When Can I Exercise After Hernia Surgery? A Week-by-Week Recovery Timeline

When Can I Exercise After Hernia Surgery?

Most patients can return to light exercise within 2–3 weeks of hernia surgery and full, unrestricted exercise within 8–12 weeks. Walking is safe and encouraged within the first 24 hours after surgery. The exact timeline depends on the type of surgery performed (laparoscopic, robotic, or open), the type and size of hernia repaired, and your individual healing progress.

Below is a complete week-by-week guide based on the recovery patterns we see at The Iskandar Complex Hernia Center, where we specialize in both straightforward and complex hernia repairs.

Exercise Recovery Timeline After Hernia Surgery

Timeframe	Activity Level	What You Can Do
Days 1–3	Rest + gentle movement	Short walks (5–10 min, 5–6x daily), deep breathing exercises, gentle ankle pumps
Days 4–14	Light daily activity	Longer walks (15–30 min), light household tasks, gentle stretching, stair climbing
Weeks 2–3	Low-impact exercise	Stationary cycling, swimming (once incisions are healed), elliptical at low resistance
Weeks 4–6	Moderate exercise	Brisk walking, light jogging, yoga (modified), light weights under 15–20 lbs, bodyweight exercises
Weeks 6–8	Progressive loading	Moderate weight training, full yoga practice, cycling outdoors, golf, Pilates
Weeks 8–12	Return to full activity	Heavy lifting, running, HIIT, contact sports, CrossFit, competitive athletics
12+ weeks	Unrestricted	Full training without limitations (for complex/revisional repairs, this may extend further)

Important: This timeline is a general guide for laparoscopic and robotic hernia repair. Open hernia repair and complex/revisional surgeries typically require an additional 2–4 weeks at each stage. Always follow the specific instructions given by your surgeon.

How Soon Can I Walk After Hernia Surgery?

Walking is the safest and most encouraged form of activity immediately after hernia surgery. Most surgeons, including Dr. Iskandar, recommend that patients begin walking within the first 24 hours following their procedure.

A good goal for the first few days is to walk for 5 to 10 minutes at a time, at least 5 to 6 times per day. These short walks serve an important medical purpose beyond general fitness — they promote blood circulation, significantly reduce the risk of blood clots (deep vein thrombosis), help prevent pneumonia, reduce post-surgical bloating, and support bowel function as your body recovers from anesthesia.

During the first week, walk at a comfortable pace on flat surfaces. You do not need to power-walk or push yourself. If you feel winded, lightheaded, or experience more than mild discomfort at the incision site, slow down or rest.

By the end of the second week, most patients are able to walk for 20 to 30 minutes continuously and can begin climbing stairs with minimal difficulty.

For more detailed walking guidance, see our complete guide: How Soon Can I Walk After Hernia Surgery?

When Can I Resume Light Exercise Like Swimming and Cycling?

Non-impact, low-resistance exercises are typically safe to begin 2 to 3 weeks after laparoscopic or robotic hernia surgery. These activities place minimal strain on the abdominal wall while providing cardiovascular benefits that support recovery.

Swimming is one of the best exercises during hernia recovery. The water supports your body weight, eliminating gravitational stress on the repair site. You can begin gentle lap swimming once your incisions are fully sealed — usually around 2 to 3 weeks. Avoid vigorous strokes, flip turns, and butterfly until at least 4 to 6 weeks post-surgery.

Stationary cycling and elliptical training are excellent options starting at 2 to 3 weeks because they provide a cardiovascular workout without the jarring impact of running. Keep the resistance low initially and increase it gradually over the following weeks. Avoid standing on the pedals or aggressive hill-climb settings, which engage the core intensely.

Outdoor cycling can begin at approximately 4 to 6 weeks, though you should avoid rough terrain, aggressive riding positions, and any route where a fall is likely during the first 6 to 8 weeks.

When Can I Lift Weights After Hernia Surgery?

Weight training requires careful, progressive reintroduction because lifting weights generates intra-abdominal pressure that directly stresses the hernia repair site. Returning to weights too early is one of the most common causes of hernia recurrence.

Weeks 4–6: Light weights and machines. You can begin lifting weights under 15 to 20 pounds, focusing on isolation exercises and weight machines that provide controlled motion. Good starting exercises include seated bicep curls, leg extensions, leg curls, seated shoulder presses with light dumbbells, and cable exercises at low resistance. Avoid Valsalva maneuver (holding your breath and bearing down) during any lift.

Weeks 6–8: Moderate weights with progressive loading. Gradually increase weight in 5-pound increments. You can begin introducing compound movements like goblet squats, dumbbell rows, and light bench press. Focus on controlled tempo (3 seconds down, 1 second pause, 2 seconds up) rather than maximizing weight.

Weeks 8–12: Return to heavy compound lifts. Deadlifts, barbell squats, heavy bench press, overhead press, and Olympic lifts can be reintroduced once your surgeon confirms the repair has healed adequately. Start at approximately 50% of your pre-surgery working weight and build back over 4 to 6 weeks. Many patients regain their full pre-surgery strength by 4 to 6 months.

For open hernia repair or complex/revisional surgery: Add 2 to 4 weeks to each phase above. Some complex abdominal wall reconstructions may require 12 or more weeks before introducing any significant resistance training.

What Core Exercises Are Safe After Hernia Repair?

The abdominal muscles are directly involved in hernia repair, which means core exercises require the most cautious and gradual reintroduction of any exercise type.

Phase 1: Weeks 2–4 — Gentle Core Activation

These exercises engage the deep stabilizing muscles (transverse abdominis) without placing significant pressure on the repair:

• Diaphragmatic breathing: Lie on your back with knees bent. Place one hand on your chest and one on your belly. Breathe in slowly through your nose, letting your belly rise. Exhale slowly. Perform 10 breaths, 3 times per day.
• Pelvic tilts: Lie on your back with knees bent. Gently flatten your lower back against the floor by tightening your lower abdominal muscles. Hold for 5 seconds. Repeat 10 times.
• Heel slides: Lie on your back with knees bent. Slowly slide one heel along the floor until the leg is straight, then slide it back. Alternate legs. Repeat 10 times per side.
• Supine marching: Lie on your back with knees bent. Slowly lift one knee toward your chest a few inches, then lower it. Alternate. Repeat 10 times per side.

Phase 2: Weeks 4–6 — Progressive Stabilization

• Bird-dogs: On hands and knees, extend opposite arm and leg simultaneously. Hold for 5 seconds. Repeat 10 times per side.
• Dead bugs: Lie on your back with arms extended toward the ceiling and knees at 90 degrees. Slowly lower one arm overhead and the opposite leg toward the floor. Return to start. Alternate sides. Repeat 8 times per side.
• Glute bridges: Lie on your back with knees bent and feet flat. Lift hips toward the ceiling by squeezing your glutes. Hold for 5 seconds. Repeat 12 times.

Phase 3: Weeks 6–8+ — Full Core Training

• Modified planks (from knees, progressing to full planks)
• Side planks
• Cat-cow stretches
• Pallof press (cable or band anti-rotation)
• Standing cable rotations at light resistance

Exercises to Avoid Until Cleared by Your Surgeon

The following exercises generate high intra-abdominal pressure and should be avoided for at least 6 to 8 weeks, or longer for open/complex repairs:

• Sit-ups and crunches
• V-ups and leg raises
• Russian twists with weight
• Heavy deadlifts
• Hanging leg raises
• Any exercise that causes visible bulging or sharp pain at the surgical site

How Does Recovery Differ by Surgery Type?

