WHAT IS A COMPLEX HERNIA?

A hernia occurs when an organ —such as the intestine or fatty tissue—pushes through an opening in the muscle layer of the abdominal wall. Hernias are more common in men. It is estimated that 25 percent of men and about 3 percent of women will develop a hernia at some point in their lifetime.

A hernia can become complex due to several reasons: large hernias (greater than 4 inches or 10 cm), recurrent hernias (hernias that came back after being previously repaired), and/or hernias with wound or mesh infections. Hernias can also be complicated due to their location, previous surgery, obesity, diabetes and other medical conditions. Each time a surgical attempt to close the opening in the lining of the abdominal wall location fails, the nature of the complexity and severity increases. The patient’s surrounding tissues can become stretched or weakened, reducing the possibility of positive outcomes.

Many people with complex hernias believe they must live with the condition, being debilitated or facing a diminished quality of life. There is often a concern that life will never feel normal again. There can be a fear of:

• A lessened quality of life

• Morbidity

• Limited mobility

• Psychological well-being

• Stress related to health and weight management

• Greater degrees of body pain

• Diminished social and physical functioning

• Lessened sexual activity

• Missed opportunities

• Occupational and career limitations

• Related health problems

• Loss of pastimes and hobbies

We understand your worries.

Helping hernia patients regain an improved quality of life is our sole focus.

There is hope at The Iskandar Complex Hernia Center.

A more nuanced answer is the complex hernia is determined from a combination of:

Hernia Size

The width of the hernia opening typically defines its degree of complexity more than the length of the hernia. A hernia of more than 4 inches (10cm) in width could indicate a complex designation.

Hernia Location

There are several areas of the body in which hernia repairs are more challenging.

• The back or side (lumbar or flank)

• Below the belly button where two muscle groups join (lateral/Spigelian)

• upper abdomen below the rib cage (subcostal)

• Diaphragmatic hernias (paraesophageal, Morgagni and Bochdalek hernias)

Previous Surgeries

Surgeries can weaken the abdominal wall—especially the muscle layer because our bodies heal by producing scar tissue instead of regenerating new muscle tissue. Unfortunately, scar tissue is weaker than our own tissue. Previous wound infections may also weaken the tissue further.

Hernia Patient History

If a patient has problems in the wound healing process, this can lead to weakened scar tissue. As a result of weakened tissue, a hernia can reopen at the point of scarring. Some conditions that lead to poor wound healing include diabetes, malnutrition and smoking.

Obesity

Obesity is a risk factor for formation of hernias and for hernias recurring after being removed or repaired due to pressure that excess weight places on a healing wound, in addition to other conditions that sometimes accompany obesity such as diabetes. Moreover, obesity can lead to more adverse events such as blood clots, wound infections and pneumonias. Therefore, it is crucial to achieve some weight loss prior to hernia repairs for better results.

Symptoms of a complex hernia include:

• A large bulge in the abdominal region or site of a previous incision/scar

• Abdominal discomfort (mild or severe pain)

• A bulge in the abdominal or groin region that is often tender to touch

• Constipation

• Nausea and/or Vomiting

• Draining fluid from a site of previous hernia repair

More serious complex hernia complications include:

• Infections: Especially those that develop drainage of fluid from an infected mesh.

• Fistulas: When there is stool or greenish fluid coming out through an opening in the skin.

• Wound Reopening: A wound dehiscence is when the previous hernia surgery suture wound does not heal but, instead, opens up partially or completely at the point of the initial incision to create a new wound or new hernia.

• Bowel obstruction: When herniated tissue becomes trapped and cannot easily be moved back into place into the body cavity, leading the bowels may become obstructed or strangulated. Often, this occurs with the small intestine and requires emergency surgery.

The risk and complications associated with abdominal wall hernias warrant not ignoring the symptoms. Hernia patients and their health and care are the sole focus of the Iskandar Complex Hernia Center.

A Revised Definition and More Focused Approach

A previous question faced by the doctors was defining what constituted a complex hernia. It was often defined by “you will know it when you see it” type of language. However, in 2013, a more formal definition was created and further clarified in 2018 as shared above.

Complex abdominal wall defects are a more challenging dilemma faced by general surgeons and plastic surgeons. As such, a new field is emerging where the surgeon focuses primarily on complex hernia surgery and abdominal wall reconstruction. This is the sole focus of the Iskandar Complex Hernia Center.

Diagnosing Your Complex Hernia — A Full Spectrum Approach to Health and Wellness

Dr. Iskandar, MD, FACS and his team have experience in gathering and assembling the needed patient history and performing a full physical exam to determine the presence and extent of a hernia.

In addition, the Iskandar Center utilizes Computed tomography (CT) scans to evaluate the complexity of your hernia. CT scans of the abdominal wall is an excellent tool for assessing hernia characteristics. A recent study revealed that utilizing CT scans allowed for the better detection of hernia recurrence after mesh repair. Using CT scanning as compared to physical examination alone increases the detection rate of hernias by 98% .

The use of CT in your diagnosis better reveals the possibility of infection or additional hernias, allowing fewer unexpected events before your repair.

If your physician thinks you have a hernia, please consider having him/her refer you to The Iskandar Complex Hernia Center for further evaluation.

Armed with years of experience, an awareness of the latest innovation in research and treatment, and leading-edge imaging technology, Dr. Iskandar, MD, FASC will make an informed diagnosis of your condition, provide surgical treatment options, and clearly and simply communicate to you and your family the prognosis of possible outcomes. You’ll know you are at a world-class medical center in the caring hands of a skilled hernia surgeon whose sole focus is helping nurture and enhance your quality of life.

SCHEDULE YOUR EVALUATION

The Iskandar Complex Hernia Center is located at Baylor Scott & White Medical Center Waxahachie, 20 minutes south of the Dallas-Fort Worth metroplex. The hospital environment allows for collaboration with multiple disciplinary teams and a comprehensive operating environment to deal with medical emergencies should they be needed.

