1. What is the Integrative Hernioplasty?
For patients, an ideal hernia surgery is also the goal pursued by surgeons. There are several main points:
- Low recurrence rate
- High safety
- Low postoperative pain
- The patient returns to normal life as soon as possible
- Few side effects
- Reduce the permanent implantation of artificial objects
- Small surgical incision
- Can return to healthy daily life and exercise
The “The Integrative Hernioplasty” is one of the few methods that can achieve the ideal goal of hernia surgery. The “The Integrative Hernioplasty” is a surgery that was developed by the “Taipei Hernia Center” and has been applied for a US patent. It features the use of endoscopic minimally invasive devices to carry out the finishing of the deep muscle fascia and hernia rupture, and the finished natural tissue is then used to achieve a three-dimensional structure reconstruction with the minimally invasive devices from a special angle.
2. What are the benefits of The Integrative Hernioplasty over traditional surgery for the wound?
The wound of the Integrative Hernioplasty is about 2 to 3 cm, which is different from traditional surgery where the wound is 6 to 10 cm. The benefits to the patient include less tissue damage, low postoperative pain, and quick wound recovery. In addition, the skin numbness around the wound after surgery is significantly reduced to 5% (the numbness of traditional surgery is about 15%). Furthermore, since it is a small incision, the epidermal nerve is prone to recover back to its original state, and the probability of long-term skin numbness is almost zero.
3. Can people who are old or have other diseases also have hernia surgery?
Yes, but patients should be evaluated by a doctor and given a treatment plan and preparation.
Older patients or patients with other diseases such as poor heart function or lung function, diabetes, immune diseases, or cancer, need an integrated preparation and care rather than simply treating hernia.
Due to the complex physical condition of patients, the severity of the surgery may be affected or complications may arise. Patients should consult specialists based on their individual condition. For example, a cardiac patient should consult a cardiologist, who will conduct an electrocardiogram examination and give the patient a vasodilator patch to reduce the risk of surgery upon determining that the patient suffers from myocardial hypoxia. Patients with diabetes should pay attention to blood sugar control and evaluate whether to stop taking anticoagulants. The medication of patients with prostatic hyperplasia may have to be adjusted before and after surgery.
4. When is the surgery required for inguinal hernia?
The definition of inguinal hernia includes the displacement of organs, such as the protrusion of mesentery and intestines which is caused by the fall to the groin and shall be confirmed by examination. In fact, only the muscles in the groin have weak spots, and it is not necessary to have surgery immediately. Only long-term follow-up and observation are needed, unless the displacement of organs is caused and the mesentery and intestines fall out, which surgery is needed.
5. Can inguinal hernia and varicocele surgery be done at the same time?
Ipsilateral inguinal hernia combined with varicocele is common, and especially occur in the left lateral varicocele. According to a study by the Department of Urology at Taipei Veterans General Hospital, inguinal hernia and varicocele often occur simultaneously, which may be related to the embryonic development of the patient.
According to the principle of treatment at Taipei Hernia Center, for symptomatic varicocele such as pain, infertility, and more serious varicocele (Grade III and Grade IV), the inguinal hernia repair and high varicocele ligation can be done simultaneously at a same wound. Take a 24-year-old male as an example, surgery not only can treat inguinal hernia, but also solve the symptoms of varicocele and the risk of infertility caused by varicocele.
It is important to note that injury to the sacral artery and testicular artery should be avoided when both surgeries are performed at the same time. Most importantly, it is best for the surgeon to specialize in both procedures so that the side effects and the recurrence of hernia and varicocele can be reduced.
6. Is it better to use mesh in inguinal hernia surgery?
This concept is not always correct. For details, see (comparative diagrams of various surgical methods). You can understand the mechanical structure of various methods of reconstructive surgery. Patching mesh is like patching a weak spot. The weak spot is still there, and the functional muscle does not grow easily into the mesh. Or even if part of the muscle fibers grows into the mesh layer, they are not able to have elastic contractile force, and cannot form an integral operation with the muscle layer of the abdominal wall. It is not always an ideal mechanical structure. Therefore, with reconstruction of natural tissue, it is possible to let the ruptured tissue structure grow again together, forming a new natural structure, and integrate it into the whole operating structure of the abdominal wall, reducing the recurrence rate, and enabling use in daily life and exercise so that it can be recovered back to its healthy state in the future.
