrence rates, with studies reporting a recurrence rate of <5% after a median follow-up period of several months. This low recurrence is achieved through meticulous dissection, proper mesh placement, and secure closure of the hernia defect.
• Enhanced Quality of Life: Patients report improvements in quality of life post-surgery, including better aesthetics and reduced pain, which are important factors for overall satisfaction with the surgical outcome. The improved quality of life is also linked to the minimal scarring and effective repair achieved with eTEP.

Overall, the eTEP technique offers significant advantages in terms of reduced pain, lower complication rates, and improved recovery, making it a favorable option for ventral hernia repair.

What types of hernias can be treated with the eTEP Rives-Stoppa Repair?

The Enhanced-view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair is primarily used to treat various types of hernias, particularly ventral and inguinal hernias. Here are the specific types of hernias that can be addressed using this technique:

• Ventral Hernias: This includes both primary ventral hernias and incisional hernias, which occur at the site of a previous surgical incision. The eTEP approach is effective for these hernias due to its minimally invasive nature and ability to place a mesh in the retromuscular space. It is particularly beneficial in cases where the abdominal wall has been weakened by previous surgeries.
• Inguinal Hernias: The eTEP technique was initially devised to address difficult inguinal hernias, including those that extend into the groin, by creating a larger extraperitoneal space, which allows for effective mesh placement without entering the abdominal cavity. This approach reduces the risk of complications commonly associated with intraperitoneal repairs of inguinal hernias.
• Complex Hernias: The technique can be adapted for complex hernias, including those with multiple defect sites or those involving previous surgical interventions. In such cases, additional procedures like Transversus Abdominis Release (TAR) may be used in conjunction with eTEP to achieve optimal repair. This adaptability makes the eTEP technique a valuable tool in the surgeon’s armamentarium for complex hernia repairs.
• Recurrent Hernias: The eTEP method is also suitable for recurrent hernias, where previous repair attempts have failed. The technique’s ability to provide a robust and tension-free repair makes it a viable option for these challenging cases. Recurrent hernias can be particularly difficult to treat, and the eTEP technique offers a reliable solution with a low recurrence rate.

Overall, the eTEP Rives-Stoppa Repair is a versatile technique that can be applied to a wide range of hernia types, offering the benefits of minimally invasive surgery with effective outcomes.

What types of hernias can eTEP Rives-Stoppa Repair not treat?

The eTEP Rives-Stoppa Repair is not suitable for certain types of hernias and conditions. The following situations are generally considered contraindications for using the eTEP approach:

• Loss of Domain: This condition involves a significant portion of the abdominal contents being outside the abdominal cavity, making it difficult to achieve a successful repair with the eTEP technique. In such cases, alternative approaches, such as open surgery or staged repair, may be necessary.
• Poor Condition of Overlying Skin: If the skin over the hernia site is in poor condition, it may not be suitable for the minimally invasive eTEP approach. This limitation is due to the risk of wound complications and the need for extensive soft tissue coverage.
• Infection or Scar Tissue: The presence of infection or significant scar tissue, such as a pubo-xiphoid scar, can complicate the eTEP procedure, making it less effective or safe. Infected or scarred tissues increase the risk of postoperative complications and may necessitate an alternative surgical approach.
• Recurrent Hernia After Rives-Stoppa or TAR: Patients who have experienced a recurrence after a previous Rives-Stoppa or Transversus Abdominis Release (TAR) repair may not be ideal candidates for another eTEP procedure. These patients may require a different approach, such as open surgery, to effectively manage their condition.

These contraindications highlight the importance of careful patient selection to ensure the safety and effectiveness of the eTEP Rives-Stoppa Repair.

Dr. Iskandar’s Thoughts on the Technique

this techniques checks a lot of the boxes when it comes to achieving the goals of a good hernia repair:

• it can be performed minimally invasive which leads to less pain and less infections
• it leads to restoration of the anatomy which leads to improvement of the core function
• placement of mesh in the retromuscular space is advantageous by leading to better mesh integration, and less mesh related complications.
• it does require advanced expertise and skills to perform safely

Conclusion

In conclusion, the Enhanced-view Totally Extraperitoneal (eTEP) Rives-Stoppa Repair represents a significant advancement in hernia surgery, offering a minimally invasive yet highly effective approach for the treatment of ventral, inguinal, and complex hernias. By combining the principles of the Rives-Stoppa technique with enhanced laparoscopic capabilities, eTEP provides surgeons with a versatile tool that reduces postoperative pain, minimizes complications, and promotes faster recovery. While not suitable for every type of hernia, the eTEP Rives-Stoppa Repair has proven to be a reliable and cost-effective option for many patients, delivering excellent outcomes with a low recurrence rate. As surgical expertise in this technique continues to grow, the eTEP approach is likely to become an increasingly preferred method for hernia repair, offering patients improved quality of life and long-term results.

source https://iskandarcenter.com/hernia-surgery/enhanced-view-totally-extraperitoneal-etep-rives-stoppa-repair/

Postoperative Urinary Retention (POUR) After Hernia Surgery

Postoperative urinary retention (POUR) is a common complication following hernia surgery, causing discomfort and potential health risks for patients. At The Iskandar Complex Hernia Center, we understand the importance of addressing this issue promptly and effectively. Our team, led by Dr. Iskandar, is dedicated to providing comprehensive care to prevent and manage POUR, ensuring a smoother recovery for our patients. In this article, we will discuss the causes, symptoms, and treatments for POUR after hernia surgery. If you have concerns about hernia surgery and its potential complications, schedule an appointment with The Iskandar Complex Hernia Center today for a thorough consultation.

What is Postoperative Urinary Retention (POUR)?

Postoperative Urinary Retention (POUR) is a common complication following inguinal hernia repair surgery, characterized by the inability to void despite a full bladder. At The Iskandar Complex Hernia Center, Dr. Iskandar and his team recognize that this condition can occur due to various factors related to the surgery, anesthesia, and patient-specific risk factors. Monitoring and managing POUR effectively is essential to prevent discomfort and further complications for our patients. Dr. Iskandar emphasizes understanding the causes and addressing them promptly to reduce the incidence and impact of POUR after hernia surgery.