The surgical approach used to repair your hernia has a significant impact on how quickly you can return to exercise. Minimally invasive techniques generally allow faster recovery due to smaller incisions, less muscle disruption, and reduced post-operative pain.

Factor	Laparoscopic / Robotic Repair	Open Repair
Walking	Within 24 hours	Within 24 hours
Light exercise	2–3 weeks	3–4 weeks
Moderate exercise	4–6 weeks	6–8 weeks
Heavy lifting / sports	8–10 weeks	10–12+ weeks
Full unrestricted activity	8–12 weeks	12–16 weeks
Incision size	3–5 small incisions (5–12mm each)	One larger incision (3–6 inches)
Post-op pain level	Mild to moderate	Moderate to significant

Robotic-assisted repair uses the same small incision approach as laparoscopic surgery but provides the surgeon with enhanced precision and 3D visualization. Recovery timelines for robotic repair are generally equivalent to laparoscopic repair.

Complex and revisional hernia repairs — including component separation, abdominal wall reconstruction, and repair of recurrent hernias — involve more extensive tissue work and may require 12 or more weeks before returning to strenuous activity. These are the types of complex cases we specialize in at The Iskandar Complex Hernia Center, and we create individualized recovery plans for each patient based on the extent of their repair.

Does Mesh Repair Affect When I Can Exercise?

Most modern hernia repairs use surgical mesh to reinforce the weakened area of the abdominal wall. Mesh provides long-term structural support but requires time to integrate with your body’s tissue — a process called tissue ingrowth that typically takes 4 to 6 weeks.

During this integration period, the mesh is gradually incorporated into the surrounding tissue, creating a strong, permanent repair. Returning to heavy exercise before tissue ingrowth is complete can compromise the repair and increase the risk of hernia recurrence.

This is one of the primary reasons surgeons recommend waiting 6 to 8 weeks before heavy lifting — it is not just about incision healing or pain management, but about allowing the mesh to become fully integrated and structurally sound.

For non-mesh (primary tissue) repairs, the healing dynamic is different. The sutured tissue needs adequate time to form strong scar tissue, which also takes approximately 6 to 8 weeks. Your surgeon will advise you based on the specific technique used.

Recovery Timeline by Hernia Type

Different types of hernias involve different anatomical locations and surgical approaches, which affects exercise recovery.

Inguinal Hernia (Groin)

Inguinal hernias are the most common type, occurring in the groin area. Exercise recovery follows the standard timeline outlined above. Specific considerations include avoiding deep lunges, wide-stance squats, and heavy leg press during the first 4 to 6 weeks, as these movements create stress in the groin region near the repair site.

Umbilical Hernia (Belly Button)

Umbilical hernias occur at or near the navel. Recovery is generally similar to inguinal hernia repair for small umbilical hernias. Core exercises require particular caution because the repair is located in the center of the abdominal wall. Avoid any direct pressure on the belly button area during exercises for at least 6 weeks.

Incisional and Ventral Hernias

Incisional hernias develop at the site of a previous surgical incision, and ventral hernias occur in the front of the abdominal wall. These often involve larger defects and may require more extensive repair with mesh, potentially including component separation. Recovery is typically on the longer end of the timeline — 8 to 12 weeks or more before moderate exercise, depending on the size and complexity of the repair.

Hiatal Hernia

Hiatal hernia repair involves the diaphragm rather than the abdominal wall, which means exercise considerations are different. Diaphragmatic breathing exercises are particularly important during recovery. Avoid exercises that increase abdominal pressure (heavy lifting, intense core work) for 6 to 8 weeks. Upper body exercises and walking can typically begin on the same timeline as other hernia types.

Related reading: Recovery From Complex Hernia Surgery

Warning Signs: When to Stop Exercising and Call Your Surgeon

Stop exercising immediately and contact your surgeon if you experience any of the following during or after physical activity:

• Sharp or sudden pain at the surgical site (mild pulling or tightness is normal; sharp pain is not)
• A visible bulge or swelling at or near the incision, especially one that appears during straining
• Increasing swelling that does not resolve with rest and ice
• Redness, warmth, or discharge at the incision site, which may indicate infection
• Fever above 101°F (38.3°C)
• Nausea or vomiting during or after exercise
• Difficulty urinating after physical activity
• Excessive fatigue that seems disproportionate to the level of activity

A key distinction: mild discomfort, tightness, or a pulling sensation around the repair site is normal during the first few weeks of returning to exercise. This is caused by healing tissue and, if mesh was used, the mesh integrating with surrounding tissue. However, this sensation should be low-level and should not worsen as you continue exercising. If it intensifies, stop and rest.

If you notice a bulge that appears during straining and disappears when you lie down, this may indicate a recurrence and requires evaluation by your surgeon as soon as possible.

Tips for Safely Returning to Your Fitness Routine

Listen to Your Body Over Any Timeline

The recovery timelines provided on this page are general guidelines based on typical healing patterns. Every patient heals differently. If you feel ready for the next phase, confirm with your surgeon first. If you do not feel ready even though you are “on schedule,” do not rush — an extra week of caution is always better than a setback.

Use the 10% Rule

When increasing exercise intensity, follow the 10% rule: increase weight, distance, or duration by no more than 10% per week. This gradual progression reduces the risk of overloading the repair site.

Wear Supportive Gear When Recommended

Some patients benefit from wearing an abdominal binder or support garment during the first 4 to 6 weeks of exercise recovery. This can provide compression and psychological reassurance, though it should not be used as a substitute for proper progression. Ask your surgeon whether a support garment is appropriate for your specific repair.

Prioritize Nutrition and Hydration

Proper nutrition supports tissue healing and recovery. Focus on adequate protein intake (critical for tissue repair), staying well-hydrated, and consuming anti-inflammatory foods including fruits, vegetables, fatty fish, and whole grains. Avoid excessive alcohol, which can impair healing and increase inflammation.

Warm Up Thoroughly

As you return to exercise, spend at least 5 to 10 minutes warming up with gentle walking or light cardio before beginning your workout. Warmed-up muscles and connective tissue are more flexible and less prone to strain.

Returning to Specific Sports and Activities

Running and jogging: Light jogging on flat, even surfaces can begin at 4 to 6 weeks. Avoid trail running, hill sprints, and interval training until 8 weeks or later. Start with walk-jog intervals (2 minutes walking, 1 minute jogging) and progress gradually.

Golf: Most patients can return to the driving range with easy swings at 4 to 6 weeks and full rounds of golf at 6 to 8 weeks. The rotational component of the golf swing engages the core, so build up gradually.

Yoga and Pilates: Modified yoga (avoiding deep twists, full inversions, and intense backbends) can begin at 3 to 4 weeks. Full vinyasa flow and Pilates reformer work is generally appropriate at 6 to 8 weeks.

Team and contact sports: Football, basketball, soccer, hockey, rugby, and martial arts should not be resumed until at least 8 to 12 weeks after surgery due to the risk of direct impact to the repair site.

HIIT and CrossFit: These high-intensity programs combine heavy lifting with explosive movements and should be among the last activities reintroduced — typically at 10 to 12 weeks, starting at significantly reduced intensity.

Sexual activity: Most patients can safely resume sexual activity at 2 to 3 weeks after surgery, or whenever they feel comfortable. Avoid positions that place significant strain on the abdominal muscles during the first 4 to 6 weeks.

