Bathing and Showering After Hernia Surgery: A Complete Guide

After hernia surgery, many patients have questions about when and how they can safely bathe or shower. Proper hygiene is important, but so is protecting the surgical site during the early stages of recovery. At The Iskandar Complex Hernia Center, we provide clear post-operative instructions to help you heal safely and confidently. In this guide, we’ll walk through the key considerations for bathing and showering after your procedure. If you have additional questions or need expert care, schedule a consultation with The Iskandar Complex Hernia Center.

When can I bathe or shower after hernia surgery?

Most patients can begin showering 24 to 48 hours after hernia surgery, as long as Dr. Iskandar or your surgical team gives the go-ahead. For those who have undergone open or minimally invasive hernia repair at The Iskandar Complex Hernia Center, showering is generally safe after 24 to 48hours depending on the method of wound closure. Before stepping into the shower, you’ll be instructed to remove any outer dressings if applicable, but steri-strips can stay in place. Afterward, gently pat the incision dry without rubbing. Full baths, hot tubs, and swimming should be avoided for at least one to two weeks, or until you’ve been specifically cleared by Dr. Iskandar, as soaking the incision too soon can raise the risk of infection. If hygiene is needed sooner, sponge bathing is an option as long as the incision stays dry. If waterproof skin glue is used then a shower is possible without any additional steps.

Are there any specific showering techniques to follow after hernia surgery?

Yes, there are specific showering techniques to follow after hernia surgery, and your surgeon will provide personalized guidance based on your recovery. During the shower, let water and mild soap gently run over the incision without scrubbing. Steri-strips and surgical glue can get wet and will naturally begin to peel off after several days—never pull them off. If you have a waterproof dressing, it can remain in place during the shower but should be replaced if it becomes wet. After showering, carefully pat the incision dry with a clean towel and allow any steri-strips or glue to air dry. Avoid applying ointments, lotions, or soaking the area in baths, hot tubs, or pools until Dr. Iskandar confirms it is safe. Always monitor the incision for signs of infection and contact The Iskandar Complex Hernia Center if you notice anything concerning.

How long should I wait before taking a bath after hernia surgery?

You should wait at least two weeks before taking a bath after hernia surgery unless Dr. Iskandar provides different instructions based on your specific recovery. Soaking in a tub, hot tub, or pool too soon can increase the risk of infection and interfere with the healing process. During the initial two weeks, showering is usually permitted starting 24 to 48 hours after surgery, but it’s important to avoid submerging the incision in water and to gently pat the area dry afterward. Every recovery is unique, so be sure to follow the personalized guidelines you receive from The Iskandar Complex Hernia Center.

7 Tips for Bathing or Showering After Hernia Surgery

1. Wait at least 1 to 2 weeks before soaking in a bathtub, hot tub, pool, or any body of water, unless Dr. Iskandar gives you different instructions.
2. Do not apply ointments, creams, or lotions to the incision site unless Dr. Iskandar has specifically directed you to do so.
3. Avoid shaving over or near the incision area until the skin is fully healed to prevent irritation or injury.
4. Monitor the incision closely for signs of infection, including redness, swelling, drainage, or warmth, and contact The Iskandar Complex Hernia Center if you notice any of these symptoms.
5. If surgical glue was used, it is waterproof and allows for showering as instructed, but do not pick at or remove the glue.
6. Always pat the incision dry with a clean towel after showering; never rub the area.
7. If you are unable to shower during early recovery, sponge bathing is acceptable as long as you avoid soaking the incision.

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What should I do if my wound gets wet during a shower?

If your wound gets wet during a shower, gently pat it dry with a clean towel—never rub the area. If there was a dressing in place that became wet, it should be removed and replaced with a clean, dry one as soon as possible. If your incision is healing without stitches and Dr. Iskandar has approved showering, it’s generally safe for water to run over the area briefly, but soaking should still be avoided. After drying the area, inspect the incision for any signs of infection such as redness, swelling, drainage, or warmth. If you notice any of these symptoms, contact The Iskandar Complex Hernia Center. Always follow Dr. Iskandar’s specific wound care instructions, especially if you’ve been advised to keep the area dry for a longer period.

Take the Next Step Toward a Confident Recovery

Knowing how to care for your incision after hernia surgery is key to healing safely and avoiding complications. If you have any concerns about your recovery or need personalized guidance, Dr. Iskandar and his team are here to help. Schedule a consultation with The Iskandar Complex Hernia Center today to get expert support every step of the way.

FAQ’s About Bathing and Showering After Hernia Surgery

Can I use soap and shampoo normally after hernia surgery?

Yes, you can use mild soap and shampoo when showering after hernia surgery, but it’s important not to let products directly contact the incision site. Dr. Iskandar advises patients to allow water and soap to gently run over the area without scrubbing. Rinse thoroughly and pat the area dry afterward. If you experience irritation or inflammation, contact The Iskandar Complex Hernia Center for guidance.

What should I do if I accidentally scrubbed the incision?

If you accidentally scrub the incision, gently rinse the area with clean water and pat it dry with a clean towel. Apply a fresh piece of sterile gauze if advised by your care team. Watch for signs of redness, drainage, or tenderness, and contact Dr. Iskandar’s office to determine if further care is needed.

Can I shower with surgical sutures in place?

Yes, most patients can shower with surgical sutures still in place, but you should not scrub or apply pressure to the incision site. At The Iskandar Complex Hernia Center, Dr. Iskandar will give you detailed instructions on how to care for your incision depending on the type of closure used, including whether you have sutures, staples, or surgical glue.

Is it normal to feel pain while showering after surgery?

Some discomfort while moving or touching the incision area during a shower is normal after hernia surgery. If the pain feels sharp or worsens over time, it may indicate a complication. Dr. Iskandar recommends managing post-operative pain with prescribed medication and contacting the clinic if pain becomes difficult to control.