What are the symptoms of Postoperative Urinary Retention (POUR) after hernia surgery?

The key symptoms of Postoperative Urinary Retention (POUR) after hernia surgery include the inability to urinate despite having a full bladder, difficulty urinating, or complete inability to void. Patients may also experience bladder pain or discomfort, abdominal swelling or pain in the lower belly, bladder spasms, urine leakage, and a strong urge to urinate but inability to do so. Not urinating for 6 hours or more after surgery is another symptom. It’s important to note that some patients may not experience any symptoms despite having urinary retention.

POUR is typically diagnosed when a patient is unable to void within 8 hours after surgery. The condition can lead to bladder overdistension, which may cause further complications if left untreated. Dr. Iskandar and his team at The Iskandar Complex Hernia Center emphasize the importance of healthcare providers being vigilant in monitoring patients for these symptoms, especially in high-risk groups such as older men, those with comorbidities, or patients who have undergone longer surgeries. Prompt recognition and treatment of POUR are crucial to prevent potential complications and ensure proper postoperative recovery. Patients can feel confident that with Dr. Iskandar, they will receive attentive and comprehensive care to ensure a safe and smooth recovery.

What causes POUR after hernia surgery?

Several factors, including anesthesia, post-operative medication, and some surgical factors, can cause postoperative urinary retention (POUR) after inguinal hernia surgery. The effects of general anaesthesia and spinal anaesthesia can interfere with normal bladder function and sensation, making it difficult to urinate after surgery. Pain medications, particularly opioids, can inhibit the urge to urinate and affect bladder muscle function. Dr. Iskandar and his team work closely with anesthesiology to manage these effects.

Surgical factors such as longer operative duration, bilateral hernia repairs, involvement of the urinary bladder within the hernia sac, and inflammation or swelling in the surgical area affecting nearby nerves can contribute to POUR. Patient-specific factors include advanced age, especially in men over 65, history of benign prostatic hyperplasia (BPH) or other urinary issues, diabetes, and a higher body mass index (≥35 kg/m2).

Perioperative factors like the use of anticholinergic medications, excessive intravenous fluid administration, and constipation can also lead to POUR. Additionally, nerve disruption from surgery and bladder overdistension, due to an inability to sense a full bladder, can make urination difficult. Psychological factors, such as anxiety about urinating after surgery, can further contribute to retention.

The multifactorial nature of POUR after hernia surgery highlights the importance of identifying high-risk patients and implementing preventive strategies. Proper management, including judicious intravenous therapy, pain control, and early mobilization, can help minimize the risk of POUR. Dr. Iskandar, an experienced surgeon, and his team are dedicated to providing comprehensive care to reduce the incidence of this complication and ensure a smooth recovery for all patients.

What is the treatment for POUR after hernia surgery?

The treatment for postoperative urinary retention (POUR) after hernia surgery at The Iskandar Complex Hernia Center typically involves catheterization and follow-up, at-home care. The standard initial treatment is bladder catheterization, which can involve either in-and-out urinary catheterization or the placement of an indwelling catheter, depending on the severity and duration of retention. This procedure helps decompress the bladder and relieve signs and symptoms of POUR. Dr. Iskandar may also prescribe alpha-blockers such as tamsulosin, prazosin, or phenoxybenzamine to relax the urethra and bladder neck, facilitating urination. Studies have shown that preoperative prescription of alpha-blockers significantly reduces the incidence of POUR after inguinal hernia repair.

In addition to these treatments that can be done at the hospital setting, simple measures can also help. Applying warm compresses to the abdomen, taking warm baths, and getting up and moving around early can be beneficial. Managing fluids is important, with careful IV fluid administration during surgery and making sure to stay properly hydrated afterward. Controlling pain is also crucial, as pain can make it harder to urinate. Dr. Iskandar carefully uses pain medications to minimize this risk. Additionally, avoiding catheterization when possible can reduce the risk of urinary tract infection.

Monitoring and follow-up are vital components of managing POUR. The team at The Iskandar Complex Hernia Center closely observes urinary output in the immediate postoperative period and uses ultrasound assessment of bladder volume when needed. In most cases, POUR resolves within 4-6 weeks. However, if symptoms persist or worsen, patients should follow up with their healthcare provider for further evaluation and management. Dr. Iskandar and his team emphasize the importance of prevention strategies, such as identifying high-risk patients preoperatively and implementing appropriate measures to minimize the risk of POUR.

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FAQ’s About Postoperative Urinary Retention (POUR) After Hernia Surgery

How common is postoperative urinary retention (POUR) after hernia surgery?

Postoperative urinary retention (POUR) is a relatively common complication, occurring in approximately 5-25% of patients after hernia surgery. The incidence can vary based on factors such as the type of anesthesia used, the duration of surgery, and patient-specific risk factors. At The Iskandar Complex Hernia Center, Dr. Iskandar and his team are vigilant in monitoring for POUR to provide timely and effective treatment, ensuring a smooth recovery for all patients.

How soon after hernia surgery does POUR typically occur?

POUR can occur immediately after hernia surgery or within the first 24 hours. The inability to void within 6-8 hours postoperatively is a common indicator. Dr. Iskandar and his team at The Iskandar Complex Hernia Center closely monitor patients during this critical period to quickly identify and manage any signs of POUR.

Are there any long-term effects of POUR after hernia surgery?

While POUR typically resolves within 4-6 weeks, if left untreated, it can lead to bladder overdistension and potential damage to the bladder muscles. Long-term complications are rare but can include chronic urinary retention or urinary incontinence. Dr. Iskandar ensures that all cases of POUR are managed promptly to prevent any long-term effects and to promote optimal patient outcomes.

What can be done to prevent POUR after hernia surgery?

Preventive strategies for POUR include careful management of anesthesia and pain medications, judicious fluid administration, early mobilization, and identifying high-risk patients preoperatively. Dr. Iskandar emphasizes a proactive approach at The Iskandar Complex Hernia Center, implementing these strategies to reduce the risk of POUR and enhance patient recovery.