Related reading: When Can I Return to Work After Hernia Surgery? · Pain Management After Hernia Surgery

Frequently Asked Questions About Exercise After Hernia Surgery

How long after hernia surgery can I exercise?

Most patients can begin light exercise like swimming and cycling at 2 to 3 weeks, moderate exercise including light weight training at 4 to 6 weeks, and full unrestricted activity at 8 to 12 weeks after laparoscopic or robotic hernia surgery. Open repair and complex hernia surgery require additional recovery time.

Can I walk after hernia surgery?

Yes. Walking is safe and strongly encouraged within the first 24 hours after hernia surgery. Aim for short walks of 5 to 10 minutes, repeated 5 to 6 times per day during the first week.

When can I lift weights after hernia surgery?

Light weights (under 15–20 lbs) can typically begin at 4 to 6 weeks. Moderate weights at 6 to 8 weeks. Heavy compound lifts like deadlifts and squats at 8 to 12 weeks, starting at 50% of pre-surgery weight.

What exercises should I avoid after hernia surgery?

Avoid sit-ups, crunches, heavy deadlifts, squats, overhead pressing, running, jumping, and any high-impact or core-intensive exercise for at least 4 to 6 weeks. Stop any exercise that causes sharp pain or visible bulging.

Can I do yoga after hernia surgery?

Gentle, modified yoga can begin at 3 to 4 weeks. Avoid deep twists, intense backbends, and full inversions until 6 to 8 weeks. Full yoga practice is typically safe at 6 to 8 weeks.

Can I swim after hernia surgery?

Swimming is one of the best recovery exercises because it is low-impact. Gentle swimming is typically safe once incisions are fully sealed, around 2 to 3 weeks. Avoid vigorous strokes for 4 to 6 weeks.

Is it normal to feel pulling when I exercise after hernia surgery?

Mild pulling or tightness around the surgical site is normal during the first few weeks of returning to activity. This is from healing tissue and mesh integration. Sharp pain, visible bulging, or increasing swelling is not normal — contact your surgeon.

Does the type of surgery affect when I can exercise?

Yes. Laparoscopic and robotic repair allow faster return to exercise (moderate activity at 4–6 weeks) compared to open repair (6–8 weeks). Complex repairs and abdominal wall reconstruction may require 12+ weeks.

source https://iskandarcenter.com/hernia-surgery/when-can-i-exercise-after-hernia-surgery-a-week-by-week-recovery-timeline/

Can Heavy Lifting Cause a Hernia?

Can heavy lifting cause a hernia?

Heavy lifting can contribute to hernia development, but it’s rarely the sole cause. Hernias occur when internal tissue pushes through a weakened area in the abdominal wall. Lifting heavy objects increases intra-abdominal pressure, which can strain an already weak spot. Many people are predisposed to hernias due to how their abdominal wall developed before birth—meaning a single lift may trigger what was already forming.

At the Iskandar Complex Hernia Center, Dr. Mazen Iskandar evaluates each patient’s unique anatomy and history to determine what contributed to their hernia. Our DFW-based practice specializes in personalized diagnostics and minimally invasive repair techniques tailored to active individuals and workers.

Can I get a hernia from working out at the gym?

Yes, gym workouts—especially heavy weightlifting—can contribute to hernia formation. Exercises like squats, deadlifts, and overhead presses increase intra-abdominal pressure, which can push tissue through a weak spot in the abdominal wall. However, hernias typically develop when a pre-existing weakness is already present. Poor lifting form, breath-holding (Valsalva maneuver), and overtraining without adequate recovery increase the risk. Proper technique and gradual progression can help reduce strain.

Dr. Iskandar frequently treats athletes and fitness enthusiasts across Dallas-Fort Worth who developed hernias during training. Our approach focuses on getting you back to your routine safely, with repair options designed to support an active lifestyle.

What types of jobs increase the risk of developing a hernia?

Jobs requiring frequent heavy lifting, repetitive straining, or prolonged physical exertion increase hernia risk. High-risk occupations include construction workers, warehouse and logistics staff, furniture movers, lumber yard workers, firefighters, mechanics, and nurses or healthcare aides who regularly lift patients. These roles often involve repeated increases in abdominal pressure over time. Observing proper lifting mechanics—using your legs instead of your back—can help reduce strain on the abdominal wall.

The Iskandar Complex Hernia Center works with patients across physically demanding professions throughout DFW, including those navigating workers’ compensation cases. Dr. Iskandar understands the unique demands of labor-intensive jobs and offers repair options designed to support a full return to work.

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Does lifting something heavy once cause a hernia, or does it develop over time?

Hernias typically develop gradually as the abdominal wall weakens over time due to repeated strain, aging, or congenital factors. However, a single heavy lift can trigger a hernia if a weak spot already exists. In these cases, the lift doesn’t cause the weakness—it simply creates enough pressure to push tissue through. This is why someone may “suddenly” develop a hernia after lifting something they’ve handled before.

Dr. Iskandar helps patients understand whether their hernia was building over time or triggered by a specific event—an important distinction when considering treatment timing and repair strategy.

What exercises are most likely to cause a hernia?

Exercises that significantly increase intra-abdominal pressure pose the highest hernia risk. These include heavy squats, deadlifts, leg presses, overhead presses, and intense core exercises like sit-ups and crunches. High-intensity training programs that combine heavy loads with explosive movements (such as CrossFit-style workouts) may compound the risk. The danger increases when proper breathing techniques are ignored or when weights exceed what the body can safely stabilize.

If you’re an active person who developed a hernia during exercise, Dr. Iskandar can assess how your training history may have contributed—and recommend a repair approach that supports your return to fitness.

How do I know if I have a hernia from lifting?

Common signs of a lifting-related hernia include a visible bulge in the abdomen or groin, discomfort or pain at the bulge site (especially when lifting, coughing, or straining), a heavy or dragging sensation, and pain that worsens throughout the day or after physical activity. Some hernias cause no symptoms initially. Doctors often discover these during routine physical exams. If you notice a new bulge after lifting, seek medical evaluation.

At the Iskandar Complex Hernia Center, we offer prompt hernia evaluations for patients throughout Dallas-Fort Worth. Dr. Iskandar can determine whether your symptoms indicate a hernia and explain your options—before the condition worsens.

Should I see a doctor if I think I got a hernia from lifting?

Yes—if you suspect a hernia after lifting, you should see a doctor for evaluation. This is important because hernias do not heal on their own and can worsen over time. While not all hernias require immediate surgery, early diagnosis allows you to understand your options and avoid complications such as incarceration or strangulation, which may require emergency intervention.

Dr. Mazen Iskandar and the team at the Iskandar Complex Hernia Center provide comprehensive hernia evaluations at our DFW location. Whether you need monitoring or surgical repair, we’ll guide you through the process and recommend a treatment plan tailored to your situation.

Think you may have a hernia?

Dr. Mazen Iskandar and the Iskandar Complex Hernia Center team offer comprehensive evaluations for patients across Dallas-Fort Worth. Schedule a consultation to discuss your symptoms and explore your options.

source https://iskandarcenter.com/abdominal-wall-repair/can-heavy-lifting-cause-a-hernia/

Is minimally invasive hernia repair the same as robotic hernia repair?