What if I develop a fever after showering?

A fever after surgery may indicate infection and is not directly related to showering unless the wound was not properly protected. Dr. Iskandar advises patients to monitor their temperature closely and contact The Iskandar Complex Hernia Center if they develop a fever, chills, or notice increased drainage from the incision.

Can I use an ice pack after a shower to reduce swelling?

Yes, using ice packs after showering can help reduce swelling and discomfort around the surgical site. Wrap the ice pack in a cloth and apply it for short intervals. Dr. Iskandar may recommend this especially in the first few days following surgery to help manage edema and localized inflammation.

How soon can I shower after inguinal hernia surgery?

Showering is typically safe 24 to 36 hours after inguinal hernia surgery, but always wait for approval from Dr. Iskandar. The timing may vary slightly based on whether your repair was open or laparoscopic. Clear instructions will be provided before you leave The Iskandar Complex Hernia Center.

What if I notice fluid leaking from the incision after a shower?

Some minor fluid drainage can be normal, especially in the first few days, but it should not have a foul odor or color. If you notice an increase in drainage or other signs of infection after showering, contact Dr. Iskandar. Proper incision care, including gently drying the area, helps prevent complications.

Should I avoid walking right after showering?

It’s safe to walk after showering, and light walking is encouraged to support healing and reduce the risk of blood clots. However, take care to move slowly and avoid slipping. The team at The Iskandar Complex Hernia Center will guide you on when and how to resume normal activities safely.

What signs after showering should prompt me to call my doctor?

If you notice symptoms like spreading redness, warmth, worsening pain, unusual drainage, or a fever after showering, it could be a sign of infection. Dr. Iskandar recommends contacting The Iskandar Complex Hernia Center if anything seems off with your incision. If these symptoms come on suddenly or severely, it may require emergency attention to prevent further complications.

source https://iskandarcenter.com/hernia-surgery/bathing-and-showering-after-hernia-surgery-a-complete-guide/

Robotic incisional hernia repair post ALIF (eTEP, bilateral transversus abdominis release) VIDEO: Dr. Mazen Iskandar Narrates the Procedure

In this video, Mazen Iskandar, MD, FACS, FASMBS narrates as he performs a Robotic incisional hernia repair post ALIF (eTEP, bilateral transversus abdominis release.)

Imagery of surgical content does appear in this video.

source https://iskandarcenter.com/hernia-surgery/robotic-incisional-hernia-repair-post-alif-video/

Preventing Hernias With Drugs: Is It In Our Future?

At The Iskandar Complex Hernia Center, we stay at the forefront of research that may impact how hernias are treated in the future. A recent study from Northwestern University has identified a promising new approach—blocking estrogen receptors to potentially reverse muscle fibrosis related to inguinal hernias. While hernia repair surgery remains the standard of care, this research raises important questions about whether drug therapies could one day play a role in treatment. While it’s an exciting development, more evidence is needed before it changes how patients are cared for. If you’re experiencing symptoms of a hernia, schedule a consultation with The Iskandar Complex Hernia Center to explore your treatment options.

Could Hormone Research Change the Way We Treat Hernias in the Future?

Emerging research into hormone signaling is beginning to reshape how we think about hernia formation and treatment. The recent discovery that estrogen receptors may influence muscle fibrosis opens up new possibilities for targeting the biological processes that lead to hernias in the first place. While surgery is still necessary to repair the physical defect, understanding these underlying mechanisms could lead to medical therapies that support or enhance surgical outcomes. At The Iskandar Complex Hernia Center, we’re closely watching these developments to evaluate how they might one day fit into a more comprehensive, personalized approach to hernia care.

Is Surgery Still the Only Effective Treatment for Hernias?

Yes—for now, surgery remains the only proven and effective way to repair a hernia. At The Iskandar Complex Hernia Center, we see firsthand how hernias progress when left untreated. They do not heal on their own and typically worsen over time, sometimes leading to complications. This is why surgical repair is still the gold standard. Although the hormone research is exciting, it’s still early-stage. Any medications based on this data would need to undergo extensive human trials before they could be safely used in clinical practice. For patients currently dealing with a hernia, surgical evaluation and treatment are still essential.

What Did the Researchers Discover About Hormones and Hernias?

The study, led by Dr. Serdar E. Bulun and Dr. Hong Zhao, focuses on a hormone receptor called Estrogen Receptor Alpha (ESR1). This receptor was found to play a key role in triggering muscle fibrosis—essentially the buildup of scar tissue in muscle—which can weaken abdominal walls and contribute to inguinal hernia development. Their research, titled “Estrogen Receptor Alpha Ablation Reverses Skeletal Muscle Fibrosis and Inguinal Hernias,” suggests that blocking ESR1 could lead to new medical strategies that work alongside surgery. As a surgeon, I find the idea of combining surgery with targeted medical therapy to improve long-term outcomes especially intriguing.

What Exactly Is an Inguinal Hernia?

An inguinal hernia occurs when tissue—usually part of the intestine—pushes through a weak spot in the lower abdominal wall. This can create a visible bulge and cause pain during activities like lifting, coughing, or bending. Inguinal hernias are the most common type of hernia, particularly among men. At our center, we routinely treat these using advanced surgical techniques tailored to the patient’s anatomy and health status. While the idea of non-surgical therapies is interesting, hernia repair remains a procedure that should be handled by experienced specialists.

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What Did the Study Find Using a Mouse Model?

To understand how hormones might influence hernia formation, researchers used a genetically modified mouse model (called Aromhum) that develops hernias in ways similar to humans. They discovered that:

• ESR1 is active in fibroblasts—cells involved in connective tissue—in the abdominal wall.
• When this receptor is overactive, it leads to excessive scarring (fibrosis), which compromises muscle strength.
• Blocking ESR1 with drugs like fulvestrant helped reverse this fibrosis and reduced the hernia’s severity.