Does the type of anesthesia used during hernia surgery affect the likelihood of POUR?

Yes, both general and spinal/epidural anesthesia can increase the risk of POUR by affecting bladder function and sensation. Dr. Iskandar and his team at The Iskandar Complex Hernia Center take this into consideration when planning surgeries and implement strategies to mitigate this risk, such as careful monitoring and postoperative care.

Can certain medications increase the risk of POUR after hernia surgery?

Yes, medications such as opioids for pain management and anticholinergic drugs can increase the risk of POUR by affecting bladder muscle function and inhibiting the urge to urinate. Dr. Iskandar carefully selects and manages medications to minimize this risk while ensuring effective pain control for patients at The Iskandar Complex Hernia Center.

How is POUR diagnosed after hernia surgery?

POUR is typically diagnosed based on patient symptoms and an inability to void within 6-8 hours postoperatively. Additional diagnostic tools, such as ultrasound assessment of bladder volume, can confirm the diagnosis. Dr. Iskandar and his team use these methods to accurately diagnose and promptly treat POUR, ensuring patient comfort and recovery.

What should I do if I experience symptoms of POUR at home after hernia surgery?

If you experience symptoms of POUR at home, such as difficulty urinating, bladder pain, or abdominal swelling, contact your healthcare provider immediately. Dr. Iskandar advises his patients at The Iskandar Complex Hernia Center to seek prompt medical attention to address any complications and to receive appropriate care.

Are there specific risk factors that make someone more prone to POUR after hernia surgery?

Yes, specific risk factors include advanced age, male gender, history of urinary issues such as benign prostatic hyperplasia (BPH), diabetes, higher BMI, and longer surgical durations. Dr. Iskandar assesses these factors in patients at The Iskandar Complex Hernia Center to tailor preventive and management strategies for POUR.

Can POUR recur after initial treatment?

While POUR usually resolves after initial treatment, it can recur if underlying risk factors are not addressed. Continuous monitoring and follow-up care are essential. Dr. Iskandar and his team provide comprehensive follow-up care at The Iskandar Complex Hernia Center to ensure that POUR is fully resolved and to prevent recurrence, ensuring long-term patient well-being.

How does Dr. Iskandar ensure the best outcomes for patients with POUR after hernia surgery?

Dr. Iskandar uses comprehensive patient data and employs regression analysis to identify risk factors and tailor prevention strategies, ensuring the best outcomes for patients experiencing POUR.

Are there different risks of POUR between open and laparoscopic hernia surgery?

While both general surgery and laparoscopy can lead to POUR, laparoscopic procedures may have a slightly lower risk due to less invasive techniques. Dr. Iskandar evaluates each patient to determine the best surgical approach to minimize complications, including POUR.

Can previous injuries or diseases increase the risk of POUR after hernia surgery?

Yes, previous injuries or diseases affecting the urinary system can increase the risk of POUR. Dr. Iskandar carefully reviews each patient’s medical history to address these risks before surgery.

source https://iskandarcenter.com/hernia-surgery/postoperative-urinary-retention-pour-after-hernia-surgery/

What is the best position to sleep after hernia surgery?

After hernia surgery, finding a comfortable and supportive sleeping position is crucial for a smooth recovery. At The Iskandar Complex Hernia Center, we understand the importance of proper post-surgical care and are here to guide you through every step of the healing process. In this article, we’ll explore the best sleeping positions to help you rest and recover effectively after your hernia surgery. For personalized health advice and a thorough consultation, schedule an appointment with Dr. Iskandar at The Iskandar Complex Hernia Center today.

What is the best position to sleep after hernia surgery?

The best position to sleep after hernia surgery is on your back with your upper body elevated at a 30-45 degree angle. This inclined position provides several benefits:

• Avoids unnecessary strain and disruption of the surgical sutures at the incision site.
• Improves mobility and control of limbs without affecting the sutures.
• Reduces discomfort and aids in faster recovery after surgery.
• Addresses additional issues like sleep apnea, acid reflux, and nasal/throat congestion.

To achieve this inclined sleeping position, you can use an adjustable bed, bed risers, wedge cushions, or a stack of pillows. It’s recommended to start with a 10-degree incline if the elevation is uncomfortable initially and gradually increase it to 30 degrees over 5-7 days. Sleeping flat on your back with a small pillow under your head is also advisable, especially after umbilical hernia surgery, as it prevents pressure on the incision site and allows for comfortable breathing. Stomach sleeping should be avoided as it puts excess pressure on the abdomen, interfering with the healing process.Side sleeping is generally not recommended in the initial recovery phase, but you can try transitioning to it gradually once the initial healing has occurred. It is helpful to use pillows between your legs and under your hips for support when side sleeping. Dr. Iskandar will provide personalized post-op instructions and expert guidance tailored to each patient’s specific needs.

Is it safe to sleep on my side after hernia surgery?

It is generally not recommended to sleep on your side immediately after hernia surgery. The best sleeping position, as advised by Dr. Iskandar at The Iskandar Complex Hernia Center, is on your back with your upper body elevated at a 30-45 degree angle. This inclined position helps avoid strain and disruption of the surgical sutures, improve mobility and control of limbs, reduce discomfort, and address issues like sleep apnea, acid reflux, and nasal congestion. You can achieve this inclined position using wedge cushions or pillows. Sleeping flat on your back with a small pillow under your head is also advisable, especially after umbilical hernia surgery, as it prevents pressure on the wound and allows comfortable breathing.

Side sleeping should be avoided in the initial recovery phase as it can put excess pressure on the abdomen, interfering with the healing process. However, you can gradually transition to side sleeping once the initial healing has occurred and with Dr. Iskandar’s approval. Use pillows between your legs and under your hips for support when side sleeping. The timeline for when you can start side sleeping varies based on factors like the type of hernia repair surgery and your individual recovery progress. It’s crucial to follow Dr. Iskandar’s specific advice and listen to your body’s signals throughout the recovery process.