TYPES OF HERNIAS

By Dr. Mazen Iskandar

Hernias are openings in the abdominal wall that can enable intestines or fat to protrude through. Hernia repair surgery aims to prevent the recurrence of the hernia by closing the defect with little or no tension. Hernias come in a variety of forms, each with unique characteristics. This article will discuss the many hernia types and how they differ from one another.

The Iskandar Complex Hernia Center offers hernia patients a listen-first, non-judgemental approach to treating all types of hernias. Dr. Iskandar, a recognized complex hernia surgeon, provides unparalleled empathy and expertise, so you can enjoy a dramatically improved quality of life. To learn more about the minimally invasive treatment options available for all types of hernias at The Iskandar Complex Hernia Center, call our office to schedule your appointment with Dr. Iskandar. You deserve to experience an improved and healthy lifestyle.

GROIN HERNIAS

The two main types of groin hernias are inguinal and femoral.

Inguinal Hernia

Inguinal hernias, often known as groin hernias, are the most common type of hernia. They occur close to the crease that divides the upper thigh from the lower abdomen. When an inguinal hernia forms, adipose tissue (fat) or the intestine may push through the opening in the abdominal wall and cause a bulge on either the right or left side. A direct inguinal hernia appears as a protrusion from the inguinal canal’s posterior wall, whereas an indirect inguinal hernia passes through the inguinal canal or the groin. The defect in the indirect inguinal canal is hidden by the external oblique muscle fibers, making it difficult to feel.

Inguinal hernia signs and symptoms include:

• Bulging

• Continuous pain

• Discomfort while sitting or when moving around

Inguinal hernias can occasionally go completely unnoticed. Inguinal hernias occur in between 10 and 15 percent of males and 2 percent of women during the course of their lifetimes. The inguinal canal, where the spermatic cord enters the scrotum, is typically where the weak spot in men is located. Hernias can sometimes develop when connective tissue from the uterus joins to tissue surrounding the pubic bone in women because the inguinal canal carries a ligament that aids in holding the uterus in place.

Tension repair of inguinal hernias has a recurrence incidence of 15% or greater, meaning that the hernia may return at a later point in time. Alternative hernia repair methods, such as laparoscopic tension-free surgery, have substantially lower recurrence rates, under 1%.

Femoral Hernia

Femoral hernias are another type of groin hernia. Although they can develop in men, they are significantly more common in women. This kind of hernia develops in the area right below the groin crease. When the lower groin becomes weak, an intestinal sac can slip into the femoral canal, which is a space near the femoral vein that carries blood from the leg up to the body. Compared to inguinal hernias, these hernias are more likely to have incarceration or strangulation as an early complication. Thus, prompt repair of these hernias after diagnosis is strongly suggested to avoid an incarcerated hernia or further complications.

DIAPHRAGMATIC HERNIAS

Diaphragmatic hernias include hiatal hernia, Morgagni hernia, and Bochdalek hernia.

Hiatal Hernia

When the top part of your stomach pushes through your diaphragm and into your ribcage, a hiatal hernia forms. Up to 60% of people will develop hiatal hernias by the time they turn 60, making it one of the most prevalent types of hernias.

Heartburn, pain, and esophageal erosion can result from these hernias’ capacity to cause acid reflux from the stomach into the esophagus. Acid reflux, chest pain, and difficulty swallowing are all hiatal hernia symptoms. The procedure to treat this type of hernia is typically more complex and may necessitate a lengthier hospital stay.

Morgagni Hernia

Morgagni hernias are a rare type of congenital diaphragmatic hernia through the anterior foramen of morgagni. These types of hernias usually do not cause symptoms and are an anterior defect. Most commonly, fat and the colon herniate through.

Bochdalek Hernia

Bochdalek hernias are a rare type of diaphragmatic hernia that is usually posterior. Most commonly fat herniates through but can also have the spleen and kidney herniate.

VENTRAL HERNIAS

Ventral hernias include epigastric, umbilical, incisional, flank, and Spigelian hernias.

Epigastric Hernia

Men experience epigastric hernias more frequently than women. They develop along a line between the breast bone and the navel and are caused by a weakening, opening, or gap in the muscles or tendons of the upper abdominal wall or epigastrium. Epigastric hernias are found below your rib cage and above your belly button in the upper abdomen. The affected area may feel tender, have a small lump, or cause bloating or constipation. However, not all epigastric hernias are symptomatic.

When you cough, sneeze or exert yourself, epigastric hernias may cause pain. There are several types of surgical repair methods for this type of hernia, including laparoscopic surgery and robotic hernia repair surgery.

Umbilical Hernia

Umbilical hernias are a type of ventral hernia that develops in the weak area around the navel caused by the umbilical cord’s blood vessels. Hernias occur when organs or tissue begin pushing through a weak spot around the belly button, causing a noticeable bulge. When you cough or go to the bathroom, it can become worse.

These hernias can develop in newborns at or shortly after delivery and can go away by the time the child is three or four years old. The weakness, nevertheless, can develop at any time in men, women, or children of any age and can last for the rest of one’s life. Umbilical hernias in adults do not go away on their own and may even get worse with time. They can occasionally be brought on by pregnancy, chronic coughing, or abdominal strain brought on by being overweight.

The signs and symptoms of an umbilical hernia are:

• A bulge in the area affected

• Pain, especially while coughing, sneezing, or carrying heavy objects. Pain can range from a subtle ache to severe pain.

• Constipation or bloating

Umbilical hernias can be treated in one of three ways.

Observation. For less severe hernias, your doctor may advise waiting to take further action in order to monitor the hernias’ progression over time.