While these findings were in mice, they suggest that modifying hormone receptor activity could one day be part of a broader treatment strategy. It’s a fascinating insight, and one I’ll be watching closely as more research becomes available.

How Could This Benefit Patients Who Need Surgery?

From my perspective as a hernia surgeon, one of the most exciting possibilities is how this research could one day improve surgical outcomes. Medications that block ESR1 might:

• Improve tissue quality before a hernia repair
• Help prevent recurrences by reducing underlying fibrosis
• Serve as a short-term treatment before surgery in patients with more complex hernias

In the mouse model, even a seven-day course of medication showed measurable improvement in muscle structure and hernia size. If similar results were seen in humans, it could mean that preoperative therapy might play a role in reducing complications or improving healing.

What Does This Mean for the Future of Hernia Treatment?

This study points to a potential shift in how we think about treating hernias; while surgery will remain essential, medications that target the estrogen receptor might serve as complementary tools to enhance outcomes. The researchers also identified specific genes and biological pathways tied to hernia development—opening doors to more targeted therapies in the future. Drugs like Fulvestrant and Raloxifene, already approved for other conditions, showed effectiveness in this early research by reducing fibrosis and improving tissue health. For complex hernia surgeons, the prospect of incorporating medical management into hernia care is an exciting development that deserves attention.

What Needs to Happen Before These Treatments Are Available?

Before any hormone-based treatments can be offered to patients, they must go through rigorous clinical trials to ensure they are safe and effective. Right now, this therapy is still in the research phase, and there are no approved medications for hernia prevention or reversal. However, the fact that these drugs are already approved for other uses could streamline the process if results in human studies are positive. As a surgeon committed to advancing patient care, I’ll continue to follow this research and evaluate how it could be integrated responsibly into our treatment protocols in the years ahead.

What Should You Do if You Have a Hernia Today?

While the future may hold more options, the best course of action for patients with hernias right now is to seek surgical evaluation. At The Iskandar Complex Hernia Center, we offer specialized care for all types of hernias, including complex and recurrent cases. If you’re experiencing symptoms like a bulge in the abdomen or groin, discomfort when lifting, or pressure that doesn’t go away, don’t wait. Schedule a consultation so we can discuss the most effective treatment plan for your situation and keep you informed about future options as they become available.

FAQ’s About Treating Hernias With Drugs

Can estrogen-blocking drugs actually reverse a hernia?

Right now, estrogen-blocking drugs like Fulvestrant are not capable of fully reversing a hernia, but early research suggests they may help improve the quality of muscle tissue impacted by fibrosis. At The Iskandar Complex Hernia Center, I explain to patients that while these medications show promise in lab models, they aren’t a substitute for inguinal hernia surgery. Instead, they may someday be used as a complement to improve outcomes in select cases.

How would blocking estrogen receptors help with hernia prevention?

Blocking estrogen receptors may reduce fibrosis in the abdominal wall muscles, which is a contributing factor in hernia formation. By preventing or reversing this process, future treatments could potentially lower the risk of hernia development in vulnerable areas of the gastrointestinal tract. As a hernia specialist, I’m watching this area of medicine closely to see how it might fit into surgical planning and long-term care strategies.

Are hormone therapies for hernias being tested in people in the United States?

Not yet. The current research has been conducted in animal models, and human trials would be the next step before anything could be offered to patients in the United States. At The Iskandar Complex Hernia Center, I help my patients stay informed about advances like these so we can evaluate new options as they become available through safe, regulated pathways.

Could estrogen receptor blockers be used before or after hernia surgery?

That’s one of the most exciting possibilities. If proven effective in humans, medications that block estrogen receptors could potentially be used before surgery to improve muscle quality or after surgery to aid healing and reduce recurrence. In my experience performing open and laparoscopic hernia repairs, including laparoscopy under general anesthesia, I can see real value in therapies that strengthen tissue around the surgical site.

What are the risks of using hormone-blocking drugs for hernia treatment?

Like any medicine, hormone-blocking drugs would come with their own set of risks and side effects, especially if used off-label. Dosing would need to be carefully studied in clinical trials to avoid unintended complications. At The Iskandar Complex Hernia Center, I always advise patients to weigh potential benefits with risks, especially when dealing with early-stage treatments that are not yet approved. Watching for signs and symptoms of complications—whether related to surgery or new medications—remains a critical part of personalized care.

source https://iskandarcenter.com/hernia-surgery/preventing-hernias-with-drugs-is-it-in-our-future/

Hernias in Men Versus Women: What’s the difference?

Hernias affect both men and women, but the types, causes, and symptoms can differ significantly. At The Iskandar Complex Hernia Center, we recognize that these differences matter when it comes to accurate diagnosis and effective treatment. Understanding how hernias present in men versus women can help patients seek care sooner and avoid complications. In this article, we’ll break down the key differences to help you stay informed. If you’re experiencing symptoms or have concerns about a hernia, schedule a consultation with The Iskandar Complex Hernia Center today.

Types of Hernias and Differences Between Men and Women

Different types of hernias affect men and women in distinct ways, often due to anatomical differences. At The Iskandar Complex Hernia Center, we evaluate each patient individually, taking these gender-specific factors into account to ensure accurate diagnosis and effective treatment.

Inguinal Hernias

Inguinal hernias are the most common type of hernia and are significantly more prevalent in men. This is due to a natural anatomical weakness in the groin area resulting from the descent of the testes during development. At The Iskandar Complex Hernia Center, we frequently see male patients with inguinal hernias presenting with a visible bulge in the groin and discomfort during physical activity. While women can also develop inguinal hernias, the condition is about eight times more likely to occur in men.

Femoral Hernias

Femoral hernias are more commonly diagnosed in women, largely because the wider shape of the female pelvis creates more space in the femoral canal. This increases the likelihood of abdominal tissue pushing through. At The Iskandar Complex Hernia Center, we pay close attention to the subtle presentation of femoral hernias in women, as these hernias tend to be smaller and harder to detect during a physical exam, which can delay diagnosis and increase the risk of complications.