12 Tips for Safe Quality Sleep After Hernia Surgery

To improve your sleep quality safely during the recovery period after hernia surgery, you can try the following strategies:

1. Maintain proper sleep positioning: Sleep on your back with your upper body elevated at a 30-45 degree angle using pillows or an adjustable bed. This reduces strain on the surgical site and improves comfort.
2. Create an optimal sleep environment: Keep your bedroom dark, quiet, and cool (60-65°F). Use blackout curtains and remove electronic devices that emit light. Consider using a white noise machine to mask disruptive sounds.
3. Establish a consistent sleep schedule: Go to bed and wake up at the same times each day to regulate your body’s circadian rhythm.
4. Practice relaxation techniques before bed: Try deep breathing exercises, progressive muscle relaxation, or meditation to reduce anxiety and promote calmness.
5. Limit caffeine and alcohol intake: Avoid caffeine in the afternoon/evening and minimize alcohol consumption, as both can disrupt sleep quality.
6. Manage pain effectively: Take prescribed pain medications as directed to prevent discomfort from interfering with sleep.
7. Avoid screens before bedtime: The blue light from electronic devices can suppress melatonin production. Stop using screens 1-2 hours before bed.
8. Take a warm shower: A warm shower 1-2 hours before bedtime can help relax muscles and promote better sleep.
9. Use supportive pillows: Place pillows strategically to support your body and reduce pressure on the surgical site.
10. Consider sleep-promoting supplements: Consult your doctor about using melatonin or other safe sleep aids during recovery.
11. Engage in light daytime activity: As approved by your doctor, gentle movement during the day can improve nighttime sleep quality.
12. Manage stress and anxiety: Practice mindfulness or seek support to address concerns that may be affecting your sleep.

By implementing these strategies, you can create an environment and routine conducive to better sleep quality, which is crucial for your recovery process. Remember to always follow Dr. Iskandar’s specific post-operative instructions regarding sleep and activity levels.

Rest Well, Recover Fast

Proper sleep is vital for a smooth recovery after hernia surgery. Following the right sleep positions and incorporating sleep strategies can significantly improve your healing process. Dr. Iskandar at The Iskandar Complex Hernia Center is dedicated to providing expert guidance tailored to your needs.

By implementing these sleep tips, you can enhance your recovery and overall well-being. For personalized advice and comprehensive care, schedule an appointment with Dr. Iskandar at The Iskandar Complex Hernia Center today. Your path to recovery starts with a good night’s sleep.

FAQ’s About The Best Position To Sleep After Hernia Surgery

How long should I sleep elevated after hernia surgery?

It’s generally recommended to sleep with your upper body elevated at a 30-45 degree angle for at least the first two weeks post-surgery. This position helps reduce strain on the surgical site and supports a smoother recovery. Dr. Iskandar advises continuing this until you are comfortable sleeping flat without any pain or discomfort.

Can I sleep flat on my back after hernia surgery?

Sleeping flat on your back is generally safe, especially after the initial healing phase. However, it’s crucial to use a small pillow under your head to prevent strain on the incision site. Dr. Iskandar recommends starting with an elevated position and gradually transitioning to a flat position as you feel more comfortable.

Is it okay to sleep in a recliner after hernia surgery?

Yes, sleeping in a recliner can be beneficial as it naturally keeps your upper body elevated, reducing strain on the surgical site. Dr. Iskandar often suggests this option for patients who find it difficult to maintain an inclined position in bed.

How can I reduce discomfort while sleeping after hernia surgery?

To reduce discomfort, sleep on your back with your upper body elevated. Use pillows to support your body and relieve pressure on the surgical site. Dr. Iskandar also recommends taking prescribed pain medications or over-the-counter analgesics as directed by your healthcare provider to ensure a comfortable night’s sleep.

What type of pillow is best for sleeping after hernia surgery?

Wedge pillows or adjustable pillows that can keep your upper body elevated are ideal. Additionally, placing pillows between your legs or under your hips can provide extra support. Dr. Iskandar, your surgeon, can recommend specific pillow types and mattress firmness that suit your recovery needs.

Can I sleep on my stomach after hernia surgery?

Sleeping on your stomach is generally not recommended as it puts excess pressure on the abdomen, increasing the risk of injury and interfering with the healing process. Dr. Iskandar advises avoiding this position to prevent complications and promote a smoother recovery.

When can I start sleeping on my side after hernia surgery?

You can gradually transition to side sleeping once the initial healing has occurred, typically after a few weeks. It’s essential to get Dr. Iskandar’s approval and use pillows for support to avoid putting pressure on the surgical site. This helps reduce edema and supports your abdominal muscles during recovery.

Should I use a body pillow after hernia surgery?

Yes, a body pillow can provide additional support and help maintain a comfortable sleep position. Dr. Iskandar recommends using a body pillow to support your back and reduce strain on the surgical site. Placing a pillow under your knee can also help align your spine and improve comfort.

Is it normal to have trouble sleeping after hernia surgery?

Some discomfort and difficulty sleeping are normal after hernia surgery. Dr. Iskandar suggests maintaining proper sleep positioning and using pain management techniques to improve sleep quality during the recovery period.

How can I ensure I get enough rest after hernia surgery?

Following a consistent sleep schedule, creating an optimal sleep environment, and practicing relaxation techniques can help ensure adequate rest. Dr. Iskandar emphasizes the importance of proper sleep for a smooth recovery and can provide personalized recommendations based on your specific situation.

source https://iskandarcenter.com/hernia-surgery/what-is-the-best-position-to-sleep-after-hernia-surgery/

How soon can I walk after hernia surgery?

When preparing for hernia surgery, patients often have several questions about the recovery and healing process. One of these questions is how soon can you walk after hernia surgery. In this article, Dr. Iskandar will provide expert insights into post-surgery recovery expectations regarding walking. For tailored advice and a detailed consultation, schedule an appointment with us at The Iskandar Complex Hernia Center.

How soon can I walk after hernia surgery?