Elective (non-emergency) surgical repair. Elective surgical repair may be advised by your doctor if your umbilical hernia is causing you a lot of pain or discomfort.

Emergency surgery. Your doctor will advise urgent or emergency surgery if the umbilical hernia poses a risk of strangling a portion of your intestine. A strangulated hernia is a medical emergency and requires immediate treatment.

Incisional Hernia

Incisional hernias are a type of abdominal hernia that develops in the abdomen near the location of prior surgery. This special type of abdominal wall hernia occurs close to previous surgical wounds when the abdominal wall has been weakened by previous surgery or when an infection in a healing surgical incision compromises the wound’s ability to heal. Between 25 to 30 percent of people who have abdominal surgery will experience an incisional hernia.

These hernias can range in size from small to very large and complex, and they can develop weeks, months, or even years following surgery. If you’ve had abdominal surgery, and the incision didn’t heal properly, it can leave a weak place in your abdominal wall. A significant bulge might develop around the incision scar if organs or tissue protrude through the incision. See your doctor as soon as possible if you suspect you have an incisional hernia, as it could become worse and be far more challenging to repair.

Spigelian and Flank Hernia

Spigelian Hernias commonly occur on the right side of the abdomen and involve the protrusion of the intestine or an empty sac through a weakness between the muscle fibers of the abdominal wall. Since there is frequently no apparent bump or swelling, it can be nearly impossible to detect. Instead of sticking out through layers of fatty tissue, it develops in the spaces between the muscles of the abdominal wall. It could be confused for a different type of abdominal ailment. Although it can affect both men and women, this type of hernia is quite uncommon. Spigelian or flank hernias frequently appear as people age, and their abdominal muscles weaken.

Sports (extreme twisting or turning), smoking, being overweight or obese, straining during urination or defecation, lifting heavy objects, and abdominal injuries are some of the causes of Spigelian hernias. Symptoms may include poor bowel function or constipation, a dull ache in the abdomen, pain when bending or straining, and a noticeable small swelling on someone with lean or low body fat (otherwise, it may be difficult to observe). Diagnosing this type of hernia can be difficult.  based on the patient’s symptoms, an examination, palpation of the area, and an x-ray, a diagnosis can be made. Open or laparoscopic surgery, utilizing a surgical mesh to repair the area, is often the recommended course of treatment.

RECURRENT HERNIAS

Hernias that return after treatment are referred to as recurrent hernias. Due to the nature of the weak abdominal wall, hernias can occur again even under ideal conditions.

Recurrent hernias are more challenging to treat than other forms of hernias because of the presence of surgical scar tissue, previous use of surgical mesh, and inflamed tissue in the area. Recurrent hernias should be examined right away to see if they can be repaired.

A surgeon who specializes in treating complex or recurrent hernias is known as a complex hernia surgeon. While many general surgeons perform hernia surgery, it becomes extremely important to locate a surgeon with extensive experience in dealing with complex hernia surgery and abdominal wall reconstruction as a case becomes more complicated. One of the top complex hernia specialists in the country, Dr. Iskandar, receives frequent referrals from other surgeons for their complex cases.

With renowned expertise and unmatched compassion, the Iskandar Complex Hernia Center offers complex hernia surgery and advanced abdominal procedures to patients with debilitating hernias. These procedures dramatically enhance patient quality of life. Contact our friendly medical team to request an appointment with Dr. Iskandar and regain the quality of life and health you’ve been missing.

RECURRENT HERNIAS

By Dr. Mazen Iskandar

A recurrent hernia is when another one occurs in the general area of a previously repaired hernia. A hernia may recur months or even years following surgery, despite the success of most hernia procedures. However, the risk of developing a recurrent hernia is most significant in the first two years after surgery.

WHAT CAUSES RECURRENT HERNIAS?

There are many reasons for hernia recurrence in patients after successful hernia repairs.

Various conditions, activities, or behaviors that put stress on or weaken the abdominal muscles after the first surgery might also result in recurrent hernias. Some of these conditions interfere with wound healing. These include:

• Smoking

• Diabetes

• Being overweight

• Chemotherapy, steroids, or other drugs that weaken the immune system

• Strenuous activities like heavy lifting

RECURRENCE RATES FOR DIFFERENT TYPES OF HERNIAS

With proper care, the majority of hernias have favorable outcomes. A recurrence of an inguinal hernia is uncommon (1 to 3 percent chance, depending on the type of hernia and many other factors). Incisional hernias are more prone to recur.

After an incisional hernia repair, the likelihood of recurrence varies depending on the patient. Risk factors such as obesity and other health conditions can increase the risk of recurrence. In addition, the size of the initial hernia defect (larger hernias are more likely to recur), whether the hernia has already been repaired (recurrent hernias are more likely to recur when repaired again), and other factors (surgical technique, the type of a patient’s tissue, etc.) are all factors that impact whether a hernia is likely to reoccur.

One to three percent of groin hernias recur, compared to five to ten percent for abdominal (ventral) hernias and ten to fifteen percent for stoma hernias. The recurrence rate for the most difficult hernias ranges from 10 to 20 percent, depending on the kind of hernia and other variables.

If you’ve wondered if you can keep your hernia from reoccurring, read that article for practical steps.

Why choose the Iskandar Complex Hernia Center for your Recurrent Hernia?

You deserve access to a world-class abdominal expert who is always accessible and committed to helping patients improve their quality of life. The Iskandar Complicated Hernia Clinic is a complex hernia and advanced abdominal surgery center devoted to significantly improving patients’ lives and giving them freedom from debilitating hernias.

In this day and age, renowned experts who genuinely care about their patients can be hard to come by. However, you can be sure that you will get compassionate care if you choose The Iskandar Complex Hernia Center to help with your recurrent hernia.

MORE FAQ’S ABOUT RECURRENT HERNIAS

Are recurrent hernias and complex hernias the same thing?

