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Got My Surgical Options Today
So, met with the surgeon today and it’s either open non-mesh or robotic with mesh for an umbilical hernia. This is my second opinion, and the first surgeon, although not a hernia specialist, recommended an open non-mesh repair. I’m told the hernia is small, and likely closer to 1cm than 2cm.
Now I’m torn. I was headstrong against mesh, but I saw Dr. Towfigh say in a recent HerniaTalk that most of the mesh issues are due to being performed by non-hernia specialists and that it is still a good option if performed by an experienced hernia surgeon. The practice I consulted with is, I believe, the highest volume robotic hernia repair practice in the US and this is their only area of practice, very positive reviews. It was stated that the mesh would be placed between the peritoneum and the abdominal wall. I didn’t ask too many other mesh questions as I wasn’t even considering it going in. I also failed to ask what suture technique would be used for the open repair, but I’m going to call to find out. I was told that it would be with sutures and under tension.
Any thoughts or advice would be appreciated. My gut tells me to still go the non-mesh route.
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1 Reply
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All your points are valid. I would say there is the option of also doing it on the robot with a product called Ovitex that is 95% absorbable and we do quite frequently with excellent results. If the surgeon telling you that he is going to do an open repair with say a size 0 permanent suture the total residual foreign body may be no different than using a product like Ovitex. In addition, there is really no need to use a fully permanent synthetic mesh for a robotic repair of an umbilical hernia that is close to 1cm. That being said the more important question is whether or not you have been imaged to ensure no significant associate diastais Recti?
The presence of diastasis can change the equation regardless of the actual defect size. If you have a 1.5cm hernia with an associated 3-4 cm diastasis this will function more like a 3-4 cm “hernia” and should be repaired with robotic plication or open plication plus hernia repair in many instances.
I would say you only received part of the story. Happy to discuss with you via a telehealth visit and give you all the options and information that will help you make your decision
Hope that helps a bit,
Dr. Szotek
Indiana Hernia Center
http://www.indianahernia.com
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