Overview

Overview

Hear from Michael Rosen, MD: Director, Comprehensive Hernia Center

An estimated 5 million Americans have hernias and only 700,000 have them surgically repaired each year. While some hernias don't cause symptoms and no treatment is needed, some patients may avoid treating their hernias because they fear painful surgery. Often, however, hernia surgery is performed on an outpatient basis with a minimal recovery period.

Each year, Cleveland Clinic surgeons perform more than 3,000 hernia repairs affording patients expertise in both common and complex cases. More importantly, patients complete a comprehensive evaluation with a board-certified surgeon to determine the best surgical procedure to avoid repeat hernias and complications.

Why Choose Cleveland Clinic's Comprehensive Hernia Center?

  • Our patient-centered care is available at 17 locations across Northeast Ohio, making routine treatment more convenient for local patients. Our main campus in Cleveland is a destination for the most complex cases.
  • Cleveland Clinic surgeons specialize in all types of hernia repair from the traditional, open technique to laparoscopic or minimally invasive surgery.
  • Each year, we perform more than 3,000 hernia repairs , including:
    • Inguinal hernias, which can be repaired laparoscopically on an outpatient basis.
    • Incisional hernias, which may require a one or two day hospital stay.
    • Ventral hernias, many which can be repaired with minimally invasive technique.
    • Complex open and repeat surgeries – including abdominal wall reconstruction – which are referred to us from all over the world. We are able to perform successful repairs on patients who have lost most of their abdominal wall due to trauma or infections, tumor resection or multiple failed hernia repairs.
What We Treat

What We Treat

Cleveland Clinic’s Comprehensive Hernia Center treats a wide range of hernias, both common and complex:

Treatments

Treatments

Each year, while an estimated 5 million Americans develop hernias, only 700,000 have them surgically repaired. Most physicians believe people avoid treating their hernias because they fear painful surgery. Today, there is little reason to fear. Hernia surgery is usually performed on an outpatient basis and patients are able to return to most normal activities in a matter of a few days.

What is a hernia?

A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing pain and other potentially serious health problems.

Men and women of all ages can have hernias. Hernias usually occur either because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall, such as the strain from heavy lifting, substantial weight gain, persistent coughing, or difficulty with bowel movements or urination. There are three primary types of hernias:

  • Incisional or ventral: appears at the site of the incision of a previous abdominal operation. This can happen soon after the operation or many years later.
  • Inguinal: develops when a portion of an internal organ such as the intestine, along with fluid, bulges through a weakened area in the muscle wall of the abdomen.
  • Umbilical: occurs around the navel and is usually present at birth, though it may not become a problem until adulthood.

What are the symptoms of hernias?

  • A noticeable protrusion in the groin area or in the abdomen
  • Feeling pain while lifting
  • A dull aching sensation
  • A vague feeling of fullness

How can a hernia be repaired?

Hernias usually need to be surgically repaired to prevent intestinal damage and further complications. The surgery takes about an hour and is usually performed on an outpatient basis (which means the patient can go home the same day of the procedure). This surgery may be performed by an open repair (small incision over the herniated area) or by laparoscopic surgery (minimally invasive). Your surgeon will determine the best method of repair for your individual situation.

Open Ventral Hernia Repair

A ventral hernia is a hernia that occurs along the vertical center of the abdominal wall.

Open Repair Surgery

During the surgery

  • An anesthesiologist (a physician who specializes in pain relief) will recommend a type of anesthesia according to your condition and health status. You will not feel pain during the surgery.
  • A small incision or cut is made in the skin.
  • The hernia “sac” containing the bulging intestine is identified.
  • The surgeon pushes the intestine inside the hernia sac back into its proper position behind the muscle wall.
  • The muscle wall is reinforced with stitches or synthetic mesh to complete the repair.

After the surgery
Most patients will be able to go home a few hours after surgery. If needed, a 23-hour extended recovery area is available. Typically, most patients feel fine within a few days after the surgery and resume normal eating habits and activities. Strenuous activity and exercise are restricted for 4 to 6 weeks after surgery.

Laparoscopic Surgery

During the surgery
Laparoscopic surgery uses a thin, telescope-like instrument (known as an endoscope) that is inserted through a small incision at the umbilicus (belly button). Usually, this procedure is performed under general anesthesia. This requires an evaluation of your general state of health, including a history and physical exam, possibly including lab work and EKG. The endoscope is connected to a tiny video camera – smaller than a dime – that projects an “inside view” of the patient’s body onto television screens in the operating room. The abdomen is inflated with a harmless gas (carbon dioxide) to allow your doctor to view your internal structures.