A hernia develops when tissue or a portion of an organ protrudes through the abdominal wall. Hernias that return after being repaired are referred to as recurrent hernias. Factors that lead to hernia being labeled as complex include the size of the hernia, recurrent hernias, history of infections, presence of stomas (ileostomy, colostomy, ileal conduit…), presence of conditions like obesity, diabetes, immunosuppression, and smoking.

At the Iskandar Complex Hernia Center, we ensure that all risk factors are addressed before surgery to minimize the risk and improve outcomes, in addition to performing the best technically possible operation. Preoperative preparation may include better blood glucose control, weight management, smoking cessation, physical therapy, and nutritional optimization.

What is the recurrence rate of robotic/laparoscopic inguinal hernia repair with surgical mesh?

The inguinal hernia recurrence rate is 1–3% in patients treated with a robotic or laparoscopic approach with mesh. In addition, patients report having less chronic inguinal pain and a faster recovery after robotic/laparoscopic hernia repair.

What is the recurrence rate of traditional inguinal hernia repair in children?

Pediatric inguinal hernias that recur are very uncommon. The recurrence rates range from 0.3 to 1.2 percent. Recurrence often shows up six months following the first repair. According to recent data, recurrence rates for open and laparoscopic repair are comparable. However, only a small percentage of experienced pediatric surgeons conduct laparoscopic repairs; most pediatric surgeons choose open surgery, not the least because of the assumed decreased recurrence risk.

Most hernia recurrences after repair of an indirect hernia (97%) are indirect, although, in rare circumstances, the recurrence turns out to be a previously undetected direct or femoral hernia. An open or laparoscopic method might be used to fix a recurring inguinal hernia. The nature of the recurring hernia may be determined via laparoscopy, and an urgent repair can be made using either a laparoscopic or open approach. In the hands of an expert, innovative laparoscopic procedures may be successful.

What does component separation mean with regard to recurrence?

Many individuals have large or complicated abdominal wall abnormalities, such as enormous abdominal wall hernias or enterocuteaneous fistulas. Component separation is one approach that may help with the management of these challenging hernias. When doing a traditional hernia repair where there is an inadequate muscle wall that can be pulled back together, a component separation is used. Component separation entails separating and advancing certain layers of the abdominal wall muscle to get the right and left-sided muscles closer to the mid-line for adequate closure. With this procedure, the abdominal wall’s structural and functional integrity and cosmetic appearance are all restored.

Giant abdominal wall hernias are typically repaired using a combination of mesh repair and component separation. It is better to leave component separation to experienced surgeons since it is a complicated surgery.

What is the relationship between recurrent hernias and scar tissue?

Whenever a surgical incision is made, or a hernia repair is performed, our body heals by forming scar tissue rather than regenerating new muscle tissue. Unfortunately, scar tissue is weaker than our native muscle tissues. Also, scarring can make recurrent hernias more complicated to repair compared to initial hernia surgeries as the tissues and organs may be more stuck to each other, increasing the risk of injuries. Therefore, when it comes to repairing recurrent hernias, specialized hernia surgeons are better equipped to treat these hernias.

What are the symptoms of a recurrent hernia?

Some signs and symptoms may include:

• A bulge at or close to the hernia’s initial location

• Pain, particularly while coughing, sneezing, or carrying heavy things. Pain may vary from a subtle ache to severe pain.

• Constipation or bloating.

We’re Here for You

Most hernia repair surgeries are successful when performed by experienced hernia specialists. The Iskandar Complex Hernia Center is an expert in hernia repair surgery and will discuss your medical and surgical history with you prior to your initial repair. Call our office to schedule your consultation, and our friendly team will be happy to assist you.

HOW LONG DOES HERNIA SURGERY TAKE?

By Dr. Mazen Iskandar

Basic hernia surgery is a common surgical procedure performed by general surgeons.

Complex hernia surgery is performed less often and by fewer surgeons. Because of the complexity of the hernia (previous failure, size of hernia, etc.), complex hernia surgery is more extensive in scope and time.  The Iskandar Complex Hernia Center performs both basic and complex hernia repairs and abdominal wall reconstruction.

How long does laparoscopic or robotic basic hernia surgery take?

The duration of a laparoscopic or robotic basic hernia repair depends on several factors. For a basic hernia repair, actual surgery time can take anywhere between 30-120 minutes, and the duration is mostly dictated by the size and the location of the hernia (inguinal, umbilical, ventral, hiatal, etc.).

While every case is unique, a general time frame of basic laparoscopic or hernia repair is as follows:

• Patient is admitted into hospital 2 hours before the scheduled start time

• Needed final pre-operative medical information is gathered and vitals recorded

• Patient is taken to the operating room and put under anesthesia (15 mins)

• Surgical prep begins (10-15 minutes)

• Actual surgical time (30-120 minutes)

• Patient in recovery room(60-120 minutes)

• Patient is discharged home

How long does robotic complex hernia surgery take to complete?

Complex hernias via robotic-assisted laparoscopic surgery typically last two hours to five hours in actual surgical time. Complex hernias by definition are usually large, recurrent hernias that often require abdominal wall reconstruction. . Robotic surgery has allowed surgeons to perform some very complex hernia surgeries that usually required an open operation which translates into significantly less chances of wound complications and a faster recovery. In fact, the majority of patients undergoing robotic complex hernia repairs are discharged the same day or spend one night in observation.

While every case is unique, a general time frame of complex hernia repair via laparoscopic surgery is as follows:

• Patient is admitted into the hospital 2 hours before the scheduled start time

• Needed final pre-operative medical information is gathered and vitals recorded

• Patient is taken to the operating room and put under anesthesia (15 mins)

• Surgical prep begins (20-30 mins)

• Actual surgical time (2-5 hours)

• Patient in recovery room (60-120 minutes)

• Patient is discharged home or admitted for observation (23 hours)

How long does open complex hernia surgery take to complete?