Umbilical Hernias

Umbilical hernias develop around the navel and are seen more often in women, especially during or following pregnancy. The stretching and weakening of the abdominal wall in this area can allow tissue to protrude, forming a hernia. Patients at The Iskandar Complex Hernia Center often seek evaluation for umbilical hernias when they notice a soft bulge near the belly button that may become more pronounced with physical activity or pressure.

Hiatal Hernias

Hiatal hernias occur when a portion of the stomach pushes through the diaphragm and into the chest cavity. While both men and women can experience this condition, it tends to be slightly more common in women. At The Iskandar Complex Hernia Center, we assess hiatal hernias carefully, as they can cause symptoms like heartburn, chest discomfort, or difficulty swallowing, regardless of gender.

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How do symptoms and presentation of hernias differ between men and women?

Hernia symptoms and presentation often differ between men and women due to anatomical and structural differences. Men typically experience more visible and pronounced symptoms, such as a noticeable bulge in the groin area accompanied by pain during physical activity, lifting, or coughing. These classic signs are often easier to identify and lead to earlier diagnosis and treatment.

In women, hernias can be more difficult to detect. The symptoms are often less obvious and may be mistaken for other conditions, such as gynecological problems or hip-related issues. For example, a woman with a femoral hernia might report vague pelvic discomfort or groin pain without a visible bulge, which can delay accurate diagnosis. Dr. Iskandar often evaluates patients who have gone through multiple consultations for unrelated conditions before discovering a hernia was the underlying cause.

Femoral hernias, in particular, are more common in women and are typically smaller and located deeper within the body, making them harder to identify during a standard physical exam. These hidden hernias carry a higher risk of complications, including incarceration or strangulation, if not diagnosed and treated promptly. At The Iskandar Complex Hernia Center, careful attention is given to these subtle differences, and advanced diagnostic tools are used to ensure that no hernia goes undetected, regardless of how it presents.

Do men and women have different risk factors for hernias?

Yes, men and women have different risk factors for developing hernias. In men, heavy lifting, straining, or activities that put pressure on the abdominal wall can worsen existing weaknesses, especially in the groin area, making inguinal hernias more likely. For women, pregnancy and childbirth are significant risk factors, as the stretching and pressure placed on the abdominal muscles during these times can lead to the development of inguinal or umbilical hernias. At The Iskandar Complex Hernia Center, Dr. Iskandar considers these gender-specific risk factors during evaluation to ensure patients receive care that addresses the underlying causes and prevents future issues.

Are there any preventive measures for hernias in men and women?

Yes, there are preventive measures that men and women can take to lower their risk of developing hernias. Preventing hernias starts with reducing strain on the abdominal wall and making choices that support core strength and overall health. At The Iskandar Complex Hernia Center, Dr. Iskandar often encourages patients to maintain a healthy weight, engage in regular core-strengthening exercises, and use proper lifting techniques to avoid unnecessary pressure on the abdomen. A high-fiber diet can also help prevent constipation and reduce straining during bowel movements, which is a common contributing factor. Avoiding smoking is important as well, since chronic coughing from smoking can increase abdominal strain. Managing chronic conditions that cause coughing or muscle weakness is another way to protect the abdominal wall. Gender-specific factors are also considered, as women are advised to avoid heavy lifting during pregnancy and support their core with safe exercises, while men are encouraged to take extra care with activities that place stress on the groin, given their higher risk for inguinal hernias.

Are hernia repair outcomes the same for both men and women?

No, hernia repair outcomes are not always the same for men and women. It needs to be recognized that hernias in men and women are almost 2 different diseases and need to be treated differently. Women tend to have an increased risk of recurrence due to increased risk of occult femoral hernias. . At The Iskandar Complex Hernia Center, Dr. Iskandar takes these differences seriously and uses a tailored approach to care that accounts for the unique challenges women may face during and after hernia repair surgery. There is high level of evidence to promote the use of minimally invasive surgery in the treatment of hernias in women to detect and treat femoral hernias as well as inguinal hernias.

FAQ’s About Hernias In Men Vs. Women

Why are inguinal hernias more common in men than women?

Inguinal hernias are more common in men because of differences in anatomy. During development, the testicle descends through the inguinal canal, leaving a natural weakness that can later allow abdominal contents to push through. Women have a narrower inguinal canal, making this type of hernia less likely. At The Iskandar Complex Hernia Center, we use advanced imaging and diagnostic techniques to evaluate these anatomical differences accurately.

Can hernias affect different organs in men and women?

Yes, hernias can involve different organs depending on the type and location. In men, inguinal hernias may involve the intestines or even extend into the scrotum, while in women, femoral hernias can involve tissue or loops of the gastrointestinal tract entering the thigh area. The Iskandar Complex Hernia Center carefully assesses each patient to determine which organ may be affected and tailors treatment accordingly.

Do men and women experience different signs and symptoms of hernias?

Yes, the signs and symptoms can differ. Men often experience visible bulges and groin pain, while women may have more subtle symptoms like pelvic discomfort or nausea. These differences can lead to misdiagnosis in women. The team at The Iskandar Complex Hernia Center is experienced in recognizing gender-specific symptoms to avoid delays in treatment.

Are minimally invasive procedures equally effective for men and women?

Minimally invasive procedures, such as laparoscopy, are generally effective for both men and women, but outcomes can vary. Women may have a higher risk of recurrence after inguinal hernia repair, so careful technique and surgeon experience are critical. Dr. Iskandar uses minimally invasive approaches whenever appropriate, focusing on long-term outcomes for each patient.

What is the role of the thoracic diaphragm in hernias?