You can typically stand and begin walking slowly within about two hours after hernia surgery. While resting is a crucial aspect of your recovery, incorporating gentle physical activities like brief walks can be beneficial. Dr. Iskandar emphasizes that it is vital to moderate your physical activities during the initial 4 to 6 weeks post-surgery. Unlike more intense forms of exercise, such as weightlifting, where pushing your limits can lead to faster improvements, recovery from hernia surgery does not accelerate with increased physical strain. However, slow, short walks play an important role in your rehabilitation. These walks aid in reducing the risk of complications and promote healing by stimulating circulation and maintaining muscle tone. At The Iskandar Complex Hernia Center, we recommend these gentle walks as they are an effective part of managing your recovery safely and effectively.

How often should I walk after hernia surgery?

There is no set duration or frequency for walking after hernia surgery, as each patient’s recovery is unique. Dr. Iskandar advises patients at The Iskandar Complex Hernia Center to start with short, manageable walks without straining themselves, lasting approximately 5 to 10 minutes. Overexertion, especially soon after surgery, can cause significant damage to the repair site and set back recovery. Initially, if you feel comfortable and can walk without pain, aim for a couple of daily sessions lasting between 5 to 15 minutes each. Remember, this is not a structured exercise regimen but a gentle reintroduction of activity to facilitate your recovery. It’s important to listen to your body and adjust your walking based on how you feel. During the first week post-surgery, keeping to brief sessions of 5 to 10 minutes each can be beneficial without overloading your body. Walking, while helpful, is not a cure-all, but it does contribute positively to the healing process by promoting circulation and reducing the risk of complications.

What are the benefits of walking after hernia surgery?

Walking after hernia surgery offers several significant health benefits including increasing circulation and promoting blood flow. This is crucial for the healing of tissues and muscles around the repaired hernia site. Improved blood flow ensures that these areas receive adequate oxygen and nutrients, which are essential for recovery.

While rest is critical after surgery, excessive immobility can lead to muscle atrophy and other complications. Thus, incorporating gentle walking into your recovery process strikes a balance between necessary rest and maintaining muscle function. It’s not about constant activity; rather, it’s about avoiding prolonged periods of inactivity to prevent the decline of muscle strength and circulation.

An additional advantage of walking post-surgery is its ability to alleviate constipation, a common issue for patients following hernia operations. Walking stimulates the bowels, which can help initiate bowel movements and relieve discomfort associated with constipation. This is especially important since constipation can cause strain on the surgical site and exacerbate pain or complications. In addition, walking can help alleviate other symptoms like nausea and gas which can occur post general anesthesia. At The Iskandar Complex Hernia Center, Dr. Iskandar recommends short, gentle walks as a part of your recovery regimen to harness these benefits effectively without overexertion.

What precautions should I take when walking after hernia surgery?

When walking after hernia surgery, it is crucial to proceed with caution to ensure your safety and the success of your recovery. At The Iskandar Complex Hernia Center, Dr. Iskandar emphasizes the importance of being very gentle with your body during the early stages of recovery. Straining or falling while walking can severely impact your surgical site and overall recovery.

It’s advisable to only walk under excellent conditions, where the risk of slipping or tripping is minimized. Initially, you should walk as though you are walking on eggshells, especially until the area that was repaired begins to feel stronger and more stable.

It’s best to avoid stairs for the first few days post-surgery if possible. While it might be necessary to use stairs, such as when returning home from the hospital, taking precautions is essential. Ensure that you hold onto the railing for support, have someone nearby to assist you in case you are unsteady, and move slowly and deliberately. These measures will help protect your hernia repair and aid in a smoother recovery process.

Navigating Recovery: Your Guide to Walking After Hernia Surgery

Recovering from hernia surgery requires careful consideration of both activity and rest. As you navigate through the healing process, remember that each step you take is a part of your journey towards recovery. If you have any questions about your recovery plan or need personalized advice, do not hesitate to reach out to us at The Iskandar Complex Hernia Center. Schedule an appointment with Dr. Iskandar today, and take the first step towards a safe and effective recovery. Your health and well-being are our top priorities, and we are here to support you every step of the way.

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More FAQ’s About How Soon Can I Walk After Hernia Surgery

What is the ideal pace to walk after hernia surgery?

Dr. Iskandar recommends walking at a slow, comfortable pace immediately following hernia surgery. It’s important to avoid any rapid or strenuous movements that might strain the surgical site. Walking slowly helps in minimizing pain and reducing the risk of complications.

Can walking too soon after hernia surgery cause complications?

Walking is encouraged and does not increase risk of complications. Dr. Iskandar advises patients to begin with very gentle and short walks, gradually increasing the duration as comfort allows.

How does walking help recovery from hernia surgery?

Walking enhances blood circulation, reduces the risk of blood clots hernia surgery, and helps to prevent muscle weakness. This activity stimulates the gastrointestinal tract and helps avoid constipation. It also helps manage edema and improve overall energy levels.

Is it normal to feel pain while walking after hernia surgery?

Some discomfort or pain while walking after hernia surgery, can be normal. Analgesic medications, as part of your prescription drug plan, can help manage this pain under the guidance of your surgeon, Dr. Iskandar.

How can I tell if I’m walking too much after hernia surgery?

Signs that you may be walking too much include increased pain, swelling around the surgery site, or any unusual symptoms such as bleeding or discharge. Dr. Iskandar advises patients to listen to their bodies and cut back on walking if any of these signs occur.

What type of footwear should I wear for walking after hernia surgery?

Choosing supportive, comfortable footwear is crucial for walking after hernia surgery to protect the wound and skin in the abdomen area and prevent emergency situations. Dr. Iskandar suggests wearing shoes that provide good arch support and have non-slip soles to prevent falls.

Should I use a walker or support while walking post-hernia surgery?

For some patients, particularly those with balance issues or extensive repairs, Dr. Iskandar might recommend using a walker or other support initially to ensure stability and safety while walking.

Can walking affect the stitches or mesh used in hernia surgery?

Gentle walking is unlikely to affect the stitches or mesh used in hernia surgery. Dr. Iskandar emphasizes the importance of gradual progression in physical activity.

What should I do if I experience increased pain while walking after my surgery?