Typical surgical time for open complex hernia surgery is between three to six hours. Some patients may not be candidates for robotic surgery due to the factors such as the size of the hernia, the need for skin removal, the need for bowel resection, the need for mesh removal, etc. Therefore, open complex hernia repairs typically are needed in more complicated cases and usually require a longer operative and recovery time.

While every case is unique, a general time frame of complex hernia repair via open surgery is as follows:

• Patient is admitted into hospital 2 hours before the scheduled start time

• Needed final pre-operative medical information is gathered and vitals recorded

• Patient is taken to the operating room and put under anesthesia (15 mins)

• Surgical prep begins (20-30 mins)

• Actual surgical time (3-6 hours)

• Patient in recovery room (60-120 minutes)

• Patient is admitted for observation (2-3 days)

No matter what kind of hernia repair you need, The Iskandar Complex Hernia Center is your answer. From a basic hernia surgery to the most complex of procedures, hernias are our sole focus. You’ll experience renowned expertise and unparalleled compassion while under our care.

HERNIA SURGERY DALLAS, TX: THINGS TO CONSIDER

By Dr. Mazen Iskandar

HOW DO I FIND THE BEST HERNIA SURGEON IN DALLAS?

While there are many surgeons who do hernia surgery in Dallas, we recommend finding a surgeon whose sole focus is hernia repair and complex hernia repair. Because a focused-on-hernias surgeon will have seen more hernia surgeries than those practicing varied types of procedures, he or she will typically be more experienced in the repair of hernias. The more complex the hernia, the more important it becomes to find a complex abdominal wall repair specialist.

SURGEON SPECIALIZING IN HERNIA REPAIR NEAR ME

The Iskandar Complex Hernia Center treats patients with both simple and complex hernias. You’ll experience renowned expertise and unparalleled compassion. Dr. Iskandar is a respected, global leader in abdominal wall reconstruction and complex hernia surgical repair. Learn more about Mazen Iskandar MD, FACS.

QUESTIONS TO ASK A DALLAS HERNIA SURGEON

We recommend asking these questions before you book an appointment with a surgeon:

Is the Dallas surgeon respected as an expert in the field of hernia surgery?

Dr. Iskandar is a globally respected complex hernia surgeon invited to keynote and present at conferences regarding hernias.

Do they have case studies or articles that make them a thought leader in the field?

Dr. Iskandar has numerous publications in medical journals and other healthcare periodicals. A few of these include:

• Patient Selection for Laparoendoscopic Inguinal Hernia Repair

• First Patient Treated in U.S.-Centered Hernia Outcomes Initiative

• Complex Inguinal Hernias

Do other surgeons typically refer their more complex cases to the surgeon you are considering?

Dr. Iskandar is one of the most referred to hernia physicians in DFW, taking on the most complex cases.

Do they offer comprehensive care, including bariatric surgery, weight loss coaching, and other support if obesity is a co-occurring symptom?

We believe in treating the whole person for the best outcome possible. This includes bariatric surgery, weight-loss strategies, and other needed support, allowing the fullest patient treatment possible for a better quality of life.

Do they provide both laparoscopic hernia repair and open hernia repair? If so, what makes them select one or the other for each case? Do they offer minimally invasive, robotic surgery?

The Iskandar Center performs laparoscopic surgery, open surgery, and robot-assisted surgery. Dr. Iskandar will review the reasons he is recommending the type of surgery, answer all your questions, and listen to your concerns.

What is the patient experience like? Does the surgeon listen first, and what is their bedside manner like? How well do they explain the procedure, what you will experience, and the expected outcomes?

You’ll experience unparalleled patient care. We want each patient to feel peace of mind going into their procedure, confident they are fully educated and in good hands.

What technology and tools are used to make a precise diagnosis?

You’ll gain the assurance that all the tools needed are at your disposal, including the newest ultrasound and MRI capabilities.

Will I have a large incision or small incisions?

We know that your appearance post-surgery matters to you. Dr. Iskandar will be happy to have a conversation about the type of surgery he recommends, why he recommends and what you can expect in terms of incision sizes.

What are the typical surgical complications for the procedure the surgeon is recommending? What are the risk factors?

While every surgery has some possible complications and risk factors, you’ll rest better knowing that these have been thoroughly discussed in your consultation and pre-operative appointment.

Why did The Iskandar Complex Hernia Center choose to be close to Dallas?

Dallas offers several benefits:

• Close proximity to DFW Airport and Love Field for patients flying across Texas, the United States, and the world to see Dr. Iskandar.

• A fabulous support team of surgeons, nurses, anesthesiologists, and medical professionals is available at our hospital in the Dallas area.

• World-class medical center surgical facilities at the Baylor, Scott, and White Hospital in Waxahachie.

• A great place for our staff to live with one of the most vibrant economies around.

AFTER HERNIA SURGERY

By Dr. Mazen Iskandar

Patients often ask what to expect after hernia repair surgery. Your recovery time will vary based on a few factors, such as your age, the type of hernia you had, the type of hernia repair surgery, and your overall health. Mild to moderate pain and a feeling of being a little under the weather are common side effects of hernia repair surgery. As you recuperate, it’s also typical to experience pulling or twinges in the affected area.

However, most patients feel better within a few days of their hernia repair and recover significantly from surgery within a week. In this article, we will cover some of the most frequently asked questions we hear at The Iskandar Complex Hernia Center about life after hernia surgery. We are always happy to discuss any other questions you may have when we meet with you at your appointment. Call our office today to schedule your consultation.

What should I expect after my hernia surgery?