Hiatal hernias occur when part of the stomach pushes through the thoracic diaphragm into the chest cavity. These are slightly more common in women and can cause symptoms like acid reflux and vomiting. At The Iskandar Complex Hernia Center, patients with suspected hiatal hernias receive a thorough evaluation to determine the extent of the hernia and the best treatment plan.

Can hernias affect the blood supply differently in men and women?

In both men and women, hernias can restrict a blood vessel and cause serious complications if left untreated. In strangulated hernias, the blood flow to the affected organ is cut off, which can be life-threatening. The Iskandar Complex Hernia Center prioritizes early diagnosis and timely surgical intervention to preserve blood flow and prevent permanent damage.

Why are femoral hernias more common in women?

Femoral hernias are more common in women due to the shape of the female pelvis and the position of the femur. This anatomical configuration creates a wider femoral canal, increasing the risk of tissue pushing through. Dr. Iskandar understands this gender-specific risk and uses careful diagnostic tools to identify these hernias, which are often missed in routine exams.

How does a hernia affect the spermatic cord or testicle in men?

Inguinal hernias in men can extend into the scrotum and may compress the spermatic cord, potentially affecting the testicle. This can lead to discomfort, swelling, or in rare cases, blood flow issues. At The Iskandar Complex Hernia Center, Dr. Iskandar takes extra care during surgery to protect these vital structures while repairing the hernia.

Are women more prone to incisional hernias after surgery?

Women may be slightly more prone to incisional hernias due to pregnancy-related stretching of the abdominal wall or previous C-sections. An incisional hernia occurs when tissue pushes through a weak point near a surgical incision. The Iskandar Complex Hernia Center uses advanced closure techniques and guidance on recovery to reduce the risk of recurrence for all patients.

How does obesity influence hernia development differently in men and women?

Obesity increases intra-abdominal pressure, which raises the risk of hernias in both men and women. However, excess fat can mask signs of a hernia in women, delaying diagnosis. In men, obesity can strain the skeletal muscle of the abdominal wall, worsening weaknesses. At The Iskandar Complex Hernia Center, we consider weight-related factors when planning both surgery and recovery to improve long-term outcomes.

source https://iskandarcenter.com/hernia-surgery/hernias-in-men-versus-women-whats-the-difference/

Umbrella – Plug Hernia Repair (femoral)

Femoral hernias are a relatively uncommon but significant type of groin hernia, occurring when abdominal contents push through a weakened area in the femoral canal, just below the inguinal ligament. Though more frequently diagnosed in women, femoral hernias can affect patients of any gender, often leading to pain, discomfort, and potential complications such as strangulated femoral hernia, which requires emergency surgery.

Hernia repair techniques have evolved significantly over the years, incorporating advancements in surgical mesh, laparoscopy, and minimally invasive surgery. Among the techniques once considered for femoral hernia repair, the plug-based approach—including the Umbrella-Plug technique—has fallen out of favor due to chronic pain issues, mesh-related complications, and long-term patient dissatisfaction. The use of plugs in femoral hernia repair has led to a high incidence of postoperative pain, foreign body reactions, and other complications, making alternative methods a far superior choice for patients.

Studies published in Google Scholar, PubMed, and journals such as Ann Surg, J Surg, and Coll Surg Engl have highlighted the risks associated with plug repairs, particularly in comparison to tension-free mesh-based alternatives or laparoscopic techniques. This article will explore the pitfalls of plug-based repairs, the complications they present, and why leading surgeons advocate against their use in femoral hernia repair.

Key Problems with the Umbrella-Plug Hernia Repair Technique

The Umbrella-Plug technique for femoral hernia repair was initially designed to enhance hernia repair outcomes while minimizing recurrence. However, clinical experience and long-term patient outcomes have demonstrated that this technique often leads to significant complications, outweighing any potential benefits. Below are the key reasons why the plug-based approach is no longer considered an optimal choice.

Mesh Plug Design: A Source of Chronic Pain and Foreign Body Reactions

Unlike traditional flat mesh patches, the Umbrella-Plug is shaped like a cone or umbrella, which often leads to excessive pressure on surrounding tissues. Because it is a 3D structure that occupies space, it can cause compression to surrounding stuctures. This can result in nerve entrapment, mesh migration, blood clot of the femoral vein and long-term discomfort. Numerous studies available on Google Scholar and PubMed have linked plug-based repairs to increased rates of chronic pain compared to suture-only repairs or alternative femoral hernioplasty techniques.

Insertion Process Leads to Long-Term Complications

While the Umbrella-Plug was designed as a minimally invasive technique, its insertion process poses significant risks. The forced expansion of the plug within the femoral canal can lead to pressure on nearby nerves, resulting in persistent pain that can become debilitating for patients. Clinical trials and studies indicate that patients undergoing plug-based repairs report a higher incidence of postoperative complications, including nerve pain and inflammation, than those who receive non-plug-based repairs.

Fixation Issues: Increased Risk of Migration and Pain

Secure fixation of the mesh plug is challenging in the femoral canal, and migration remains a concern. the medial border of the femoral canal is the femoral vein and the plug can be secured medially. Improper fixation combined with the rigid structure of the plug, can lead to irritation of key anatomical structures, including the femoral vein and surrounding nerves. Many surgeons have found that patients who received plug-based repairs experience higher recurrence rates and a greater likelihood of requiring revision surgery to address complications.

Why Surgeons Advocate Against Plug-Based Hernia Repairs

Chronic Pain: A Major Postoperative Concern

Unlike tension-free mesh-based alternatives, plug repairs introduce a significant risk of chronic pain due to nerve entrapment and foreign body reactions. Research confirms that patients who undergo plug-based repairs frequently report persistent discomfort that can interfere with daily activities and quality of life. Tension-free repair methods that do not involve plug insertion have been shown to provide superior long-term outcomes with lower complication rates.

