The obvious objective of surgical repair is to eliminate the hernia and reconstruct the anatomy that caused that hernia in such a way that there is a minimized chance that it will ever recur again. This objective must also minimize pain and discomfort, complications, scarring, psychological trauma and recovery time. It must maximize safety, comfort, success and the patient’s ability to return to a normal routine of activity and work as soon as possible. Because surgery will be an unfamiliar and therefore anxiety producing experience, the surgeon must reinforce your confidence by communicating that he is anticipating, planning for and attending to many details and assisting you to understand in advance the gist of his planned experience.

The repair must be accomplished with maximum safety and minimal risk of complications resulting from the surgery or preexisting medical conditions. The patient’s socioeconomic obligations should be compromised as little as possible. The repair should have minimal chance of recurrence and recovery must result in full resumption of all normal activities at a reasonably early time. After recovery the surgical area should present satisfactory cosmesis without pain or discomfort. This array of objectives should be accomplished in almost all cases at the first operation.

A structured understanding of hernias enables your surgeon to comprehensively convey the indications for surgery, as well as the options, risks, benefits, relative advantages and disadvantages and then the realistic expectations of what will be experienced postoperatively. A confident understanding by you allows for elimination of fear of the unknown and rational participation in the decision making process. The consultation must be an efficient educational process.

In the following text, I’ll describe some techniques of both traditional anterior incisional and laparoscopic repairs. Make sure that your surgeon covers this ground and you understand the conversation.

Note: simplified diagrams will be required to illustrate the anatomy.

    A. Douglas Heymann,
    MD, FACS.
    Over 50 years of experience.

    Dr. Heymann

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