The length of your post-operative recovery depends on the kind of hernia you have and the procedure that needs to be done. Most patients who have a minimally invasive procedure, such as laparoscopy or robotic hernia surgery, are able to leave the hospital the same day and even walk the night after the procedure. Some patients may need to stay in the hospital for a few days, particularly those who had component separations or abdominal wall reconstructions. Although some individuals may need prescription pain medication, discomfort is often treated with over-the-counter analgesic pain medicine.

For the first few weeks following surgery, most patients are advised to avoid lifting anything greater than 15 pounds; however, more complex cases may be subject to different restrictions. Although all individuals will have different limitations, you should generally be as active as your doctor’s instructions allow. After your operation, get in touch with Dr. Iskandar as soon as possible if you have any questions or concerns about your recovery.

What is the fastest way to recover from hernia surgery?

Supporting the body’s natural healing process is the main focus of recovery after hernia surgery. As much as anything, staying rested and stress-free can expedite the healing process.

You can resume light gentle exercise when you’re feeling up to it. Returning to your feet helps accelerate the natural healing process since it increases blood flow. But don’t push yourself to heal faster, and make an effort to remain conscious of any pain or discomfort while you move. Those are cues from the body advising you to take it slower. Call your doctor if you have any questions about how your recovery is going.

Can you bend down after hernia surgery?

After a major abdominal wall surgery or open groin hernia repair, it is best to refrain from prolonged bending or twisting. Bending or twisting is unlikely to disrupt the repair but can cause discomfort and abdominal pain in the first couple of days after surgery. You can bend down after hernia surgery; you should just do so slowly and with care.

What is the best position to sleep after hernia surgery?

Sleep is crucial after surgery to aid in recovery, but it can be very challenging to fall asleep following a hernia operation because the pain you’re feeling in your abdomen can get worse with even the smallest motions, such as changing your position or breathing.

How then should you sleep after a hernia operation? One of the most important things you can do to improve your quality of sleep and hasten your recovery from hernia surgery is to sleep with your upper body elevated at a 30-45 degree incline.

Until the surgery site is fully healed, doctors particularly recommend sleeping on your back with your upper body elevated during the first few weeks. Sleeping in this upright position provides a number of benefits, including:

• Avoid unnecessary strain and unintentional disruption of the surgical suture while resting at the surgery site.

• Improved control and limb mobility are possible without affecting your sutures.

• Reduce discomfort and accelerate recovery following surgery.

• Addresses additional issues such sleep apnea, acid reflux, and congestion of the nose and throat.

After hernia surgery, an adjustable bed, a chair, a bed riser, a wedge cushion, or a stack of pillows are the best options for sleeping in an inclined posture. Some individuals may find the elevation to be an uncomfortable deviation from their regular sleeping position. Start with a 10 degree incline if you are uncomfortable and increase it gradually to 30 degrees over the course of 5-7 days.

Can sneezing damage hernia repair?

Your incision will hurt more than it has in a few days if you cough or sneeze hard. This is not a reason for concern. For up to six months following surgery, the majority of hernia repairs will experience some discomfort.

When you need to cough or sneeze for a few weeks after surgery, you should splint or brace your incision. This entails applying gentle pressure to the incision with your hands, a blanket that has been rolled up, or a pillow. Additionally, if you sneeze with your mouth open (also known as a cough sneeze), your incision won’t be put under as much stress.

How much should I walk after hernia surgery?

Following hernia surgery, there is no prescribed time limit or number of walks you should take. Since each circumstance is unique, there is no exact science in this. As a result, we advise going slowly and refraining from trying to accomplish too much at first. Walking is beneficial for your hernia surgery recovery, but if you overdo it and strain the area that was just fixed, serious injury may result. Overextending your body will cause more damage than good. Don’t try to walk if you don’t think you can do it comfortably. However, you can do a few sessions of walking per day for as little as 5 to 15 minutes at a time if you can walk comfortably without straining.

Walking won’t make any miracles happen but can definitely aid in your recovery. After your hernia surgery, a little bit of walking can go a long way, so limit it to a few quick 5–10 minute sessions per day for the first week or so.

Are there food restrictions after hernia surgery?

Consuming a balanced diet (nutrition) after surgery is crucial to healing and a quick recovery. However, eating the appropriate combination of nutrients is only one aspect of diet following hernia surgery. The majority of the dietary recommendations following hernia repair are very similar, though specifics will vary depending on where your hernia was located and how extensive the surgery was.

Your diet will generally be limited to liquids for 12 to 24 hours following major surgery, especially if the hernia involved the intestines. There are several causes for this liquid diet. First, anesthesia frequently causes nausea and vomiting, which solid meals might make worse. Second, after the majority of hernia repairs, it is preferable to avoid applying pressure to the stomach and intestines.

After your hernia repair you will still need to restrict your diet to some extent until you are given the all-clear for semi-solid or solid foods. It is advisable to limit your diet to extremely soft foods for the first few days after surgery so that your abdominal and intestinal muscles won’t have to work too hard or strain and to avoid any alcoholic drink. Following hernia surgery, the following foods are good choices:

• Milk

• Yogurt

• Sorbet

• Vanilla ice cream.

• Strained purees and other creamed vegetables

• Nutritional beverages (no chocolate)

• Vanilla pudding

Focus on fiber-rich foods and staying hydrated once you are able to begin eating more substantial meals. After a hernia operation, you can consume any foods that are high in dietary fiber or water content, such as fruit; just steer clear of anything that will give you gas. Good options are:

• Watermelon

• Apples

• Pears

• Bananas

• Beans

• Zucchini

• Eggplant

• Whole grain rice

• Whole grain bread

• Oatmeal

• Bran

Additionally, pay attention to including lean protein in each meal. Steak and other difficult-to-digest foods should be avoided. The best options include dairy products like cheese and eggs, fish, chicken breast, and leaner cuts of beef and pork. If cheese tends to make you constipated, stay away from it until you’re fully recovered. Being careful to not upset the gastrointestinal tract is crucial as you reintroduce solid foods.