Higher Risk of Mesh Migration and Foreign Body Reactions

One of the most significant drawbacks of the Umbrella-Plug technique is mesh migration. Due to the conical shape of the plug, movement over time can lead to irritation of adjacent structures, increasing the risk of recurrence and requiring further surgical intervention. Studies highlight the complications associated with migrating mesh plugs, emphasizing the need for better, more stable repair techniques.

Minimally Invasive Alternatives Provide Better Outcomes

While plug repairs were initially marketed as a quick, minimally invasive solution, better options now exist. Laparoscopic and robotic techniques, such as the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches, allow for precise hernia repair without introducing the risks associated with mesh plugs. These techniques provide the benefits of reduced pain, quicker recovery, and lower recurrence rates, making them the preferred choice among experienced hernia surgeons.

Moreover, it is recommended for all women with groin hernias to undergo minimally invasive repairs over open repairs. In this scenario, minimally invaive repairs allow for the diagnosis and repair of femoral hernias that may not be detected readily with open approaches.

Better Alternatives to Plug-Based Repairs

Tension-Free Mesh Repair

One of the best alternatives to the Umbrella-Plug technique is a tension-free mesh repair, which provides reinforcement without inserting a bulky, rigid plug. This approach allows the mesh to conform naturally to the patient’s anatomy, reducing the risk of chronic pain and foreign body reactions.

Laparoscopicor robotic Hernia Repair (TAPP and TEP Techniques)

Laparoscopic and robotic techniques offer a minimally invasive way to repair femoral hernias without the risks associated with mesh plugs. Studies from J Surg, Royal College of Surgeons, and clinical trials across the United States have demonstrated superior patient outcomes with laparoscopic methods, including lower pain levels and decreased recurrence rates.

Suture-Only Techniques in Select Cases

For certain patients, particularly those with small femoral hernias, a suture-only approach may be a viable alternative. This method avoids the risks associated with mesh placement while still providing effective reinforcement of the femoral canal.

Dr. Iskandar’s Thoughts on Plug Repairs

Dr. Iskandar firmly believes that plug-based hernia repairs, including the Umbrella-Plug technique, should no longer be used due to their high risk of complications and long-term patient dissatisfaction. The phrase “Say No to Plugs” has become a guiding principle for many leading hernia surgeons who prioritize patient outcomes over outdated surgical techniques. Instead, tension-free mesh repairs and laparoscopic approaches provide safer, more effective, and more comfortable solutions for femoral hernia patients.

Conclusion

The Umbrella-Plug technique for femoral hernia repair was once considered a viable option, but ongoing research and clinical experience have revealed its significant drawbacks. Chronic pain, mesh migration, and long-term complications make plug-based repairs a suboptimal choice. Surgeons worldwide are now advocating for tension-free mesh repairs, laparoscopic techniques, and suture-only approaches where appropriate. With patient safety and long-term outcomes in mind, the best approach is clear: Say No to Plugs.

 

 

https://journals.indexcopernicus.com/api/file/viewByFileId/699439

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=3d2c78a7a4c29ad9c97ca930cdc460a7bbdffdee

https://pmc.ncbi.nlm.nih.gov/articles/PMC4201027/

https://jamanetwork.com/journals/jamasurgery/fullarticle/394820

 

source https://iskandarcenter.com/hernia-surgery/umbrella-plug-hernia-repair-femoral/

Dr. Mazen Iskandar Selected to Contribute to Prestigious Surgical Journal

Dr. Mazen Iskandar, renowned hernia surgeon and founder of The Iskandar Complex Hernia Center, has been selected to author two chapters in Surgical Endoscopy and Other Interventional Techniques, the official journal of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES). This distinction underscores Dr. Iskandar’s expertise and leadership in the field of complex hernia repair and minimally invasive surgery.

About Surgical Endoscopy and Other Interventional Techniques

Surgical Endoscopy and Other Interventional Techniques is a highly respected, peer-reviewed medical journal that serves as the official publication of SAGES and EAES, two of the leading international organizations dedicated to advancing the field of minimally invasive surgery. The journal publishes groundbreaking research, innovative surgical techniques, and expert reviews covering a broad spectrum of endoscopic, laparoscopic, and robotic-assisted procedures.

By fostering collaboration among the world’s top surgeons and researchers, Surgical Endoscopy and Other Interventional Techniques plays a vital role in shaping the future of surgical advancements. The journal is recognized for its commitment to evidence-based medicine, ensuring that surgeons worldwide have access to the latest developments and best practices. Contributing to this esteemed publication is a significant honor, as it reflects a surgeon’s depth of expertise, thought leadership, and impact on the field.

Dr. Iskandar’s Contributions

Dr. Iskandar’s expertise will be showcased in two critical chapters:

Chapter 10: Port Type, Positions, and Number in Laparoscopic Ventral Hernia Repair – This chapter focuses on the role of trocar placement in hernia surgery. Dr. Iskandar will provide an updated perspective on laparoscopic and robotic trocar placement, a method that improves precision, optimizes surgical workflow, and enhances patient recovery.

Chapter 18: Management of Bowel Injury During Laparoscopic Ventral Incisional Hernia Repair – This chapter will address best practices for identifying and managing bowel injuries during hernia repair. It will emphasize that, in most cases, a recognized injury can be repaired immediately, provided there is no thermal damage. This discussion is essential for improving patient outcomes and reducing surgical complications.

Recognized Authority in Hernia Surgery

Dr. Iskandar’s contributions to this esteemed journal further cement his status as a leader in the field of hernia surgery. His expertise and dedication to advancing surgical techniques are also reflected in The Iskandar Complex Hernia Center’s designation as one of only two Hernia Centers of Excellence in North Texas by the Surgical Review Corporation (SRC). This recognition is not easily achieved; it requires facilities to meet stringent standards, demonstrating superior patient outcomes, adherence to best practices, and exceptional surgical expertise.