7. Can you make an overview of the inguinal hernia surgery since there are so many methods?
According to the evolution of hernia surgery, it can be easier to understand:
Traditional natural tissue stitching methods can be divided into 2D (Bassini) and 3D (Shouldice):
In the 18th century, the 2D hernia surgery invented by Dr. Bassini was a great invention compared to the previous historical method of using a hernia sac for compression. In the Middle Ages, fire tongs were even used to burn the wound and close the groin. The 2D hernia surgery enabled systematic repair of most hernias, but the long-term recurrence rate was as high as 5~10% due to the 2D structure. It wasn’t until the 1940s and 1950s when Canadian military doctor, Dr. Shouldice invented “Shouldice” hernia surgery, which is a 3D reconstruction, in order to reduce the recurrence of hernia in draftees whom the recurrence of hernia causes them to be unable to participate in the war. The recurrence rate was reduced to about 1%, and gradually became the gold standard for global hernia surgery. However, 3D reconstruction is complicated, and it involved personal experience of the doctor. Although the recurrence rate was low, most non-specialized hernia surgeons could not accumulate experience easily, so they continued to use 2D suturing or resulting the different recurrent rate. In the 1990s, because of the invention of the synthetic plastic propylopelene, it began to be used in hernia surgery. The recurrence rate of 2D reconstruction with mesh patch declined to 2~3%, and the operation was simple. Therefore, it was heavily used by most non-specialized hernia surgeons. In the 2000s, with the development in the technology of laparoscopic minimally invasive devices, surgeons further gained the ability to drill holes from a distance, from the abdominal cavity or the anterior layer of the abdominal cavity, to the posterior layer of the abdominal wall muscles to patch the mesh, attempting to be deep in the inner layer to reduce the complexity of entering from the anterior. However, there are limitations due to several problems (1) since the mesh can only be used to patch on the weak spot of muscle layer of the abdominal wall from the posterior, it cannot be used for suturing the 2D muscle layer, only relying on the mesh to resist abdominal pressure. (2) It is limited by potential weak spots such as fat-type hernia protrusion of anterior layer that are difficult to treat. (3) When stitching the mesh on posterior layer, it is necessary to avoid important tissues such as large blood vessels and nerves. It is not easy to completely pave and set the mesh. (4) It is impossible to detect the weak spot and tension of the structure of muscle layer with a laparoscopic device, and it is possible that a potential recurrence spot will be left out and the mechanical structure of the repair is uneven. The factors above cause the recurrence rate of hernia in laparoscopic surgery to be 3 to 7%, plus due to the need for general anesthesia with tracheal intubation, the risk of anesthesia is higher, and the abdominal cavity or the peritoneal anterior layer must be injected with carbon dioxide to support operation space. There may be postoperative abdominal muscle pain and increased risk of anesthesia.
“The Integrative Hernioplasty” can achieve deep leveling and 3D reconstruction of hernia surgery with a small, minimally invasive incision (about 3-4 cm for men and 1.5-2 cm for women) and the recurrence rate is 0.2%, achieving the goal of an ideal hernia surgery.
The incisions of traditional hernia surgery, natural tissue suturing method, 2D (Bassini) and 3D (Shouldice) are large (6 to 12 cm for male and 5 to 8 cm for female). Vertical incision of subcutaneous tissue and fascia is more damaging to tissue. The postoperative scarring reaction period is longer, which will form long lumps in the wound, and postoperative pain may be higher; the lumps may last for three months to six months and disappear. In the minimally invasive hernia surgery, a 2-3 cm opening is cut in the skin, and then the subcutaneous tissue and fascia are opened with the minimally invasive device and not broken. Therefore, the postoperative tissue swelling and pain are low, less postoperative pain, fast recovery, and smaller scar. It does not form a temporary lump of tissue. Even if a lump forms, it will only form at the surgical incision and will not appear at the upper part of the whole groin, and the speed of disappearance will be faster.
8. What are the preparation and procedures for hernia surgery?
In order to improve the quality of service, the appointment system is adopted.
The attending physician of the Hernia Center will give consultation based on the patient’s condition, and communicate the surgical related matters. Patient with special diseases such as heart disease and diabetes must then consult a specialist. The anesthesiologist will be invited to provide consultation when necessary.
Preoperative medication: (preventive medication will be given based on the individual circumstances)
＊Older men (over 60 years old) may take prostate medication so that the urine flows smoothly to avoid prostatic hyperplasia and postoperative orchitis which is caused by the backflow of urine to the vas deferens.