If walking exacerbates your pain after surgery, Dr. Iskandar advises reducing the walking duration and pace. If pain persists, it’s important to consult with him or your healthcare provider at The Iskandar Complex Hernia Center.

What precautions should I take with my hygiene after walking when recovering from hernia surgery?

After inguinal hernia surgery, it’s important to keep the surgical suture area clean to prevent infection. You may shower as advised by your nursing staff, but avoid direct water pressure on the scar until it heals. Discuss the use of any laxative or dietary fiber supplements with your doctor to ease bowel movements without straining the surgical site.

How soon after hernia surgery can I resume walking my dog?

Patients are usually advised to avoid walking their dogs until they can walk comfortably without pain and with confidence in their ability to control the pet. Dr. Iskandar suggests waiting at least a couple of weeks and reassessing based on your specific recovery progress.

source https://iskandarcenter.com/hernia-surgery/how-soon-can-i-walk-after-hernia-surgery/

Extended Totally Extraperitoneal (eTEP) Hernia Repair Technique

The Extended Totally Extraperitoneal (eTEP) hernia surgery repair technique is a novel and advanced approach for the treatment of ventral and inguinal hernias. eTEP is a minimally invasive approach that can be performed laparoscopically or with robotic assistance, rather than being an open surgery technique. This technique was first introduced by Jorge Daes in 2012 and has since been adapted and refined by other surgeons for various types of hernias, including ventral hernias. The eTEP technique is characterized by its minimally invasive approach, which involves creating a large surgical workspace in the extraperitoneal space without entering the abdominal cavity. This is achieved through a series of surgical maneuvers and strategies aimed at enhancing the extraperitoneal work area and allowing for the placement of a larger surgical mesh to repair the hernia defect.

The eTEP Hernia Repair Technique Procedure Steps

The procedural steps for an eTEP (Extended Totally Extraperitoneal) hernia repair can vary depending on the type of hernia being treated (inguinal, ventral, or lumbar). However, the general steps for the eTEP approach are as follows:

1. Accessing the Extraperitoneal Space: The first step involves entering the extraperitoneal space, which is the space outside of the peritoneal cavity where the organs are located. This is typically done through a small incision and various methods are used.
2. Creating a Surgical Workspace: Once access is gained, the surgeon creates a large surgical workspace in the extraperitoneal space or retrmoscular space by dissecting and separating the tissues to expose the area where the hernia is located.
3. Hernia Sac Reduction: The hernia sac and its contents are then reduced, meaning they are pushed back into the proper anatomical position.
4. Defect closure: the hernia defect is closed, and the abdominal wall is tightened by placating the rectus muscle.
5. Mesh Placement: A mesh is placed in the retromuscular space to reinforce the area and prevent the hernia from recurring. The mesh is usually cut to the size of the space and therefore requires little to no fixation which can reduce post-operative pain.
6. Wound closure: After the mesh is positioned correctly, the surgical workspace is deflated, and the incisions are closed.
7. Postoperative Care: The patient is typically allowed to consume clear liquids a few hours after surgery and may be discharged within 48–72 hours, depending on their recovery.

 Key Features of eTEP Hernia Surgery

• Minimally Invasive: The eTEP technique is minimally invasive, providing lower overall complication rates, decreased wound complications, and shorter hospital stays compared to traditional open hernia repair methods.
• Mesh Placement: It allows for the placement of mesh in the retromuscular space, which is believed to offer better outcomes in terms of recurrence. Typically a larger mesh is placed in that space that covers and strengthens the majority of the abdominal wall. the retromuscular space is well vascularized leading to better mesh integration and less infections. Also mesh placement in this space requires little to no mesh fixation resulting in less pain. Lastly, placement of mesh outside the abdominal cavity leads to less chances of adhesions to intestine and scarring.
• Component Separation: For defects too wide to be closed without tension, a component separation procedure, specifically the posterior rectus sheath release is performed identical to a Rives-Stoppa repair. In cases of larger defects, a Transversus Abdominis Release (TAR) can be performed for further release. This enables tension-free closure of the hernia gap and achieves greater mesh overlap.
• Versatility: The eTEP approach can be adapted for various types of hernias, including ventral, inguinal, and lumbar hernias, making it a versatile technique for hernia repair.

 Advantages of eTEP Technique for Hernia Repair

• Reduced Risk of Complications: The extraperitoneal approach reduces the risk of intestinal injury, lessens the need for visceral retraction, and minimizes the frequency of postoperative ileus and intraperitoneal adhesions.
• Enhanced Recovery: Early discharge and enhanced recovery are possible due to diminished pain and a greater likelihood of early mobilization and unrestricted movement.
• Economic Benefits: The use of mesh in the eTEP technique is not only effective in reducing recurrence rates but is also cost-effective. the mesh used in the retromuscular space does not require a special coating and is typically costs less.

What are the success rates of eTEP hernia repair?

Here are the key findings from a recent study, explained in laypersons’ terms:

The study involved surgeons who did eTEP hernia surgery on 150 patients over three years.

Out of the 150 patients:

• 73 (48.7%) had incisional hernias (hernias that happen at an old surgery scar)
• 48 (32%) had primary hernias (hernias that happen for the first time)
• 29 (19.3%) had recurrent hernias (hernias that came back after being fixed before)

Most of the patients were females (74%). Primary hernias happened equally in males and females, but incisional and recurrent hernias were more common in females.

For smaller hernias, doctors used a method called eTEP RS (Rives-Stoppa). For larger hernias, they used eTEP TAR which also relaxes some muscles to help close the hernia.

The eTEP RS repair took about 2 hours to do, while eTEP TAR took about 3.5 hours.

After the surgery:

• Only 5.8% of patients had fluid collect under the skin (seroma)
• Only 3.3% felt some bulging or discomfort in the upper belly
• No patients got infections or had the hernia come back during the surgery study.

This study shows the eTEP method worked well to repair different kinds of hernias, even complicated ones, with few problems afterward. The study reports it is a good option, especially for hernias on the sides of the belly. Surgeons need a lot of special training to do it well.

