X

New surgeon at Massena Memorial specializes in minimally invasive hernia procedures

Posted 9/20/14

MASSENA -- Dr. Jose Luis Mejia, board certified in general surgery and a recent addition to the Massena Memorial Hospital staff this year, has brought with him his more than 10 years of experience …

This item is available in full to subscribers.

Please log in to continue

Log in

New surgeon at Massena Memorial specializes in minimally invasive hernia procedures

Posted

MASSENA -- Dr. Jose Luis Mejia, board certified in general surgery and a recent addition to the Massena Memorial Hospital staff this year, has brought with him his more than 10 years of experience performing hernia repair with minimally invasive surgery, also known as laparoscopic surgery.

A hernia is a lump of intestine or organ tissue that bulges through a tear in the wall of the abdomen. Some compare it to an inner tube protruding through a weakness in the sidewall of a bicycle or auto tire. It's not normal but can be readily fixed, according to a press release from Massena Memorial Hospital.

A minimally invasive procedure using tiny incisions through which the surgeon inserts a TV camera inside the abdomen aids repair of the problem.

This is a same-day surgery procedure with less recovery time and pain, according to the hospital.

An estimated five million Americans have hernias, and it's the most common reason primary care physicians refer a patient for surgery.

A hernia typically occurs around the navel, the upper abdomen or the groin as a result of weakness in abdominal tissue, often associated with a congenital condition or a previous incision. Most of the times these problems require surgery.

“In men, the majority are in the groin area (inguinal hernias)”, said Dr. Mejia. “Some inguinal hernias occur at the point where the top of the thigh meets the abdomen; others protrude into the scrotum, creating a swollen appearance. The inguinal canal is the passage through which the testes of a male child descend into the scrotum before birth. This is an area where there's some natural weakness in the abdominal lining, and some men are more vulnerable than others to tears,” he explained.

Femoral hernias, near the top of the thigh, are three times more common among women than men. Some of this increased risk may be related to weaknesses in the abdominal lining associated with prior pregnancy and childbirth.

Heavy lifting, straining or coughing can bring on a hernia, but in most cases, there is simply a predisposition for weakness in the abdominal wall. This lining is made of connective tissue, not muscle, and cannot be strengthened, although strengthening the outer layer of abdominal muscle can help reduce stress on it.

A hernia may develop gradually or appear rather suddenly. Symptoms include pain, pressure or a heavy feeling in that area, particularly when lifting, coughing or bending at the waist. Men may have swelling of the scrotum, on one side or both.

“In many cases, however, there are no symptoms except for the telltale lump. Most hernias are easy to diagnose, but when there's pain but no visible protrusion, ultrasound or a CT scan may be needed,” said Mejia.

Although some protrusions can be pushed back in temporarily, a hernia will never get smaller or go away on its own. A truss can be used to hold it in place, but it's only a temporary measure, and there is concern among professionals that a truss may actually damage protruding organ tissue. More important, there's always a risk that a portion of the bowel can become trapped in the opening, shutting off blood supply and creating a medical emergency.

In traditional hernia surgery, the doctor makes an incision four to six inches long over the site of the hernia. After the tissue is pushed back to its proper place, the weakened abdominal wall is sutured together. Various techniques that have been introduced over the past several decades include a multi-layer closure that has decreased the rate of recurrence.

Open hernia surgery can be done in an outpatient setting using local anesthesia. The patient, however, usually requires some bed rest at home and a week or two away from work, especially if the job involves physical activity, while the incision heals.

Particularly when the incision is large, tension can remain high over the hernia site. To decrease this tension and lower the risk of recurrence, surgeons over the past decade have frequently inserted a patch made of synthetic mesh material behind the sutures. Initially, doctors worried about possible infections arising from the implanted material, but with improved methods and materials, long-term studies have found minimal risk.

Today, the recurrence rate is usually less than three percent when surgery is performed by a skilled, experienced team. Once a repeat hernia repair has been made, however, the risk of subsequent recurrences can be as high as 20 to 30 percent.

“Today, a less invasive surgical option introduced over the last decade is laparoscopic hernia repair. Instead of one long incision at the site of the hernia, the surgeon makes three small cuts through which narrow tubes are threaded into the abdomen to view and repair the hernia from the inside. One tube contains a small video camera; the others have small surgical instruments,” explained Mejia. Laparoscopic surgery takes about the same amount of time as the traditional procedure, but it usually requires general anesthesia.

Hernias are frequently bilateral -- occurring on both sides of the abdomen. With traditional surgery, bilateral hernias require two incisions, but laparoscopy can be performed with the same three small incisions.

Laparoscopy is also a good choice for the repair of a recurrent hernia that was previously repaired by traditional surgery, according to the hospital story. Rather than cutting through scar tissue, the surgeon can make the repair from the inside out.

Laparoscopic surgery heals faster, allowing most patients to return to work within a week. For some individuals, the reduction in lost time may make the laparoscopic approach more cost effective.

For more information or a consultation with Dr. Mejia, call the MMH Surgical Group at 769-4656.