Can I drink coffee after hernia surgery?

Yes, you can. Begin by consuming bland liquids like coffee, Gatorade, tea, water, soup and crackers, or jell-o. As tolerated, you can gradually raise your diet to a regular diet.

How do you have bowel movements after hernia surgery?

Constipation is a very frustrating problem to have, and it is made worse if you are recovering from abdiminal hernia surgery. Constipation following surgery is very common and can be caused by anesthesia, the surgery, and certain pain medications. The best piece of advise we can offer is to try to avoid constipation before it starts. In the days before your surgery, as well as afterward, make sure you are consuming meals high in fiber and drinking lots of water.

Stool softeners should be used following surgery to prevent constipation. However, if you do become constipated, you shouldn’t try to force a bowel movement. Following these tips can help prevent constipation and make having a bowel movement less painful. Dr. Iskandar will go over with you prior to your hernia repair tips to preventing constipation after surgery.

How do you know if something is wrong after hernia surgery?

The signs and symptoms of a ruptured or torn hernia mesh implant are similar to those of surgical mesh failure, which include:

• Gas or bloating or inability to pass stools or gas

• Fever when there is no known cause

• Nausea, vomiting, and/or chills

• Skin that is warm or hot where the surgical incision was made.

If you have any of these symptoms you should contact Dr. Iskandar immediately. It is very unlikely, and the risk is quite low that you will have any of these possible complications occur when following Dr. Iskandar’s post-operation instructions diligently.

When can you resume sexual activity after hernia repair surgery?

When you have sexual intercourse for the first time after hernia surgery, especially an inguinal one, there may be some discomfort. Let pain be your guide in these situations. Although there is no restriction on when you can resume sexual activity following hernia surgery, it is advisable to speak with your doctor beforehand.

When can you take a shower after hernia repair surgery?

Showering is permitted between 24 and 36 hours following surgery. Before taking a shower, remove any bandages that may be covering the incisions.

You will see skin glue firmly affixed to your skin. The glue is waterproof and can get wet in the shower without harm. The skin glue will start to peel up 7 to 10 days following surgery, and at this time you are free to remove it completely if you so choose. When you arrive for your postoperative follow-up appointment, your incisions will be examined. Avoid applying creams, medicines, or other healing aids to your incisions.

How long does a hernia operation take to recover?

Recovery from open surgery for inguinal hernia repair, typically takes at least two or three weeks. In the case of a laparoscopic surgery or robotic surgery, recuperation takes one to two weeks. Recovery from surgery for a larger abdominal hernia may take uo to a month. Each person is different and recovery times can vary. Dr. Iskandar will give you recommendations for your unique situation and let you know when it is ok to resume normal activities.

The Iskandar Complex Hernia Center offers complex hernia surgery and advanced abdominal procedures with unparalleled empathy and expertise, so you can enjoy a dramatically improved quality of life. Call our office today to schedule your appointment with Dr. Isakandar to learn more information about hernia repair surgery.

WHEN TO WORRY ABOUT HERNIA PAIN

By Dr. Mazen Iskandar

Hernias are a common medical condition that can cause varying degrees of discomfort and pain. Many patients suffer from debilitating abdominal pain, often because they and their doctors are unaware of the options. At The Iskandar Complex Hernia Center, we offer complex hernia surgery and advanced abdominal procedures with unparalleled empathy and expertise, so you can enjoy a dramatically improved quality of life. This article will help you understand when to worry about hernia pain and provide valuable insights into hernia symptoms, diagnosis, treatment options, and when to seek medical attention.

WHAT ARE THE CHARACTERISTICS OF HERNIA PAIN?

Hernia pain can have several characteristics that vary from person to person. The severity, duration, and location of the pain can all be different for each patient depending on the type of hernia, its location, and its complexity.

Severity

Hernia pain can range from mild discomfort to severe, debilitating pain.

Duration

Pain from a hernia can be acute, occurring suddenly and lasting for a short time, or chronic, persisting over a longer period.

Location

The location of hernia pain depends on the type of hernia. For example, inguinal and femoral hernias cause pain in the groin area, while umbilical hernias cause pain near the belly button.

WHEN TO WORRY ABOUT HERNIA PAIN

If you have persistent or worsening pain, sudden pain or certain symptoms of complications, or any other concerning symptoms of a hernia, you should see a doctor right away. It is essential to recognize when hernia pain may be a cause for concern. Certain situations indicate your hernia may be more serious and should cause you to be concerned and seek medical attention.

Persistent or Worsening Pain

If your hernia pain does not improve with rest or becomes more severe over time, it may indicate a worsening condition that requires medical attention.

Signs of Complications

Certain symptoms may suggest complications related to your hernia, such as:

1. Strangulation: A strangulated hernia occurs when the blood supply to the herniated tissue is cut off, which can lead to tissue death. Symptoms of a strangulated hernia include sudden, severe pain, nausea, vomiting, and a rapid heart rate.

2. Obstruction: A hernia can cause an obstruction in the intestines if it traps part of the intestine, leading to symptoms such as abdominal pain, bloating, nausea, vomiting, and constipation.

3. Incarceration: An incarcerated hernia is when the herniated tissue becomes trapped and cannot be pushed back into place. This can cause pain and discomfort, and if left untreated, it may lead to strangulation.

When should you seek medical attention?

If you experience persistent or worsening pain, signs of complications, or any other concerning symptoms, it is essential to seek prompt medical attention.

WHAT IS A HERNIA?