The peritoneum (the inner lining of your abdomen) is cut to expose the weakness in the abdominal wall. A mesh patch is attached to secure the weak area under the peritoneum. The peritoneum is then closed with staples or sutures.

After the surgery
Following the procedure, the small abdominal incisions are closed with a stitch or two or with surgical tape. Within a few months, the incision is barely visible.

Benefits of laparoscopic hernia surgery

  • Tiny scars rather than one larger incision
  • Reduced postoperative pain

Innovations

Cleveland Clinic hernia experts have developed and currently use

  • Newer minimally invasive methods
  • Leading-edge approaches to complex abdominal wall reconstructions, including robotic surgery and special techniques to prevent raising skin flaps
  • Novel methods of resection involving complex defects

Some of these innovations have reduced post-operative infections and wound complications by more than 50 percent.

Images

FAQ

FAQ

How soon can I return to work?

It depends on what type of work you do and which type of surgery you have. Typically, open repair patients may go back to deskwork within a week depending on how well you feel. Similarly, with laparoscopic repair, you may go back to deskwork within a few days.

If heavy lifting is required (greater than 20 – 25 lbs.), open repair patients may restrict this activity for 4 to 6 weeks. Patients with laparoscopic repair usually can begin heavy lifting in two weeks.

When can I resume normal activity?

Normal activity (minus exercise other than walking) for both open and laparoscopic repair can be resumed as soon as you feel well – usually within a few days.

Do I need a referral?

No, you do not need a referral to come to Cleveland Clinic. However, your insurance may require a referral. Be sure to check with your health care provider prior to your appointment.

How long does the surgery take?

Between one to two hours.

What causes a hernia?

A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing pain and other potentially serious health problems. Specifically, eighty percent of all hernias are located near the groin. Hernias may also be found below the groin (femoral), through the navel (umbilical) and along a previous incision (incisional).

How do I know if I have a hernia?

You may experience any of the following symptoms:

  • A noticeable protrusion in the groin area, or in the abdomen
  • Feeling pain while lifting
  • A dull aching sensation
  • A vague feeling of fullness

How is a hernia treated?

If a hernia causes no symptoms, you and your physician may choose to watch and see if any changes occur. A binder or support may be recommended for comfort, but does not treat the hernia. Most often surgery is required.

Will my hernia reoccur?

Approximately 5 to 10% of hernias are estimated to re-occur depending on the type of hernia. By following your physician’s recommendations following surgery, you can greatly affect your healing process and ultimate outcome.

Are there risks in delaying my surgery?

Your physician will recommend the urgency of need for surgery. In some cases, if the bowel becomes trapped in the opening caused by weakened muscles, blood flow can be blocked; causing pain to increase and often requiring prompt surgery.

Appointments and Locations

Appointments and Locations

Appointments

To make an appointment at any one of our comprehensive Hernia Center locations, please call 216.444.6644.

If you are a MyChart patient, you may log in and make your appointment request from your MyChart account.

Locations

Resources and Clinical Trials

Resources and Clinical Trials

Web Resources

Webchat Transcript

Health Essentials

Hernia Clinical Trials 

Below, find clinical trials that are currently enrolling patients:

Long-term Results of Heavy Weight versus Medium Weight Mesh in Ventral Hernia Repair

Use of mesh during hernia repair is a standard procedure since the use of mesh has been shown to significantly decrease the chances of hernia recurrence. Most commonly used meshes are made from a synthetic material called polypropylene. There are several types of polypropylene mesh on the market, which are manufactured in different sizes and shapes to best fit patient needs. Also, some meshes contain more polypropylene than the others – this is called “mesh weight”. Polypropylene meshes are classified as heavy-weight (more material) or medium-weight (less material). Both mesh weights are currently used for hernia repair. Nevertheless, there is no good evidence that one is superior to the other, so the choice of one over the other is usually based on surgeon preference. Our study aims to determine whether there is a difference in patient quality of life, pain and rates of complications 1 year after surgery. To achieve that, participants of our study undergo the exact same operation, but are assigned to receive either one of these meshes using a process that is similar to a flip of a coin (randomization).

Who is eligible to participate: Adult patients who are scheduled to undergo an elective hernia repair, where mesh is planned to be placed below the muscles of the abdominal wall (retromuscular mesh position). Also, patients cannot have any ongoing infection (clean wound) and hernias cannot be larger than 20cm as measured by imaging studies.