Dr. Mazen Iskandar is thoroughly trained and experienced in eTEP surgery. You can view a video of Dr. Iskandar performing a complex eTEP procedure (Note: contains images of surgery).

What types of hernias can be repaired with the eTEP technique? 

The eTEP (Extended Totally Extraperitoneal) technique can be used to repair various types of hernias, including:

• Ventral Hernias: The eTEP technique was initially devised to tackle large groin hernias but has been extended to include ventral hernias, where the mesh is placed in the retromuscular space.
• Incisional Hernias: It is also used for incisional hernias, which can occur as a complication of laparotomies.
• Recurrent Hernias: The eTEP approach is suitable for recurrent hernias, offering a minimally invasive option for patients who have had previous hernia repairs.
• Atypical Sited Hernias: The technique has been successfully used for atypically sited hernias such as lumbar, subcostal, and Pfannensteil hernias.
• Lateral Hernias: eTEP is particularly useful for managing unusual lateral hernias such as subcostal (L1) and iliac (L3) hernias, which are close to fixed bony structures and require adequate mesh overlap.

What kind of hernias cannot be treated with eTEP? 

There are certain situations where the eTEP technique might not be the best choice or could be contraindicated:

• Strangulated Hernias: While there is a case report showing the feasibility of the eTEP technique in an emergency setting for a strangulated incisional hernia, the general use of eTEP in the emergency repair of strangulated hernias, especially when bowel resection is required due to necrosis, might be limited. This is because the presence of bowel necrosis or infection is a contraindication for the use of this technique in such emergency situations.
• Hernias with Bowel Necrosis or Infection: The eTEP technique might not be suitable for hernias where there is significant bowel necrosis or infection, as the presence of these conditions could complicate the minimally invasive approach and might necessitate a more direct and open surgical intervention to address the issue adequately.
• Hernias Requiring Immediate Bowel Resection: In cases where immediate bowel resection is necessary due to the condition of the herniated tissue, the eTEP approach may not be the most appropriate choice. The need for immediate and direct access to the bowel for resection might favor a more traditional open approach.
• Patients with Extensive Previous Abdominal Surgeries: Although not explicitly mentioned as a contraindication, patients with extensive scarring and adhesions from previous abdominal surgeries might present a higher risk of complications due to the difficulty in creating the extraperitoneal space without causing injury to the bowel or other structures.

Final Thoughts

The eTEP hernia surgery repair technique represents a significant advancement in the field of hernia repair. Its minimally invasive nature, combined with the strategic placement of mesh and the potential for component separation, offers a comprehensive solution for hernia repair that is associated with improved patient outcomes, including reduced complication rates, faster recovery times, and lower recurrence rates. Surgeons seeking to adopt this technique should have detailed knowledge of the anatomy of the extraperitoneal space and undergo formal training, ideally including practice on fresh cadavers under mentorship, to ensure the safety and effectiveness of the procedure.

 

 

source https://iskandarcenter.com/hernia-surgery/extended-totally-extraperitoneal-etep-hernia-repair-technique/

How to Avoid Constipation After Hernia Repair

Undergoing hernia repair surgery is an important step towards regaining your health and improving your quality of life. Dr. Iskandar and the team at The Iskandar Complex Hernia Center understand that post-operative recovery is just as crucial as the surgery itself. One common concern many patients face after hernia repair is constipation, a condition that can add discomfort and delay recovery. In this article, we’ll share effective strategies to prevent constipation, ensuring a smoother and more comfortable recovery process.

10 Tips to Avoid Constipation After Hernia Repair

Ensuring a comfortable recovery after hernia repair surgery at The Iskandar Complex Hernia Center involves managing post-operative constipation effectively. Dr. Iskandar and his team prioritize patient education on preventive measures to maintain digestive health. Here are 10 strategies to maintain regular bowel movements and ensure a comfortable recovery:

1. Enhance Digestion with a Fiber-Rich Diet
   • Incorporate foods high in fiber, such as berries, avocados, beans, and whole grains, into your meals. These options help soften stool and promote regular bowel movements, counteracting the constipating effects of less nutritious comfort foods.
2. Avoid narcotic pain medicine
   • Narcotic pain medicine can induce constipation. Medications like Tylenol and non-steroidal anti-inflammatory drugs (ibuprofen, naproxen etc…) are preferred as they don’t cause constipation.
3. Stay Hydrated to Ease Bowel Movements
   • Drinking sufficient water softens the stool and is crucial for preventing constipation, especially important when taking prescribed pain medications, which can contribute to digestive sluggishness. Begin hydrating before your surgery and continue diligently post-operation.
4. Prune Juice: A Natural Constipation Remedy
   • Prune juice, rich in fiber and sorbitol, is effective for stimulating digestion and easing constipation. Aim for 8 to 10 ounces a day to help maintain regularity during your recovery, but remember that balance is key.
5. Introduce Yogurt into Your Diet
   • The beneficial bacteria in plain yogurt can improve digestive health and assist in preventing constipation. It’s a nutritious choice that supports bowel movements by enhancing your gut flora.
6. Utilize Olive Oil as a Dietary Aid
   • Olive oil can act as a natural lubricant in the digestive system, facilitating easier passage of stool. Whether added to meals or consumed directly, it’s an effective way to alleviate constipation.
7. Light Physical Activity to Stimulate Digestion
   • Following Dr. Iskandar’s recommendation, engage in short walks to promote digestive health without exerting undue stress on your recovery. Just 5 to 10 minutes of gentle walking can make a significant difference.
8. Consider Stool Softeners
   • Preparing with stool softeners before surgery, as advised, can provide a gentle solution to post-surgery constipation. Consult with your surgeon, Dr. Iskandar, for the appropriate timing and usage to soften stools.
9. Consultation for Laxative Use
   • For persistent constipation, discuss the possibility of laxatives with your hernia surgeon. While effective, laxatives should be a last resort due to their potential side effects and the need for a careful approach to post-operative care.
10. Encourage Natural Bowel Movements by Sitting on the Toilet
    • Regularly sitting on the toilet can trigger your body’s natural reflexes for bowel movements, providing a passive strategy to address constipation. This should be a patient, strain-free process, especially critical during hernia recovery.
11. Avoid Highly Processed Foods
    • During recovery, it may be tempting to indulge in comfort foods like pizza or burgers, but these can exacerbate constipation. Opting for less processed options and focusing on nutritionally rich foods aids in smoother digestion and overall health.