Many patients are unsure whether minimally invasive hernia repair and robotic hernia repair refer to the same technique. Dr. Iskandar often explains that robotic repair is one option within the broader category of minimally invasive methods, but it is not the only one. Understanding the differences helps patients choose an approach that matches their hernia type, goals, and comfort level. This guide breaks down how each method works and what sets them apart so patients can make informed decisions.

What does minimally invasive hernia repair include?

Minimally invasive hernia repair includes two primary approaches: laparoscopic repair and robotic repair. Dr. Iskandar recommends minimally invasive surgery (laparoscopic or robotic) whenever it is safe and appropriate because it reduces trauma to the abdominal wall and surrounding skeletal muscle, leading to less pain, quicker healing, and fewer scar-related issues. Both laparoscopic and robotic techniques fall under a minimally invasive procedure because they use small incisions and reduce tissue disruption compared to open surgery. Once these two methods are understood, other variations can be discussed based on a patient’s specific needs, but laparoscopic and robotic repairs remain the main techniques used across the United States.

• Laparoscopic hernia repair: This method uses laparoscopy, meaning a small camera and long instruments are placed through three to five tiny incisions. The surgeon stands at the bedside and operates while viewing a 2D screen. It is widely used across the United States and remains a reliable choice for many types of hernias.
• Robotic hernia repair: This uses robotics to enhance the surgeon’s visualization and instrument precision.
• Endoscopic totally extraperitoneal (TEP) repair: This is performed behind the abdominal wall without entering the main cavity of the abdomen. It is often used for groin-based hernias such as an inguinal hernia.

All of these approaches fall under minimally invasive surgery because they reduce tissue disruption, minimize infection risk, support overall health, and allow many patients to return to normal activity sooner with less discomfort compared to open surgery.

How is robotic hernia repair different from other minimally invasive options?

Robotic hernia repair is a specific form of minimally invasive surgery that uses advanced technology to give the surgeon improved access and precision. Dr. Iskandar performs the operation from a console, directing robotic arms that hold the camera and instruments. This setup allows a magnified 3D view and greater instrument flexibility.

Key differences from standard laparoscopic surgery include:

• The surgeon operates from a console instead of standing at the table.
• The robotic camera provides high-definition, 3D visualization.
• Robotic instruments have wrist-like movements that help in tight spaces.
• Robotics allow for more controlled placement of surgical mesh and careful handling of the abdominal wall.

Because of these capabilities, robotic repair is especially helpful for large ventral hernias, recurrent hernias, and complex cases where precision matters. Dr. Iskandar may recommend robotic repair when these advantages contribute to a stronger, safer repair.

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Are outcomes similar between robotic and other minimally invasive repairs?

For most straightforward hernias, such as a routine inguinal hernia, robotic and laparoscopic techniques produce similar outcomes. Current research shows no major differences in long-term recurrence, strength of repair, or signs and symptoms during recovery for simple cases. This gives patients confidence that either option can work well when matched to the right situation. What really matters in this situation is the surgeon’s experience and comfort level with a particular approach.

However, some practical differences exist:

• Operative time: Robotic surgery can take longer due to equipment setup.
• Cost: Hospitals offering robotic systems may have higher procedural expenses.
• Recovery: Both approaches typically allow faster recovery than open surgery. Some patients with complex hernias may experience slightly less immediate postoperative pain with robotic surgery, although this varies.

For larger or more challenging hernias, robotic surgery may provide advantages in closing defects, reinforcing the abdominal wall, and managing scar tissue from prior operations. Dr. Iskandar evaluates each patient individually to determine which minimally invasive surgery approach is most appropriate.

When is one approach preferred over the other?

Choosing between robotic and laparoscopic minimally invasive surgery depends on several factors, including hernia type, the patient’s anatomy, and the complexity of the repair.

Key considerations include:

• Hernia complexity: A simple inguinal hernia often responds well to laparoscopic repair, while large or recurrent hernias may benefit from robotic precision.
• Surgeon experience and hospital resources: Outcomes depend heavily on the surgeon’s skill with each technique. Not every hospital has robotic systems, and surgeon expertise plays a major role in recommending the right approach.
• Patient-specific factors: Previous abdominal operations, scar tissue, medical conditions, and anesthesia needs all influence which method is safest.

Robotic surgery is a valuable tool, but it is not necessary for every case. Dr. Iskandar’s goal is to match each patient with the approach that provides the best balance of safety, durability, and recovery.

What should patients consider when choosing between these approaches?

Patients deciding between minimally invasive surgery options should focus on the factors that affect long-term success, safety, and quality of life. Dr. Iskandar helps patients understand how each technique supports a durable repair, minimizes infection risk, protects the organ structures involved, and encourages smooth healing.

Patients may want to discuss:

• Whether robotics provide meaningful advantages for their hernia.
• How past abdominal surgeries might influence access and mesh placement.
• Their recovery goals and how quickly they hope to return to work or activity.
• Imaging findings that affect how the abdominal wall should be reinforced.

A clear conversation allows patients to feel confident and prepared for surgery.

Take the Next Step Toward Answers and Relief

Minimally invasive and robotic hernia repairs both offer effective avenues for recovery, and choosing between them starts with understanding the strengths of each option. Dr. Iskandar combines advanced surgical skill with a compassionate, patient-centered approach to help people move forward with clarity and confidence. If you’re ready to learn which minimally invasive surgery approach is right for your situation, schedule a consultation with The Iskandar Complex Hernia Center today.

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC9314304/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9187240/

source https://iskandarcenter.com/hernia-surgery/is-minimally-invasive-hernia-repair-the-same-as-robotic-hernia-repair/

New Studies Show Expert Surgeons Reduce Risks in Large Hiatal Hernia Surgery for Dallas–Fort Worth Patients

If you’ve been diagnosed with a large hiatal hernia, recent medical research brings important insights about your treatment. Two major studies published in 2024 confirm what surgeons have long suspected: hernia size matters, and choosing an experienced specialist significantly impacts your surgical outcome. For patients needing hernia repair in the Dallas-Fort Worth area, Dr. Mazen Iskandar at The Iskandar Complex Hernia Center offers exactly this type of specialized expertise.^[1][2][3]

Understanding Type III and Type IV Hiatal Hernias

Before diving into the research, it helps to understand what these hernias are. Your diaphragm is a large muscle that separates your chest from your abdomen. It has a small opening called the hiatus where your esophagus (the tube that carries food to your stomach) passes through.^[4]

In a hiatal hernia, part of your stomach pushes up through this opening into your chest cavity, where it doesn’t belong. There are four types of hiatal hernias, with Type III and Type IV being the most complex:^[5][6][4]

Type III hernias (also called mixed hernias) happen when both the connection point between your esophagus and stomach AND a portion of your stomach slide up into your chest.^[6][4]

Type IV hernias are the most serious. In these cases, not only does your stomach push into your chest, but other abdominal organs—like your intestines, colon, or spleen—can also move up through the opening.^[7][4][6]

These larger hernias often cause bothersome symptoms including:^{[8][9][10][11]}

• Severe heartburn and acid reflux
• Chest pain or pressure
• Difficulty swallowing food or liquids
• Feeling full after eating only small amounts
• Shortness of breath
• Food coming back up into your throat

When symptoms become significant or the hernia grows large, surgery is usually recommended to prevent serious complications.^[2][12][4]

Study #1: Large Hernia Size Linked to Higher Complication Risk

The Research:

In November 2024, researchers led by Seitaro Nishimura published important findings in Cureus, a peer-reviewed medical journal. The study, titled “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair,” examined patients who underwent repair of complex Type III or Type IV hiatal hernias between 2014 and 2024.^[13][1][2]

Key Finding:

The research demonstrated that larger hiatal hernias are associated with an increased risk of severe complications after surgery. This means the bigger your hernia, the more challenging the repair becomes, and the higher the potential for problems during recovery.^[1][2]

Why Size Matters:

Think of it like fixing a small tear versus a large hole in fabric. A small repair is straightforward, but fixing a large defect requires more extensive reconstruction, takes longer, and demands greater surgical skill. The same principle applies to hiatal hernias.^[14][15]

Supporting research confirms these findings. Multiple studies show that larger hernia size correlates with:^[12][15][14]

• Higher rates of early postoperative complications
• Increased likelihood of requiring intensive care unit admission
• Greater chances of hospital readmission within 30 to 90 days after surgery
• Longer recovery times

One study found that hernias larger than 7 centimeters (about 3 inches) or involving more than half the stomach are considered “large” and carry significantly higher surgical risks.^[12]

The Bottom Line:

Large, complex hiatal hernias are challenging surgical cases that require experienced hands. The complications tracked in this research used the Clavien-Dindo classification system, which grades problems based on their severity. While most complications are minor and manageable, the research emphasizes that larger hernias demand specialized surgical expertise to minimize serious issues.^{[16][17][2][14][1]}

Study #2: Advanced Surgical Technique Dramatically Reduces Recurrence

The Research:

Just three months earlier, in August 2024, Dr. Zena Saleh and colleagues from Cooper University Hospital published groundbreaking findings in Surgical Endoscopy, one of the world’s leading surgical journals. Their study, “Optimizing Outcomes in Paraesophageal Hernia Repair: A Novel Critical View,” examined 297 patients who underwent paraesophageal hernia repair between 2015 and 2023.^{[3][18][19][20]}

Key Finding:

Surgeons who performed repairs using an advanced technique called the “critical view” achieved dramatically better outcomes than those using standard repair methods:^[18][19][3]

• Hernia recurrence rate: Only 9.7% with the critical view approach compared to 20% with standard repair (a 51% reduction)^[3][18]
• Reoperation rate: Just 0.5% compared to 10% with standard techniques (a 95% reduction)^[18][3]

What is the “Critical View”?

This advanced surgical technique requires significant skill and experience to execute properly. It involves:^[19][3]

• Complete mobilization of the esophagus up to the level of the inferior pulmonary vein (a major blood vessel in the chest)
• Full dissection and clearing of the posterior mediastinum (the space behind your breastbone)
• Careful visualization of specific anatomical landmarks including the left crus of the diaphragm and left gastric artery
• Precise exposure that allows the surgeon to see the spleen in the background while retracting the distal esophagus

The study showed that 65% of these advanced repairs were performed robotically, 22% laparoscopically, and 14% through open surgery. The types of hernias repaired included Type III (48%), Type I (36%), Type IV (13%), and Type II (2%).^[19][18]

Why This Matters:

This research proves that surgical technique and experience directly impact your long-term results. The critical view approach dramatically reduces the likelihood that your hernia will come back or that you’ll need another surgery down the road. However, this sophisticated technique requires extensive training and expertise to perform safely and effectively.^[3][18][19]

What These Two Studies Tell Us Together

When we look at both studies side-by-side, a clear picture emerges:

Size and complexity increase risk. Recent research confirms that larger Type III and Type IV hernias present greater surgical challenges and higher complication risks.^[2][1]

Expert technique reduces complications and recurrence. The August 2024 study proves that advanced surgical approaches performed by experienced specialists lead to far better outcomes—cutting recurrence rates in half and nearly eliminating the need for repeat surgery.^[18][3]

Experience is essential. Multiple studies consistently demonstrate that surgeons who regularly perform complex hernia repairs achieve superior patient outcomes, fewer complications, and lower recurrence rates. In fact, recent research shows that revisional hiatal surgery (fixing a hernia that comes back) is so complex that it should only be performed at specialized tertiary care centers with high surgical volumes.^[21][22][23]

Why Dr. Mazen Iskandar is A Leading Choice in DFW

Dr. Iskandar embodies exactly what this research tells us to look for: specialized training, extensive experience, mastery of advanced techniques, and a dedicated focus on complex hernia surgery.^[24][25][26]

Unmatched Credentials and Training

Medical Education: Dr. Iskandar earned his medical degree from the prestigious American University of Beirut, one of the leading medical schools in the Middle East. He completed his general surgery residency at Mount Sinai Beth Israel in New York City, one of the nation’s top teaching hospitals.^[25][24]

Advanced Fellowship Training: After residency, Dr. Iskandar pursued specialized fellowship training in minimally invasive and bariatric surgery at NYU-Langone in Brooklyn. This additional training provided him with advanced skills in complex abdominal procedures, including hiatal hernia repair.^[24][25]

Academic Experience: Before joining Baylor Scott & White Health in 2019, Dr. Iskandar served as an assistant professor of surgery at Mount Sinai School of Medicine in New York City. In this role, he taught surgical residents and fellows while conducting research to advance the field. He currently serves as an Associate Professor on the Texas A&M School of Medicine^[25][24]

Board Certifications: Dr. Iskandar is board-certified in both general surgery and metabolic bariatric surgery by the American Board of Surgery. These certifications require rigorous examination and demonstrate his mastery of surgical principles and techniques.^[25]

Professional Recognition and Leadership

Fellow of the American College of Surgeons (FACS): This prestigious designation recognizes surgeons who demonstrate the highest standards of surgical practice, ethics, and professionalism.^[24][25]

Professional Memberships: Dr. Iskandar is a Fellow of the American Society for Metabolic and Bariatric Surgery and a member of the Society of American Gastrointestinal and Endoscopic Surgery. These organizations represent the leading edge of minimally invasive surgical techniques.^[25]

Surgeon of Excellence: In January 2024, Dr. Iskandar earned the “Surgeon of Excellence in Hernia Surgery” accreditation from the Surgical Review Corporation, recognizing his outstanding surgical outcomes and adherence to the highest quality standards.^[27]

Thought Leader: Dr. Iskandar has published numerous peer-reviewed articles, book chapters, and presentations in hernia and bariatric surgery. In 2025, he was selected to author two chapters for Surgical Endoscopy and Other Interventional Techniques, one of the world’s most respected surgical journals. This invitation reflects his recognition as a leading authority in minimally invasive hernia repair.^[28][25]

The Iskandar Complex Hernia Center Difference

Specialized Focus: Under Dr. Iskandar’s leadership, the Baylor Scott & White Center for Hernia Surgery was established specifically to manage hernia cases ranging from simple to highly complex and recurrent hernias. This focused approach means every aspect of your care is optimized for hernia treatment.^[26][25]

Referral Destination: Physicians throughout Texas and beyond refer their most challenging hernia cases to Dr. Iskandar because of his exceptional expertise and outcomes. As referring physicians note, “Dr. Iskandar is a surgeon to call when other doctors run out of options for complex hernia patients”.^[29][26][24]

One of Only Two in Texas: The Iskandar Complex Hernia Center is one of only two Hernia Centers of Excellence in Texas dedicated exclusively to complex hernia repair, providing patients with unparalleled expertise and comprehensive care.^[30][31]