＊Before surgery, oral prophylactic antibiotics may be taken to prevent urinary tract infections.
* One day before the surgery or on the day of the surgery, the patient will orally take a dose of antacids. Patients with gastroesophageal reflux may have acid reflux, which will cause esophageal damage when lying down during the surgery.
* Patients with long-term constipation shall take constipation medication before and after surgery. It is recommended to eat more high-fiber fruits and vegetables to avoid constipation after surgery.
＊Patients with frequent cough shall take cough medication before surgery, or seek medical advice from Department of Chest and Department of Otorhinolaryngology to avoid postoperative coughing and sneezing which may cause wound pain.
For example, in inguinal hernia, the surgery site shall be brushed with a special brush. For details, the center will arrange a nurse to administer health instruction.
Surgical procedures (1~6 is shown using an arrow flow chart):
Admission, admission registration
Entering the operating room
Preparing for anesthesia
Eating after surgery
The time for entering and leaving the operating room is about two hours. The patient is anesthetized with intravenous injection by the anesthesiologist first and brushed and disinfected for about half an hour. The operation time is about half an hour. The recovery time is about half an hour to an hour.
Other precautions can be found through the health instruction given by the nurse.
9. Is it possible for surgical anesthesia to cause complications?
Patients with general anesthesia rely on the ventilator to breathe and some complications may occur.
In some patients with underlying diseases, such as sporadic systemic diseases, stroke, and heart disease, the complications that occur after surgical anesthesia account for 0.2% in general literature, and do not occur in “The Integrative Hernioplasty”.
Other anesthesia-related risks especially regional (spine) anesthesia, such as allergies, shock, chronic headache, back pain, and threat to life, are currently only reported in rare cases, and there is no statistical data.
Many patients with hernia are older men, and it is more important to pay attention to the risk of anesthesia. The peripheral team of the Taipei Hernia Center includes the Departments of Cardiology, Chest, Anesthesiology, and Metabolism. If necessary, the doctor will consult physicians from other departments, such as cardiac function examination, and the surgery will be performed after evaluation and adjustment.
10. Why should I fast before inguinal hernia surgery?
At Taipei Hernia Center, fasting should start 6 hours before surgery. This is because the patient will fall asleep during the surgery due to the effect of the sedative. If the food is still in the stomach, there is a risk of aspiration pneumonia. In order to ensure that the patient is 100% safe, the anesthesiologist will require the patient to fast for 6 hours before surgery to ensure that the stomach is empty during the surgery.
The Integrative Hernioplasty performed at Taipei Hernia Center has a quick postoperative recovery time. Therefore, generally, you can eat once you go back to the ward without a long post-surgery waiting period unless there are special factors.
11. Is it necessary to shave pubic hair for hernia surgery?
Yes, but the shaving of the pubic hair must be carried out in the operating room. Since bacteria will breed in hair follicles in about half an hour after shaving, they need to be disinfected immediately.
12. Does local anesthesia in patients cause nervousness due to patients being wide awake?
The anesthesia method we use is mainly local anesthesia, and patient is intravenously injected with sedative to let them fall asleep. Therefore, the patient will undergo surgery while sleeping without fear and nervousness during surgery. Unlike the anesthetics used in general anesthesia, the intravenous sedative can reduce the burden of cardiopulmonary function.
In our anesthesia procedure, when the patient is sent to the operating room, the anesthesiologist will inject the patient with sedative by intravenous drip and the patient will be under physiological monitoring throughout the procedure. After the patient falls asleep, the preoperative preparation begins, and then the surgical site is injected with anesthetic. The patient is asleep throughout the whole process, and the patient will not feel discomfort.
After the surgery, the anesthesiologist will wake the patient up. The patient can open his/her eyes, and there may be some drowsiness. Therefore, the anesthesiologist will continue to monitor and observe the patient for half an hour to an hour in the anesthesia recovery room. After the patient is fully awake, he/she can be transferred to the general ward. The patient can eat, get out of bed, and urinate on his/her own. At the Taipei Hernia Center, the anesthesia is different from the traditional regional or general anesthesia, which requires the patient to fast and lie down on the bed for 8 hours and a urethral catheter inserted. Our patients have higher comfort and quick recovery, and are discharged from the hospital on the day after surgery.
