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A Customized Approach

Mon, 07/25/2011 - 6:36am

Jonathan Yunis, MD, FACS, Center for Hernia Repair, Sarasota, FL

July 25, 2011

Few surgeons have gone as far as I have to really limit their practice solely to hernia surgery. Today, I perform about 600 hernia operations per year. In focusing solely on hernia repair, there are several creative aspects, or things I’ve changed over the years in my practice.

One of the most common hernia problems is groin hernias, involving inguinal and femoral hernias. Still to this day, there is significant controversy about the best way to fix a hernia. Currently in the world, there are approximately eight common techniques used with passion by surgeons in their locations that they feel strongly are the best and only way to fix a particular hernia.

Over the last 15 years, I’ve been able to pursue training with surgeons in other parts of the world who are also dedicated to hernia surgery. I have gained appreciation of what works for these experts and have practiced what I have learned from them. Today, my armamentarium for hernia management includes, but is not limited, to:

  • Laparoscopic total extraperitoneal hernia repair.
  • Laparoscopic transabdominal preperitoneal hernia repair.
  • Open hernia repair with Lichtenstein technique.
  • Open hernia repair with Shouldice technique.
  • Open hernia repair with Prolene Hernia System technique.
  • Open hernia repair with preperitoneal mesh placement.
Furthermore, I believe it’s important to be proactive in dealing with the cosmetic defects of the abdominal wall when I approach ventral hernias. Especially in younger women, I am very interested in reconstructing the abdominal wall along with the hernia repair in order to provide adequate cosmesis.

Customizing the hernia repair approach to the patient's individual needs can promote positive outcomes.

It is my initial approach with any patient to customize the proposed surgery based on the following individual factors; such as level of activity, weight, what they do for a living, and what the hernia looks like.

Furthermore, I believe it’s important to be proactive in dealing with the cosmetic defects of the abdominal wall when I approach ventral hernias. Especially in younger women, I am very interested in reconstructing the abdominal wall along with the hernia repair in order to provide adequate cosmesis.

Specifically, patients with a ventral hernia in the abdominal wall, even if they’re not overweight, tend to gain weight through the hernia. This tends to protrude through the lower abdomen and stretch the skin. In some cases, especially women who are otherwise fit and have a reasonable amount of fat on them, I will combine lower abdominal wall surgery with an abdominoplasty to achieve adequate cosmetic results.

Finally, for the future, I am interested in accomplishing hernia repair using even lighter, lower profile mesh and smaller incisions. I am currently working to change some of the techniques of my laparoscopic inguinal hernia repair using 2.5 mm trocar devices versus the typical 5 mm devices so the scar looks more like a needlestick. I feel that because I’ve had the opportunity to treat a large volume of hernia cases, I have been able to become an expert on different approaches to take a customized approach to hernia repair.

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