Advanced Surgical Techniques and Technology

Minimally Invasive and Robotic Surgery: Dr. Iskandar’s philosophy emphasizes achieving durable, favorable outcomes through better patient preparation and innovative techniques, including robotic surgery. Research consistently shows that minimally invasive approaches lead to faster recovery, less pain, and lower complication rates compared to traditional open surgery.^{[22][32][33][24][25]}

Customized Treatment Plans: Dr. Iskandar uses the most current research and proven methods to customize each patient’s treatment plan based on their specific anatomy, hernia size, health status, and individual needs.^[32][33][24]

Comprehensive Approach: For large hiatal hernias, surgical repair typically involves multiple steps:^[34][4]

1. Returning the stomach and any other displaced organs back to the abdomen
2. Carefully repairing the enlarged opening in the diaphragm to the proper size
3. When appropriate, using specialized mesh reinforcement to reduce recurrence risk
4. Creating an anti-reflux valve (fundoplication) to prevent acid reflux

Dr. Iskandar’s mastery of these techniques, combined with his use of advanced technology, maximizes the chances of a successful, lasting repair.^[32][24][25]

Real Patient Results

The Iskandar Complex Hernia Center has transformed the lives of countless patients dealing with complex hernias. Jose Gonzalez shares his experience:

“After two years of increasing pain and discomfort following an operation, my quality of life was getting worse and worse as the months went on. Dr. Iskandar told me in the first meeting that he was 90% sure he could repair my growing hernia with no recurrence. A few months after surgery, Dr. Iskandar told me I was back to normal. Now I can ride my motorcycles and go off-roading in my Jeep. I can move around without discomfort and pain. It’s a night-and-day change”.^[26]

What to Expect from Your Hiatal Hernia Surgery

Understanding the basics of hiatal hernia repair can help reduce anxiety about the procedure:

Pre-Surgery Preparation: Dr. Iskandar emphasizes thorough patient preparation, including optimizing your overall health, managing any related conditions, and ensuring you understand what to expect.^[24][25]

Surgical Approach: Most repairs are performed using minimally invasive laparoscopic or robotic techniques through small incisions. These approaches offer faster recovery and less discomfort than traditional open surgery.^[22][34][32]

Hospital Stay: Depending on the complexity of your hernia and your overall health, most patients stay in the hospital for 1-3 days after surgery.^[35][34]

Recovery Timeline: While individual recovery varies, most patients return to light activities within 2-3 weeks and full activities within 4-6 weeks.^[34]

Long-Term Outcomes: When performed by experienced surgeons using advanced techniques, hiatal hernia repair offers excellent long-term results with high rates of symptom relief and low recurrence rates.^{[36][34][3][18]}

Taking Control of Your Health

If you’re living with a large Type III or Type IV hiatal hernia in the Dallas-Fort Worth area, you don’t have to suffer with uncomfortable symptoms or worry about serious complications. The research is clear: size matters, technique matters, and experience matters.^{[14][1][2][3][18]}

Dr. Mazen Iskandar offers all three:

• Recognition of complexity: He understands that larger hernias require specialized surgical expertise^[1][2]
• Mastery of advanced techniques: He performs the sophisticated surgical approaches proven to reduce complications and recurrence^[3][18]
• Extensive experience: He has dedicated his career to complex hernia surgery with outcomes that make him a regional referral center^[26][24][25]

Schedule Your Consultation

The Iskandar Complex Hernia Center is located at the Baylor Scott & White Center for Hernia Surgery in Waxahachie, Texas, serving patients throughout the DFW metroplex and beyond. Dr. Iskandar accepts both direct patient appointments and physician referrals.^[26][25]

Contact Information:

• Location: 2360 N Interstate 35E, Suite 310, Waxahachie, TX 75165
• Phone: 469-800-9832
• Hours: Monday through Friday, 8:00 AM – 5:00 PM^[25]

Dr. Iskandar is multilingual, speaking English, French, and Arabic, making care accessible to diverse patient populations.^[25]

Don’t let a complex hiatal hernia diminish your quality of life. With the right surgeon and specialized care, you can achieve lasting relief from symptoms and get back to the activities you love. Contact The Iskandar Complex Hernia Center today to schedule your consultation with Dr. Mazen Iskandar and take the first step toward feeling like yourself again.

---

References

1. Nishimura S, et al. “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair.” Cureus 16(11), November 2024. View source
2. Nishimura S, et al. “Association Between Large Hernia Size and Severe Postoperative Complications After Type III/IV Hiatal Hernia Repair.” Cureus, 2024. View source
3. Saleh Z, Verchio V, Ghanem YK, et al. “Optimizing outcomes in paraesophageal hernia repair: a novel critical view.” Surgical Endoscopy, Published online August 12, 2024. View source
4. National Center for Biotechnology Information (NCBI) – StatPearls: “Hiatal Hernia”. View source
5. Medscape Reference: “Hiatal Hernia Overview”. View source
6. Medscape Reference: “Hiatal Hernia Imaging”. View source
7. PMC Article: Type IV Hiatal Hernia. View source
8. PMC Article: Hiatal Hernia Symptoms and Complications. View source
9. Annals of Esophagus: Hiatal Hernia Management. View source
10. Mayo Clinic: “Hiatal Hernia – Symptoms and Causes”. View source
11. Cleveland Clinic: “Hiatal Hernia: What It Is, Symptoms, Treatment & Surgery”. View source
12. Healthline: “What Size Hiatal Hernia Needs Surgery”. View source
13. Cureus: Nishimura S, et al. Research Profile. View source
14. PubMed: Research on hernia size and surgical complications. View source
15. PubMed: Outcomes in large hiatal hernia repair. View source
16. Cureus: “Feasibility of Anti-Reflux Gastric Bypass for Massive Paraesophageal Hernia in Obese Patients with Gastroesophageal Reflux Disease”. View source
17. PubMed: Surgical complications classification systems. View source
18. PMC: Full text of “Optimizing outcomes in paraesophageal hernia repair: a novel critical view”. View source
19. German National Library: Study documentation on paraesophageal hernia repair. View source
20. ResearchWithNJ: “Optimizing outcomes in paraesophageal hernia repair: a novel critical view” – Study fingerprints and citations. View source
21. Annals of Esophagus: Revisional hiatal hernia surgery. View source
22. Annals of Esophagus: Minimally invasive hiatal hernia repair outcomes. View source
23. Video-Assisted Thoracic Surgery: Complex hiatal hernia management. View source
24. The Iskandar Complex Hernia Center: Dr. Mazen Iskandar Profile. View source
25. Baylor Scott & White Health: Dr. Mazen Iskandar, MD, FACS – Biography and Credentials. View source
26. The Iskandar Complex Hernia Center: Official Website. View source
27. EIN News: “Dr. Mazen Iskandar Earns Surgeon of Excellence in Hernia Surgery Accreditation from SRC”. View source
28. Press Advantage: “Dr. Mazen Iskandar Selected to Contribute to Prestigious Surgical Journal”. View source
29. The Iskandar Complex Hernia Center: For Surgeons and Physicians. View source
30. Tallahassee.com: “The Iskandar Complex Hernia Center – One of Only Two Hernia Centers of Excellence in Dallas-Fort Worth”. View source
31. Daily News Journal: “The Iskandar Complex Hernia Center – One of Only Two Hernia Centers of Excellence in Dallas-Fort Worth”. View source
32. GlobeNewswire: “The Iskandar Complex Hernia Center Unveils a Revolutionary Approach to Complex Hernia Surgery Repair and Treatment”. View source
33. Financial Content: “The Iskandar Complex Hernia Center Highlights the Advancements in Fundoplication Surgery for GERD and Hiatal Hernia Repair”. View source
34. PMC: Hiatal hernia repair surgical techniques and outcomes. View source
35. PMC: Hospital stay and recovery after hiatal hernia surgery. View source
36. PMC: Long-term outcomes of hiatal hernia repair. View source
37. Brigham and Women’s Hospital: “Hiatal Hernia”. View source

source https://iskandarcenter.com/hernia-surgery/studies-show-expert-surgeons-reduce-risks-in-large-hiatal-hernia-surgery-dallas-fort-worth-patients/