13. What should I pay attention to after hernia surgery?
- Surgical incision care: The patient must temporarily avoid contact with water at the wound (about one week, before the removal of the suture). The surgical beauty line is about three or four sutures under the skin and with the medical staples, the wound healing is the best, but it cannot touch water.
- Return visit: It is important to conduct return visits. Postoperative recovery is important and visits should be coordinated with the doctor. Return visit for assessment occurs at about one week, one month, six months and one year after the surgery. The doctor will inform the patient of the precautions, understand the individual patient’s condition, and evaluate whether it is necessary to conduct a return visit every year according to the individual condition of the patient.
- Exercise and exertion: Normally, you can get out of bed and climb stairs on the day after surgery. You can ride and drive on the next day after surgery. Due to the use of surgical sedative on the day of surgery, it may affect the patient’s judgment when driving vehicles and patients should not drive by themselves. Running or lifting weights heavier than 10 kg should only be done three weeks after surgery. There is no impact on going abroad and taking flights, but it is better if the baggage is within 10 kg. Exercise such as weight training should start slowly three months after surgery. Training that affects the rectus abdominis, such as sit-ups and push-ups should begin half a year later.
- Health care: Pay special attention after surgery to avoid colds. If you experience sneezing or coughing two weeks after surgery, it will easily cause wound vibration, affecting the results of surgery and easily causing recurrence.
- Reduce constipation: The medication of patients with prostatic hyperplasia should be adjusted and to help facilitate urination to reduce the impact on the wound when exerting force on the abdomen, helping the structure to recover.
- Take anticoagulant before surgery: Normally, anticoagulants can be taken on the day after surgery. Please consult with your doctor.
- Reduce smoking: Drink plenty of water, do not sit for a long time as it will affect the circulation and pay attention to hygiene when going to the washroom by covering the toilet bowl before flushing to reduce the impact of airborne bacterial contamination.
14. How long should I wait after hernia surgery before preparing for pregnancy? What if I am pregnant?
Women can begin preparing for pregnancy one week after the removal of sutures and two weeks after the surgery.
In clinical situations, it is common to see many women with hernia consider hernia treatment because they have decided on pregnancy, or because they worry that their pregnancy will affect the severity of the hernia. Pregnant women are indeed prone to increased abdominal pressure, which can cause hernia or strengthen their symptoms. Or it may cause uncomfortable pregnancy, the risk of intestines getting stuck, or even the inability to give birth naturally due to hernia.
During the second trimester of pregnancy (fourth, fifth, and sixth months), the fetus is stable. You can consider surgery under local anesthesia to reduce the increase in hernia due to enhanced abdominal pressure caused by the growing fetus, to increasing the convenience of natural childbirth. In accordance with the personal condition, hernia size and advice given by gynecologist, we will discuss together whether the surgery should be performed during pregnancy and whether to choose natural childbirth or caesarean section.
15. Can athletes resume strenuous exercise after hernia surgery?
Avoid lifting heavy objects (10 kg or more), sudden exertion (such as sneezing, coughing) or vigorous exercise within three weeks after surgery to avoid damage to the reconstructed tissue structure and reduce the possibility of recurrence.
After a month, you can start brisk walking, light running, golfing and other sports, as long as there is no pain, and then gradually increase the amount of exercise.
It is better to start playing vigorous sports three months after surgery, such as basketball, football, badminton and weight training.
Many professional athletes at the Taipei Hernia Center have returned to the professional sports field and regained their normal performance.
16. Can I engage in normal sexual behavior after the hernia surgery?
Hernia surgery does not affect the blood supply to the penis and the condition of the muscles. However, in order to protect the position of the hernia surgery, patients should abstain from sexual behavior for one week after surgery. You can engage in normal sexual behavior after one week after surgery.
17. When can I take a flight following discharge from hospital after surgery?
After inguinal hernia surgery, the patient can take a flight once he or she discharges from the hospital. The surgical wound and the structure right after the reconstruction will not be affected by the change of air pressure. In addition, for patients taking flights a few days after the surgery who want to carry baggage, it is recommended to avoid sudden exertion of force when lifting baggage. Please ask others to assist in carrying luggage if necessary. Many patients who come to Taiwan to have the surgery from North America, Hong Kong, mainland China, South Africa, and Paraguay take their flight on the next day or a few days after surgery. They follow the doctor’s advice, feel comfortable, and return successfully to their respective home countries.