Will having a bowel movement after hernia repair be painful?

After hernia repair surgery, it’s normal to experience some level of pain and discomfort, particularly in the area of the repair when moving, which may affect how easily you can have a bowel movement. This could happen anytime from one to ten days after the surgery. Anesthesia used during surgery can also slow the gastrointestinal tract. It’s important to avoid straining or forcing a bowel movement during this time to prevent excess pressure on the hernia repair. Instead, we advise patients to relax, perhaps with a book or phone in hand, to allow the body to proceed naturally.

Having a bowel movement after hernia repair surgery is a common concern among patients at The Iskandar Complex Hernia Center, primarily due to the potential discomfort . Dr. Iskandar and his team are committed to ensuring that each patient’s recovery process is as smooth and pain-free as possible, emphasizing the importance of managing expectations and following post-operative guidelines to minimize discomfort.

To manage pain and encourage gentle bowel movements, we recommend several strategies. Utilizing stool softeners post-surgery can soften stools, making them easier to pass without straining. Maintaining hydration and adhering to a high-fiber diet are also key in preventing constipation, which in turn facilitates smoother bowel movements. Moreover, engaging in light physical activities, such as walking, can stimulate the digestive system, supporting regular bowel movements without overexertion.

Always communicate openly with your surgeon about any concerns or unusual symptoms so that you can receive personalized advice and support. Dr. Iskandar and the team at The Iskandar Complex Hernia Center are here to guide you through your recovery, ensuring a comfortable and safe return to normalcy.

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More FAQ’s About How to Avoid Constipation After Hernia Repair

What foods should I avoid to prevent constipation after hernia repair?

Dr. Iskandar recommends avoiding foods that can exacerbate constipation following hernia repair. These include highly processed foods, red meat, dairy products, and sweets. Such foods are low in fiber and can slow down digestion. He advises focusing on a balanced diet rich in fruits, vegetables, and whole grains to support smoother bowel movements and a more comfortable recovery.

What are some natural remedies to relieve constipation after hernia repair?

To naturally relieve constipation after hernia repair, Dr. Iskandar suggests several effective remedies. Increasing your intake of water and fiber-rich foods is fundamental. Additionally, warm liquids in the morning, such as herbal tea, can stimulate digestion. Gentle exercise, like walking, is also beneficial. Dr. Iskandar may recommend specific herbal supplements or probiotics, but it’s important to consult with him before trying any new remedy to ensure it complements your recovery plan.

What specific foods should I eat to prevent constipation after hernia repair surgery?

Dr. Iskandar recommends focusing on a diet rich in fiber to prevent constipation post-hernia repair. Incorporate fruits like pears and apples, vegetables such as leafy greens and carrots, whole grains, and legumes. Dietary fiber helps maintain the health of the gastrointestinal tract and facilitates the passage of human feces. Eating fiber rich foods help increase stool bulk and promote regular bowel movements.

Can I use over-the-counter laxatives immediately after my hernia surgery to prevent constipation?

Dr. Iskandar advises against using over-the-counter laxatives to encourage defecation without prior consultation. While they may seem helpful, they can interfere with your recovery process. It’s best to discuss with him about the safest options for your specific case.

How does water intake influence constipation after hernia repair?

Adequate hydration is crucial for preventing constipation after hernia repair, as explained by Dr. Iskandar. Water helps soften stool, making it easier to pass. He recommends drinking at least eight glasses of water a day to facilitate bowel movements and aid recovery.

Is it normal to feel pain during bowel movements after hernia repair surgery?

Some discomfort or slight pain during the first few bowel movements post-surgery is normal. Analgesic medications, such as Ibuprofen and Paracetamol, can alleviate pain associated with bowel movements post-surgery. However, Dr. Iskandar emphasizes that extreme pain, nausea or fever is not and could indicate complications. If you experience significant pain, contact The Iskandar Complex Hernia Center immediately.

How long after hernia repair surgery can constipation last?

Constipation duration varies among patients, but it’s generally temporary. Dr. Iskandar notes that most patients see improvement within the first week as they adjust their diet and hydration levels and gradually increase physical activity.

Are there any specific exercises I can do to prevent constipation after my hernia repair?

Dr. Iskandar recommends gentle walking as the safest exercise to prevent constipation post-surgery. Start with short walks and gradually increase as comfortable. Avoid strenuous activities that strain the abdomen until he clears you for such exercises.

How does pain medication after hernia surgery affect constipation?

Pain medications, especially opioids, can lead to constipation by slowing down the digestive system. Certain narcotics, a type of prescription drug used for pain management after surgery, can lead to constipation as a side effect, which is why it is important to closely manage medication intake. Dr. Iskandar advises staying hydrated, eating fiber-rich foods, and discussing stool softeners as preventive measures during your recovery period. Docusate is an example of an over-the-counter drug that can be used under the guidance of Dr. Iskandar to soften stools and prevent straining during bowel movements.

Can stress after hernia repair surgery contribute to constipation?

Yes, stress can impact your digestive system and contribute to constipation. Dr. Iskandar encourages practices such as deep breathing, meditation, or gentle yoga to manage stress and support a healthy digestive process during your recovery.

What are the signs that constipation after hernia repair is severe and requires medical attention?

If you experience no bowel movements for more than three days, severe abdominal pain, bloating, or symptoms of bowel obstruction, Dr. Iskandar stresses the importance of seeking immediate medical care to prevent complications.

Can altering the timing of pain medication intake help manage constipation after hernia repair?

Adjusting the timing of your pain medication can sometimes help, but it should not be done without consulting Dr. Iskandar. He may offer alternative pain management strategies or adjust your medication to alleviate constipation without compromising pain control.

source https://iskandarcenter.com/hernia-surgery/how-to-avoid-constipation-after-hernia-repair/