Early Hernia Treatment: How it Can Prevent Hernia Complications

Hernias are a common medical issue, but delaying treatment can lead to unnecessary complications. Dr. Mazen Iskandar and The Iskandar Complex Hernia Center emphasize the importance of addressing hernias early to reduce risks such as pain, enlargement, and emergency situations. With advanced surgical expertise and compassionate care, the center provides patients with solutions designed for long-term health and recovery. To learn more about your options, schedule a consultation with The Iskandar Complex Hernia Center today.

When should I see a doctor about my hernia?

You should see a doctor about your hernia as soon as you notice signs and symptoms such as a bulge in the abdomen or groin, discomfort, or pain that worsens with activity. Dr. Iskandar explains that a hernia occurs when muscle fibers in the abdominal wall tear, creating an opening where part of the gastrointestinal tract or other tissue can protrude. While a hernia may seem small at first, it might not heal on its own and carries a risk of enlargement or complications over time. During a physical examination, a hernia can often be confirmed when the bulge becomes more noticeable while standing, straining, or with a cough. Seeking prompt care ensures patients receive an accurate diagnosis and the opportunity to consider early hernia repair before emergencies develop.

Why is seeing a hernia doctor sooner rather than later a better option?

Seeing a hernia doctor early is a better option because it reduces the risk of complication and allows for safer, less complex treatment. Small hernias are often treated with a minimally invasive procedure such as laparoscopy, where a camera and specialized tools are used to repair the abdominal wall with surgical mesh and surgical suture. These approaches generally require less anesthesia, result in less pain, and support a faster recovery compared to delayed hernia surgery. By acting early, the patient avoids progressive tissue damage, circulatory system issues caused by trapped blood flow, and the psychological stress of living with the constant concern that the hernia could worsen. Dr. Iskandar emphasizes that elective surgery performed on healthier tissue delivers better results and minimizes disruption to everyday life.

Should I go to the ER about my hernia?

You should go to the ER about your hernia if it suddenly becomes very painful, firm, cannot be pushed back inside, or is associated with nausea or vomiting. These changes can indicate an incarcerated or strangulated hernia, where blood supply to the trapped organ or tissue is cut off, creating a life-threatening complication. In such cases, the patient may experience severe edema, tenderness, or discoloration around the skin of the hernia site, and men can sometimes notice swelling of the scrotum or testicle when an inguinal hernia becomes obstructed. A femoral hernia, which often occurs in the thigh near the sex organ, carries similar risks and must be taken seriously. Emergency hernia repair in the hospital often requires urgent surgery to prevent permanent damage, highlighting the importance of early treatment to avoid this scenario.

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What complications can develop if hernias are left untreated?

If hernias are left untreated, patients risk incarceration, strangulation, and bowel obstruction, all of which can cause significant pain and endanger the gastrointestinal tract. Incarcerated hernias occur when organ tissue becomes trapped in the abdominal wall defect, while strangulated hernias cut off blood flow to that tissue, requiring immediate surgical intervention. Bowel obstruction can follow, leading to nausea, vomiting, and inability to pass stool or gas, which places the human body under dangerous pressure. Untreated hernias may also enlarge over time, creating space where surrounding muscle and tissue adhere abnormally, making later surgery more complex and recovery more difficult. Research continues to confirm that early elective repair dramatically reduces these risks and safeguards long-term health outcomes.

How does early hernia repair improve recovery?

Early hernia repair improves recovery by limiting the size of the defect, allowing for more straightforward surgical techniques and shorter healing time. Dr. Iskandar often recommends laparoscopic hernia surgery for eligible patients, which involves inserting a camera through a small incision and reinforcing the wall with surgical mesh. This minimally invasive procedure typically results in less bleeding, reduced pain, and quicker return to normal function compared to open surgery for large or complicated hernias. Early repair also reduces the risk of complications with the circulatory system and ensures healthier tissue integration with the mesh, improving long-term durability. Patients benefit from shorter hospital stays, lower risk of wound disease or skin breakdown, and better overall results.

What role does diagnosis and monitoring play in hernia treatment?

Diagnosis and monitoring play a critical role in determining whether a hernia requires immediate repair or ongoing observation. A health care provider may use physical examination, imaging such as CT scan, or ultrasound to confirm the diagnosis and assess the size and risk associated with the hernia. For some small hernias that are not causing symptoms, temporary management with a truss or support garment may be considered, but these measures are not curative. Regular follow-up ensures that any change in the hernia’s size, associated pain, or new complication is addressed promptly before the need for urgent surgery arises.

How does delaying hernia surgery increase risk?

Delaying hernia surgery increases risk by allowing the defect in the abdominal wall to enlarge and place more pressure on the surrounding muscle, tissue, and organs. Larger hernias are more difficult to repair, often requiring longer surgery under anesthesia, greater use of surgical mesh, and more extensive tissue dissection. Inguinal hernia surgery and femoral hernia surgery both become more technically demanding when the hernia has grown or caused secondary complications in the scrotum, thigh, or testicle. Patients who delay may also develop complications such as adhesions, circulatory system strain, or increased susceptibility to skin breakdown around the hernia. These issues contribute to longer recovery times, higher complication rates, and greater disruption of everyday activities compared to patients who choose early intervention.

What are the benefits of choosing early treatment with Dr. Iskandar?

The benefits of choosing early treatment with Dr. Iskandar include faster recovery, reduced risk of emergency surgery, and improved quality of life. Patients undergoing elective hernia repair are less likely to experience complication, more likely to return quickly to daily routines, and benefit from modern techniques such as laparoscopy guided by a camera for precision. Early intervention also reduces the risk of circulatory system compromise, tissue necrosis, or damage to adjacent organs and ensures a lower likelihood of requiring extensive therapy or hospitalization. For men with inguinal hernias, treating the condition early prevents potential complications in the groin, scrotum, or testicle that may affect long-term health. As a highly experienced hernia surgeon, Dr. Iskandar offers patients confidence in achieving the best possible result while protecting their long-term health.

Schedule a consultation with Dr. Iskandar at The Iskandar Complex Hernia Center today to take the first step toward safe, effective hernia repair and lasting relief.

source https://iskandarcenter.com/hernia-surgery/early-hernia-treatment-how-it-can-prevent-hernia-complications/

Robotic Repair of Right Bochdalek Hernia [VIDEO]

The following video of a Right Bochdalek Hernia Repair by Dr. Mazen Iskandar contains scenes of medical surgery.

