Hernia repair is one of the most commonly performed surgical procedures worldwide. In fact, there are over 600,000 hernia repair surgeries performed each year in the U.S. alone. A hernia is a weakness or defect in the abdominal muscles which can result in the protrusion of tissue through an opening in the outer layers of the abdominal wall. Hernias can develop at any part of the abdominal wall, but generally occur in areas that have a natural tendency to be weak. These areas include the groin (inguinal hernias), umbilicus (umbilical hernias), hiatus (hiatal hernias) and incisions from previous surgeries (incisional or ventral hernias). While hernias generally do not pose serious long-term health problems, they can cause severe pain and discomfort for those suffering from this condition.
Hernias may be present from birth, or can be caused by strain on the abdominal muscles. In either case, hernias do not go away by themselves and depending on the degree of bulging or pain, generally require a surgical procedure to be repaired. Hernia repairs are usually done on an elective basis, which means that the patient and physician decide whether or when the procedure should be performed. Emergency procedures are only done for strangulated hernias, which are hernias that have become pinched to the point that the blood supply is cut off. These hernias require immediate medical attention since they can become infected and lead to a life threatening condition very quickly.
Hernias are typically repaired through a surgical procedure called herniorrhaphy, in which the surgeon repairs the hole in the abdominal wall by sewing surrounding muscle together or by placing a patch called “mesh” over the defect. Most surgeons make an incision at the site of the hernia in order to gain access to the defect, although some surgeons prefer to do these procedures laparoscopically.
During a laparoscopic hernia repair, the surgeon makes very small incisions to pass through specialized instruments and an endoscope, a device that allows the surgeon to see the abdominal area without opening the patient up. Laparoscopic hernia repair generally results in less postoperative pain and recovery time than open surgery. There is still a great deal of controversy over the long-term benefits of laparoscopic hernia repair, however, and it is by no means an option for every patient.
The use of surgical mesh to repair hernias is gaining in popularity with surgeons. Most meshes currently on the market are made from synthetic materials such as polypropylene, polyester, silicone or polytetrafluoroethylene (PTFE), commonly known by the DuPont brand name Teflon®. While these meshes have good strength characteristics, they remain in the body as permanent implants and sometimes can cause adverse reactions when the surrounding tissue identifies these materials as foreign bodies.
In order to avoid adverse reactions to synthetic materials, some surgeons prefer to use meshes made of biomaterials which are gradually resorbed by the body over time and are then eliminated through biological processes. Since these meshes are not permanent implants, they generally only offer temporary repair of abdominal wall defects and additional surgical procedures are sometimes required to replace the absorbed mesh.
An alternative to synthetic and absorbable mesh is human tissue. There are a handful of companies that are now marketing processed, freeze-dried human dermis for soft tissue repair and augmentation. This material is implanted using the same technique as other meshes and provides for revascularization, cellular ingrowth and “remodeling” into the patients tissue. While this option generally provides a permanent repair with few adverse reactions, the processing and distribution of human tissue is not regulated by the Food and Drug Administration (FDA) as are most other products that are implanted in the human body. In fact, there have been a number of recent cases of serious infections and even deaths resulting from the implantation of human cadaveric tissue during surgical procedures.
New technologies have recently been developed to solve the problems associated with the use of synthetic substances, absorbable materials and human tissue in hernia repair procedures. Scientists in Europe have been conducting research and development into alternatives to these products over the past two decades and have made major breakthroughs in this area over the past several years. New ways of collecting and processing natural materials have led to a series of products that offer the strength of synthetic compounds, the biocompatibility of biomaterials and the regenerative properties of human tissue.
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