A hernia is a medical condition that occurs when an internal organ or tissue protrudes through a weak spot or defect in the surrounding muscle or connective tissue. This can cause a visible bulge and discomfort in the affected area. There are several types of hernias, each occurring in different parts of the body:

Inguinal Hernia

The most common type of abdominal hernia, an inguinal hernia, occurs when part of the intestine or fatty tissue protrudes through an opening in the abdominal muscles or the inguinal canal, which is located in the groin area. Inguinal hernias are more common in men than women.

Femoral Hernia

A femoral hernia occurs when a part of the intestine or fatty tissue pushes through the femoral canal, which is located near the groin and upper thigh. Femoral hernias are more common in women than in men.

Umbilical Hernia

An umbilical hernia occurs when part of the intestine or fatty tissue protrudes through the abdominal wall near the belly button. This type of hernia is more common in infants and young children, but it can also affect adults.

Incisional Hernia

An incisional hernia develops when a part of the intestine or other tissue pushes through a weak spot in the abdominal wall at the site of a previous surgical incision.

Hiatal Hernia

A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm, the muscle separating the chest and abdomen. This type of hernia is more common in older adults and can cause gastroesophageal reflux disease (GERD).

WHAT ARE THE SIGNS AND SYMPTOMS OF A HERNIA?

Hernias can present with various symptoms depending on their type and severity. Some common symptoms include:

Bulging

A visible or palpable lump in the affected area is a common sign of a hernia. The hernia bulge may be more noticeable when standing, coughing, or bearing down.

Discomfort

Hernias can cause pain or tenderness in the affected area, especially when lifting, bending, or coughing. The pain may be mild to severe and can worsen over time.

Limited Mobility

Some hernias can cause difficulty moving or performing daily activities due to pain and discomfort.

HOW ARE HERNIAS DIAGNOSED?

A healthcare professional can diagnose a hernia through several methods, including a physical exam and imaging tests.

Physical Examination

Your doctor will perform a physical examination to look for a visible or palpable bulge in the affected area, especially when you cough or bear down. They may also ask about your symptoms and medical history.

Imaging Tests

In some cases, your doctor may order imaging tests to confirm the diagnosis and determine the severity of the hernia. These tests may include:

1. Ultrasound: An ultrasound uses sound waves to create images of the internal structures, allowing your doctor to visualize the hernia and assess its size and location.

2. CT scan: A computed tomography (CT) scan combines multiple X-ray images to create detailed, cross-sectional pictures of the body. This can help your doctor determine the extent of the hernia and detect any complications.

3. MRI: Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to generate detailed images of the body’s internal structures. This can provide your doctor with additional information about the hernia and surrounding tissues.

WHAT ARE THE TREATMENT OPTIONS FOR HERNIAS?

Treatment for a hernia depends on the type, severity, and presence of complications. Your doctor may recommend watching and waiting or hernia surgery. For small, uncomplicated hernias that do not cause significant pain or discomfort, your doctor may recommend watchful waiting. This involves monitoring the hernia for any changes in size or symptoms and avoiding activities that may worsen the condition.

If your hernia is causing significant pain, increasing in size, or leading to complications, your doctor may recommend surgery. There are several surgical techniques for hernia repair, including open surgery, laparoscopic surgery, and robotic surgery. During an open hernia repair, your surgeon makes an incision near the hernia, pushes the herniated tissue back into place, and repairs the defect in the abdominal wall with stitches or mesh.

Laparoscopic surgery is a minimally invasive procedure in which your surgeon makes several small incisions in the abdomen and inserts a laparoscope (a thin tube with a light and camera) and specialized surgical instruments. The surgeon then repairs the hernia using mesh or sutures, often resulting in shorter recovery times and less post-operative pain compared to open surgery.

Robotic-assisted hernia repair is another minimally invasive option that uses a robotic system controlled by the surgeon. This method offers greater precision and control, which can lead to fewer complications and improved outcomes.

Dr. Iskandar is a renowned complex hernia surgeon and will recommend the treatment option that is best for your unique situation.

WHAT ARE THE RISK FACTORS FOR HERNIAS?

Several factors can increase your risk of developing a hernia, including age, gender, weight, and lifestyle. Older adults have a higher risk of developing hernias due to weakened muscles and connective tissue. Men are more susceptible to inguinal hernias, while women are more prone to femoral hernias. Excess body weight can increase pressure on the abdominal wall, making it more susceptible to hernias. Certain lifestyle changes can help reduce your risk of developing a hernia. These include maintaining a healthy weight, avoiding heavy lifting or using proper lifting techniques, and practicing good posture.

WHY CHOOSE THE ISKANDAR COMPLEX HERNIA CENTER FOR HERNIA TREATMENT?

At The Iskandar Complex Hernia Center, we are committed to providing the highest level of care for our patients with hernias. Our highly skilled surgeon is board-certified and has extensive experience in performing complex hernia surgeries and advanced abdominal procedures. We understand that each patient’s needs and circumstances are unique. Our team will work closely with you to develop a personalized treatment plan that best addresses your specific condition.

Dr. Iskandar is trained in the latest minimally invasive surgical techniques, including laparoscopic and robotic-assisted hernia repair, to ensure optimal results and faster recovery times. Following your hernia surgery, our team at The Iskandar Complex Hernia Center will provide comprehensive post-operative care to ensure a smooth recovery. You will have regular follow-up appointments with your surgeon to monitor your progress and address any concerns.

Recognizing when to worry about hernia pain and seeking prompt medical attention is crucial for preventing complications and ensuring the best possible outcome. At The Iskandar Complex Hernia Center, our experienced surgeon and compassionate staff are committed to providing the highest level of care for patients with complex hernias.

If you’re experiencing hernia pain or would like more information about hernia treatment options, contact The Iskandar Complex Hernia Center today. Our knowledgeable staff is available to answer your questions and help you schedule a consultation with our expert surgeon, Dr. Iskandar. Don’t let hernia pain control your life any longer; take the first step towards a dramatically improved quality of life by reaching out to us.