This is Mazen Iskandar, presenting a case of a robotic repair of a right Bochdalek hernia. The patient is a 63-year-old female with history of an open Roux-en-Y gastric bypass in 2009, and with significant weight loss, who presented initially with a fat containing Bochdalek hernia that was surveilled and over time, it started having bowel as you can see here in the scan. So, given the enlargement and now that it’s containing intestines, despite minimal symptoms, the decision was made to proceed with surgery. The patient was placed in a supine position with a bump on her right side and lysis of adhesions was initially done laparoscopically to remove some of the adhesions related to her previous open gastric bypass. And forearms was used with the tip up and arm number four to be used for dynamic retraction.

Here, we are retracting the liver and lysing some of the adhesions between the liver and the hernia sac. And the hernia sac was reducing pretty nicely. Very similar to reducing a direct hernia or a paraesophageal hernia. Then I was able to start reducing the small intestine. My access port was used as an assistant Yankauer for suctioning. So, as you can see there was a lot of small bowel that was herniated. The colon which you can also see on the left of the screen was incarcerated, but by reducing the small bowel first, it gave more room for reduction of the right colon. After reducing all of the small bowel, we were able to then reduce the colon much more easily than if we had tried to reduce that in the beginning.

And here is the defect in the posterior diaphragm. We then proceeded to completely mobilize and reduce the sac, dissecting the sac away from the pleura. The goal was to completely reduce and mobilize the sac.

The edge of the sac is now visible. And complete mobilization and reduction of the sac was now achieved. We then proceeded to mobilize the sac away from the posterior diaphragm and mobilized the liver. We identified the vena cava, the porta hepatis, and we ensured that we were away from them. And so now, we are mobilizing the posterior diaphragm and the superior pole of the kidney to be better able to close the defect and reinforce it with mesh. Once we mobilized enough retroperitoneum, we proceeded to close the defect, which measured 6 centimeters with 2-0 permanent V-Loc.

And the defect closed without much tension.

We then measured the space for mesh placement and I opted to use a 9-centimeter Symbotex mesh. The mesh was placed into the pocket between the kidney and the diaphragm, and was fixated to the diaphragm and to the peritoneum using 2-0 silk sutures.

Then the excess mesh was trimmed to ensure that there is no mesh in contact with viscera. So, the mesh was tailored. And once the liver was dropped, the mesh was completely excluded. Thank you for watching.

source https://iskandarcenter.com/hernia-surgery/robotic-repair-of-right-bochdalek-hernia-video/

Shingles vs Hernia: When Viral Nerve Damage Mimics Abdominal Wall Defects

It’s not uncommon for patients to experience symptoms that seem like a hernia—only to later learn that shingles is the true cause. At The Iskandar Complex Hernia Center, we occasionally evaluate individuals with abdominal pain, swelling, or bulging that turns out to be the result of nerve damage from the shingles virus rather than a true hernia. While these two conditions can feel similar, their causes and treatments are very different. In this article, we’ll explain how to tell the difference and when to seek expert care. If you’re dealing with unexplained abdominal wall symptoms, schedule a consultation with The Iskandar Complex Hernia Center for an accurate diagnosis and treatment plan.

How can shingles cause a bulge that looks like a hernia?

Shingles can cause a visible bulge in the abdomen by damaging motor nerves and weakening the abdominal wall muscles—a condition called postherpetic pseudohernia. This rare complication occurs when the herpes zoster virus (the same virus responsible for chickenpox) reactivates in the spinal cord and affects motor fibers traveling through the vertebral column. When motor branches are involved, particularly those serving the skeletal muscle of the abdominal wall, it leads to flaccid paralysis or even localized paralysis. As a result, the weakened wall may bulge outward, mimicking a hernia even though no fascial defect is present. While it may resemble a hernia from the outside, this condition does not involve a tear or structural opening and typically resolves over time without surgery.

What’s going on with the nerves when this happens?

When shingles (caused by the herpes zoster virus) flares up, it can do more than just cause a rash and pain. In rare cases, the virus affects not just the sensory nerves that cause burning or tingling but also the motor nerves that help your muscles move. This can result in something called segmental paresis—a fancy way of saying the nerves in a certain part of your abdomen stop working properly. That part of your muscle becomes too weak to hold firm, and the result is a bulge. This usually shows up on one side of the abdomen or flank and matches the area served by the affected nerve, also known as a dermatome.

What signs suggest the bulge might be caused by shingles and not a hernia?

There are a few key clues. If you’ve had shingles recently—or even just the nerve pain and rash associated with it—pay close attention to any new bulges. Shingles-related bulges usually show up in the same area as the rash and may be paired with changes in skin sensation, like numbness or burning. The bulge itself tends to be soft and painless and doesn’t have the “cough impulse” or firmness that abdominal hernia cases often do. You also might notice a loss of abdominal reflexes on that side. These are signs that the nerve, not the muscle or tissue itself, is the root of the problem.

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How do doctors determine whether it’s shingles-related or a true hernia?

A physical examination and your medical history are the first steps. Dr. Iskandar will ask about recent shingles outbreaks, pain patterns, and any changes in skin feeling. Imaging tests like a CT scan or ultrasound are especially helpful—they show whether there’s an actual tear or defect in the abdominal wall. If no defect is found, it’s more likely a pseudohernia. In some cases, a test called electromyography (EMG) can be used to check if the muscle is getting signals from the nerve. All of this helps build a clear picture so you get the right treatment.

What does treatment look like for a shingles-induced pseudohernia?

Because the problem comes from nerve damage—not a physical hole in the abdominal wall—surgery is usually not needed. Instead, treatment focuses on helping the nerve heal. This often includes antiviral medication which can help reduce the effects of the virus. Pain relief is another big part of care, especially since shingles can cause nerve pain long after the rash is gone. Some patients may benefit from physical therapy to help rebuild strength in the abdominal muscles. Most people see improvement within a few months, but full healing can take up to 18 months.

When should someone see a surgeon or be more concerned?

While most pseudohernias caused by shingles improve with time, there are red flags that mean you should see a surgeon. These include severe or worsening pain, changes in the skin over the bulge (like redness or dark patches), or symptoms of a bowel blockage—like nausea, vomiting, bloating, or not being able to pass gas or stool. Also, if the bulge becomes hard and doesn’t go back in, or if it continues for more than a year without getting better, it’s time for a closer look. These could be signs of a true hernia, an infection, or another abdominal disease that requires further evaluation.

What’s the long-term outlook for patients with this condition?

The good news is that most patients recover fully. Once the nerve heals, the muscle usually regains its strength and the bulge goes away. While rare, some patients may experience lingering symptoms like constipation, urinary issues, or even a longer-term change in how the muscles feel. However, these outcomes are uncommon. The prognosis is typically very good, especially when the condition is recognized early and managed properly. What’s most important is getting an accurate diagnosis so you can begin healing without delay or confusion.

Wondering What’s Really Causing Your Bulge? Let’s Find Out Together.

It’s easy to assume any abdominal bulge is a hernia, but as this condition shows, that’s not always the case. With expertise in complex abdominal wall issues and a commitment to getting to the root of the problem, Dr. Iskandar provides the answers patients need. Whether it’s nerve-related, structural, or something else entirely, we’re here to guide you through the diagnosis and healing process. If you’ve noticed a new bulge—especially after shingles, chickenpox, or unexplained nerve pain—schedule a consultation with The Iskandar Complex Hernia Center and get the clarity you deserve.

source https://iskandarcenter.com/hernia-surgery/shingles-vs-hernia-when-viral-nerve-damage-mimics-abdominal-wall-defects/