Principal Investigator: Michael Rosen, MD

Registry Based Randomized Controlled Trial Comparing Operative Time Between Telescopic Dissection vs. Balloon Dissection during Laparoscopic TEP Inguinal Hernia Repair

There are many ways an inguinal hernia can be repaired. For example, this can be performed through an open incision, or through a laparoscopic (minimally invasive) approach. One of the most common laparoscopic techniques is called TEP. To repair an inguinal hernia with this technique, the surgeon has to initially dissect what is called the preperitoneal space. For this, your surgeon can either use a disposable device called a balloon dissector or they can simply dissect this space using surgical instruments and the laparoscopic surgery camera. Both techniques are used around the world according to surgeon preference and also availability of the balloon dissector. At our institution, we have experienced laparoscopic surgeons that are able to perform this operation either with or without the disposable balloon. We are conducting a study to check differences in operative times, postoperative pain and patient quality of life in the instances where the disposable balloon was used and when it was not.

Who is eligible to participate: Adult patients who are scheduled to undergo an elective repair of their inguinal hernia and are considered suitable by their surgeon to undergo a TEP approach. For this study, patients who have hernia on only one side can participate. If you have a hernia that is recurrent (was already repaired but is back now), you are able to participate only if the prior surgery was performed through an open incision.

Principal Investigator: Michael Rosen, MD

A Prospective Randomized Trial of Biologic Mesh versus Synthetic Mesh for the Repair of Complex Ventral Hernias

Ventral hernia repair is a frequent sequela of abdominal surgery. Some of these hernias present in a contaminated field. This study will compare the safety, efficacy, and cost-effectiveness of two different meshes commonly used to repair a hernia in this situation: Synthetic prosthesis (Made from plastic material) versus a biologic prosthesis (made from pig tissue). There is currently no evidence on which material is best. We aim to evaluate early and long-term recovery effects of both materials on the quality of life and the rate of hernia recurrence as well as the occurrence of any complications. Participants in this study will be assigned to a study group by chance (randomization) using a process similar to the flip of a coin. Half of the people will receive biologic mesh and the other half will receive synthetic mesh. Participation in this study will last 24 months after your hernia is repaired.

Who is eligible to participate:

  • 21 years or older
  • Scheduled to undergo a planned open singled staged reconstruction of a contaminated (DCD wound class 2 or 3) abdominal wall defect
  • Estimated parastomal hernia or midline defect of >9 cm 2 by physical /or radiological exam
  • BMI under 45 kg/m2

Principal Investigator: Michael Rosen, MD

The Role of the Robotic Platform in Inguinal Hernia Repair Surgery

Inguinal hernia repair is the most commonly performed general surgery procedure in the United States. New advances in technology allow the repair to be done laparoscopically or robotically rather than open repair. However, there is no consensus regarding whether laparoscopic or robotic platform is the optimal approach to this surgical procedure. The purpose of this study is to compare these two platforms and determine if one has a more positive impact on post-operative pain, while also comparing post-operative recovery period, cost, surgeon ergonomics, and recurrence.  Participants in this study will be assigned to a study group by chance (randomization) using a process similar to the flip of a coin where one half of the people will receive laparoscopic surgery and the other half will receive robotic surgery.

Participation in this study will last for 24 months.

Who is eligible to participate:

  • 21 years or older
  • primary or recurrent unilateral inguinal hernia repair needed
  • no prior open abdominal surgery or previous preperitoneal mesh placement
  • no prior open abdominal surgery
  • BMI less than or equal to 40kg/m2

Principal Investigator: Michael Rosen, MD

Registry Based, Randomized Controlled Trial Comparing Laparoscopic vs. Robotic Ventral Hernia Repair with Intraperitoneal Onlay Mesh (IPOM)

There are currently several approaches to the repair of ventral hernias. When a ventral hernia is eligible to be repaired through a minimally invasive approach, both the laparoscopic and robotic platforms are acceptable methods to perform the operation. Nevertheless, there remains little data comparing the outcomes of the laparoscopic ventral hernia repair and the robotic ventral hernia repair. To help determine if the robotic platform has an impact on postoperative pain and other postoperative outcomes, we are using a registry-based, randomized clinical trial (like a coin toss) through the Americas Hernia Society Quality Collaborative (AHSQC).

Who is eligible to participate:

  • At least 18 years old
  • Hernia ≤7cm
  • Be eligible for a minimally invasive approach to repair

Principal Investigator:  Ajita Prabhu, MD

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