Additionally, Dr. Iskandar holds the distinction of being a Surgeon of Excellence in Hernia Surgery, an accreditation granted by SRC to a select group of surgeons who meet and exceed the highest standards of surgical proficiency and patient care. This recognition sets him apart as one of the foremost hernia surgeons in the nation, reinforcing his commitment to providing world-class treatment.

Why This Matters for Patients

For patients seeking expert hernia care, Dr. Iskandar’s role in shaping the future of minimally invasive hernia surgery offers a compelling reason to trust his expertise. His involvement in academic research and surgical advancements directly benefits patients by ensuring they receive care informed by the latest medical innovations. The integration of robotic techniques and refined laparoscopic procedures leads to faster recovery times, reduced post-operative pain, and improved surgical outcomes.

At The Iskandar Complex Hernia Center, patients can expect:

• State-of-the-art surgical techniques, including robotic-assisted hernia repair
• Minimally invasive approaches that reduce complications and recovery time
• Personalized, expert-led, compassionate treatment from a nationally recognized hernia specialist

Commitment to Surgical Excellence

Dr. Iskandar’s contributions to Surgical Endoscopy and Other Interventional Techniques, along with his established recognitions, reaffirm his standing as a leader in hernia surgery. His unwavering commitment to innovation, patient care, and surgical excellence ensures that The Iskandar Complex Hernia Center remains at the forefront of hernia treatment. As he continues to contribute to both research and clinical advancements, patients can trust that they are receiving care from one of the top hernia specialists in the field.

source https://iskandarcenter.com/hernia-surgeon/dr-mazen-iskandar-selected-to-contribute-to-prestigious-surgical-journal/

Nissen Fundoplication or Toupet or Dor fundoplication with or without absorbable mesh (hiatal)

When it comes to addressing gastroesophageal reflux disease (GERD) and hiatal hernias, surgery is often the best solution for patients who have not responded to conservative treatments such as lifestyle changes or proton-pump inhibitor therapy. Among the surgical options, fundoplication techniques like Nissen fundoplication, Toupet fundoplication, and Dor fundoplication are widely used. These procedures aim to restore the natural barrier function of the lower esophageal sphincter (LES), preventing the backward flow of acid and stomach contents into the esophagus. Each approach differs in the way the stomach is wrapped around the esophagus, offering varying levels of reflux control and minimizing postoperative complications like dysphagia.

The decision to perform one of these procedures often depends on findings from diagnostic tools such as endoscopy, esophageal motility studies, and upper gastrointestinal series. These evaluations help identify the disease severity, the presence of a hiatal hernia, and the overall condition of the gastrointestinal tract. For patients undergoing hiatal hernia repair, the use of surgical mesh—either absorbable or permanent—remains a topic of significant discussion. While mesh can reinforce the repair and reduce short term recurrence rates, it is not without risks, including stenosis.

With advancements in laparoscopy and minimally invasive techniques, fundoplication surgeries now offer shorter recovery times, improved outcomes, and reduced risks of complications. However, the success of these procedures also relies heavily on the surgeon’s expertise, meticulous preoperative planning, and individualized care for each patient. This article explores the different types of fundoplication, their benefits and drawbacks, and the evolving role of mesh in surgical practice, supported by insights from randomized controlled trials, meta-analysis, and systematic reviews. Whether addressing GERD, a hiatal hernia, or associated complications like Barrett’s esophagus or esophagitis, these surgeries continue to play a pivotal role in modern gastroenterology.

Fundoplication Techniques

Fundoplication surgeries aim to strengthen the barrier between the esophagus and the stomach, reducing gastroesophageal reflux by wrapping the stomach partially or completely around the esophagus. the wrap essentially functions as a valve mechanism to reduce reflux. The choice of technique is tailored to the patient based on the severity of GERD, the presence of a hiatal hernia, and findings from diagnostic studies such as esophageal motility studies, endoscopy, and upper gastrointestinal series. Each technique offers distinct benefits and potential challenges.

Nissen Fundoplication

The Nissen fundoplication is the most commonly performed and well-established surgical option for GERD and hiatal hernia repair. In this technique, the surgeon creates a 360° posterior wrap of the stomach around the esophagus, fully encircling the lower esophageal sphincter (LES). This approach effectively increases pressure at the LES, preventing acid reflux and regurgitation.

Key Benefits:

• Superior control of reflux symptoms.
• High success rates in patients with severe GERD or large hiatal hernias.
• Long-term durability

However, the Nissen fundoplication is associated with higher rates of postoperative dysphagia, particularly in patients with pre-existing esophageal motility disorders. Careful preoperative assessment using an esophageal motility study can help identify patients at higher risk of complications.

Toupet Fundoplication

The Toupet fundoplication involves a 270° posterior partial wrap, which partially encircles the esophagus but leaves a portion of it uncovered. This technique is less restrictive than the Nissen and is particularly suitable for patients with weak esophageal motility or those at higher risk of postoperative complications such as dysphagia.

Key Benefits:

• Lower incidence of postoperative dysphagia, as it places less tension on the esophagus.
• Effective reflux control for most patients, comparable to the Nissen in many cases.
• Reduced bloating and difficulty belching compared to the Nissen.

Research studies, including randomized controlled trials, have demonstrated that the Toupet fundoplication provides good long-term outcomes in symptom control, patient satisfaction, and reduced complications.

Dor Fundoplication

The Dor fundoplication involves a 180° anterior partial wrap, where the stomach is wrapped around the front of the esophagus. This technique is often performed in conjunction with a Heller myotomy for patients with achalasia, as it helps prevent reflux after the myotomy while preserving the posterior gastroesophageal anatomy.

Key Benefits:

• Preserving posterior structures, reducing the risk of esophageal injury or disruption.
• Effective in preventing reflux in select populations, such as those undergoing treatment for achalasia or those with mild GERD.
• Lower likelihood of postoperative complications like dysphagia or stenosis.

While it may not provide as strong reflux control as the Nissen or Toupet, the Dor fundoplication is a valuable option for patients with specific indications.

Tailoring the Technique to the Patient

Choosing the most appropriate fundoplication technique depends on multiple factors, including:

• Esophageal motility: Patients with weak motility often benefit from partial wraps like Toupet or Dor to minimize pressure on the LES.
• Hiatal hernia size: Large hernias may require additional techniques like mesh reinforcement.
• Patient-specific risks of postoperative complications like dysphagia, bloating, or regurgitation.

Surgeons rely on diagnostic tools such as endoscopy, barium swallow studies, and esophageal motility studies to guide their decision-making. Each procedure has demonstrated efficacy in improving patient outcomes when performed with appropriate indications and surgical expertise. By tailoring the technique to the patient’s unique anatomy and disease profile, the likelihood of achieving durable symptom relief increases significantly.

Comparison of Techniques

Nissen fundoplication, Toupet fundoplication, and Dor fundoplication are all effective surgical techniques for managing gastroesophageal reflux disease (GERD) and hiatal hernias, but each has distinct advantages and considerations. Studies, including randomized controlled clinical trials and systematic reviews, have shown that the Nissen fundoplication provides excellent long-term reflux control due to its complete 360° wrap around the esophagus. However, it is associated with a higher risk of postoperative dysphagia, particularly in patients with weak esophageal motility. In contrast, the Toupet fundoplication, which uses a 270° posterior partial wrap, offers comparable control of reflux symptoms while significantly reducing the incidence of dysphagia, making it a preferred option for patients with impaired esophageal motility or a history of swallowing difficulties.

The Dor fundoplication, a 180° anterior wrap, is often used in conjunction with procedures such as Heller myotomy for achalasia and is particularly effective in preventing reflux in these cases. While the Dor wrap may not provide the same level of reflux control as the Nissen or Toupet, it minimizes tension on the lower esophageal sphincter (LES) and preserves posterior anatomy, reducing the risk of complications such as stenosis or injury. Long-term studies and meta-analyses have shown that patient satisfaction, symptom relief, and overall efficacy are comparable across the three techniques when they are appropriately matched to the patient’s condition and anatomical considerations. These findings emphasize the importance of individualized treatment plans, informed by preoperative diagnostics like endoscopy, esophageal motility studies, and upper gastrointestinal series, to ensure optimal outcomes for each patient.

Use of Mesh in Hiatal Hernia Repair

The inclusion of mesh in hiatal hernia repair is a topic of active investigation, with both potential benefits and risks.

Potential Benefits

• Surgical mesh, namely absorbable mesh, has shown promise in reducing short-term recurrence rates when compared to primary surgical suture repairs. However, permanent mesh is not used around the esophagus due to risk of erosion and infection

Concerns

• Risks include mesh-related complications such as erosion, infection, and stenosis especially in the case of permanent mesh.
• Long-term outcomes, as noted in meta-analyses and studies indexed in PubMed, reveal no significant difference in recurrence rates between mesh and non-mesh repairs.

Current Trends

• Many surgeons prefer absorbable mesh to reduce long-term complications while maintaining the benefits of short-term reinforcement.
• The decision to use mesh is often based on factors like the size of the hiatal defect, tissue quality, and patient-specific risk factors.

Postoperative Outcomes and Risks

Fundoplication surgeries, whether Nissen, Toupet, or Dor, are generally effective in alleviating the signs and symptoms of gastroesophageal reflux disease (GERD) and improving quality of life for patients. Postoperatively, most individuals experience significant reductions in symptoms such as regurgitation, bloating, chest pain, and heartburn. Studies, including systematic reviews and meta-analyses, have demonstrated high rates of long-term symptom relief and patient satisfaction across all three techniques. However, the potential for complications remains, and outcomes can vary depending on the specific procedure and patient factors.

Postoperative dysphagia is a common concern, particularly following Nissen fundoplication, due to the increased pressure created by the complete 360° wrap. While this can often resolve over time, severe or persistent dysphagia may require additional intervention. The Toupet fundoplication, with its partial 270° wrap, poses a lower risk of dysphagia while still providing effective reflux control, making it a preferred option for patients with pre-existing esophageal motility disorders. The Dor fundoplication, with its 180° anterior wrap, has the lowest likelihood of postoperative dysphagia and is particularly advantageous for patients undergoing additional procedures, such as Heller myotomy.

Other potential complications include bloating, stenosis, or recurrence of GERD symptoms. Rarely, complications such as esophageal injury or mesh-related issues (if mesh is used during hiatal hernia repair) can occur. Factors such as surgeon expertise, proper preoperative planning, and adherence to postoperative care guidelines play a critical role in minimizing risks. Despite these concerns, the overall efficacy and durability of fundoplication surgeries make them a highly reliable option for patients with GERD or hiatal hernias who have not responded to medical therapies like proton-pump inhibitors.

Dr. Iskandar’s Thoughts on the Technique

• the choice of technique depends mostly on the symptoms, size of the hernia, esophageal motility. Larger hiatal hernias also known as paraesophageal hernias are approached differently than smaller hiatal hernias.
• Absorbable mesh is selectively used in larger hernias, or in the case of recurrent hernias

 

Conclusion

The choice among Nissen fundoplication, Toupet fundoplication, and Dor fundoplication depends on patient-specific factors, including the severity of GERD, the presence of a hiatal hernia, and findings from preoperative diagnostics like esophageal motility studies. While the role of surgical mesh remains controversial, selective use of absorbable mesh shows promise in reducing short-term recurrences without increasing long-term complication rates. As research evolves, evidence-based approaches will continue to improve outcomes for patients undergoing these procedures.

source https://iskandarcenter.com/hernia-surgery/nissen-fundoplication-or-toupet-or-dor-fundoplication-with-or-without-absorbable-mesh-hiatal/