Hernia

your hernia your choice

As the Hernia Specialists of Minnesota we recognize that there is one thing many patients with hernias are not offered, choice. For decades we have prided ourselves in working together with our patients through a shared decision making process to develop a treatment plan. We offer a wide range of repair and reinforcement options allowing us do to what is right for you. Connect with us by using the “Message us” button at the bottom of your screen or at (218) 927-6904.

what we do

• Hiatal Hernia Repair
• Umbilical Hernia Repair
• Inguinal Hernia Repair
• Ventral Hernia Repair
• Incisional Hernia Repair

Once a hernia has been diagnosed and the decision has been made to repair it, the next question is what technique will be used. As the Hernia Specialists of Minnesota we are proficient in all modern repair techniques and have access to the latest technology. This allows us to tailor our approach toward your specific situation. We have a strong preference for minimally invasive techniques when possible.

Traditional Surgery
Traditional, open surgery involves creating a single incision over the site of the hernia and then repairing the hernia through that incision. This incision will vary in size depending on the hernia but is typically much larger than the incisions used in minimally invasive techniques. Due to the larger incision there is typically more pain, a longer recovery and higher chance of complications. For these reasons we prefer a minimally invasive approach whenever possible. Open repair may still be appropriate in some situations. The most common include very large or complicated hernias, revision (redo) repairs and patients that cannot tolerate general anesthesia.

Minimally Invasive Surgery
During minimally invasive surgery instruments and a lighted camera are placed through multiple small incisions to perform the surgery. Traditionally this has been “laparoscopic” surgery with straight, rigid instruments. Over the last several years we have transitioned to offering almost all of our hernia repairs using the robotic assisted platform. Minimally invasive surgery leads to less pain and allows for a quicker return to normal activity for our patients. Most go home the same day.

• DaVinci Robotic Assisted Surgery
• Laparoscopic Surgery

Da Vinci Robot
Using a da Vinci robot, the surgeon makes a few small incisions in the abdomen using long, thin instruments and a tiny camera. The camera sends images to a video monitor in the operating room to guide your surgeon during the operation. The robot is designed to provide surgeons with enhanced capabilities, including high definition 3D vision and a magnified view. The surgeon controls the robot, which translates his or her hand movements into smaller, precise movements of tiny instruments inside the body. The robot cannot act on its own. Surgery is performed entirely by the surgeon.

Robotic surgery offers even more advantages over traditional minimally invasive surgery. The da Vinci surgical robot allows surgeons to see with a magnified, 3D view and use advanced instruments, which results in even more precise surgery. The surgeon is always in full control of the robotic system. Results may vary, but the value of robotic-assisted hernia repair is less pain during recovery and a faster return to work and normal activities than those who have an open procedure. With the advanced instruments we are able to do more surgeries in a minimally invasive fashion than ever before.

Every 60 seconds, a surgeon starts a da Vinci robotic-enhanced procedure somewhere in the world. That being said, many surgeons do not have access to or have the appropriate training to perform hernia repairs the robotic platform. This causes them to have to revert to more traditional techniques. While the results are still excellent, this may cause the patient to have more pain, a prolonged recovery, and to spend more time away from what matters most to them.

• Open Surgery
• Component Separation
• Treatment of Infected Mesh
• Revision/Redo Surgery
• Biological Reinforced Techniques
• No Mesh Techniques

The use of mesh has revolutionized hernia repair over the last several decades. By using mesh we can drastically reduce the chance of the hernia coming back (recurrence). That being said, we are open and understanding about the criticism that mesh has received and now offer a variety of options including no mesh repair, biologic reinforced repair and traditional mesh repair. Ultimately this will be a choice made between your surgeon and you. We recommend you use the SCAFFOLD Guide to further explore your options.

Mesh History

Hernia repairs have traditionally had a high chance of failing. Since the 1980s there has been a steady increase in the use of mesh to reinforce hernia repairs which has dramatically decreased the chance of the hernia coming back. The use of mesh can also decrease the possibility of pain after surgery. Currently, well over 90% of hernia repairs are performed using mesh reinforcement.

150 Types of Hernia Mesh
Available on the market include: synthetic (plastic), absorbable synthetic, biologic (animal derived) and hybrids which are made of a combination of synthetic and biologic materials.

Like most things in life an individualized approach is best when deciding which type of mesh reinforcement to use for your hernia repair. Traditional, synthetic (plastic) mesh has an excellent track record and is used in the vast majority of hernia repairs across the globe. Many patients are attracted to newer technologies such as reinforced biologic mesh. We recommend exploring this interactive guide developed by abouthernia.com to learn more about your options.

Is it all true?
It is difficult to search the web about hernias without coming across a flood of advertisements questioning mesh safety.

It has been greatly blown out of proportion, but yes, like any surgical product mesh can cause complications. Many of the meshes that were more likely to cause complications have been recalled by the FDA. However, any mesh has the potential to cause pain, infection, scar tissue formation which can lead to bowel blockage, abnormal connections with the bowel (fistula) and lead to return of the hernia (recurrence) due to mesh migration or shrinkage (contraction). All of these complications are very rare and, in general, the benefit of using mesh reinforcement far outweighs the risk.

about hernia repair options

Yes, in select situations a no mesh hernia repair is safe, feasible and effective. However, we often find that after a thorough discussion with their surgeon patients select NOT to have a no mesh repair. In most instances no mesh hernia repairs are performed using open surgical techniques which lead to increased post-operative pain and longer recovery. The chance of the hernia coming back is also drastically increased in a no mesh repair. After discussion, we find that the fear patients have isn’t actually of mesh, it is of having a permanent foreign body inside of them. These patients often end up selecting a biologic or reinforced biologic mesh which will be slowly remodeled into their own body’s natural tissues. This allows for the “best of both worlds”. Ultimately decreasing (or eliminating) the amount of foreign body left from the repair while maintaining strength to limit the chance of the hernia coming back. We encourage you to use the resources throughout this website and to speak further with your surgeon to learn more about this very important decision.

Hernia Education

A hernia is a gap or space in the strong tissue that holds muscles in place. A hernia occurs when the inside layers of the abdominal wall have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause discomfort, severe pain, or other potentially serious problems that could require emergency surgery. Both men and women can get a hernia. Hernias may also occur in children. You may be born with a hernia (congenital) or develop one over time.

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth, or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation. Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth. The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional). Other types include outer groin (femoral) and upper stomach (hiatal). Most hernias are external hernias. This means that the protrusion is toward the outside of the body and creates a bulge you can see.

It is usually easy to recognize a hernia.

Other times a hernia may be detected by your doctor on a routine physical examination. The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. Another sign of this is if the bulge used to come and go, but now is stuck out. These symptoms are cause for concern and you should immediately contact your physician or surgeon.

The most common way to diagnose a hernia is by history and physical exam with your healthcare provider or surgeon. Often the signs are very classic and can even be determined by a telehealth visit. Sometimes additional studies are necessary. If this is the case your surgeon can help determine whether an ultrasound or CT scan will be best to help confirm the diagnosis

Most hernias are NOT dangerous, however, some can contain bowel or other intra-abdominal contents that can become stuck out (incarcerated) or twisted (strangulated). Especially concerning is if the area around the hernia becomes red, hot, or extremely tender. If this occurs you should go to your nearest emergency department. We do not typically recommend you limit your activity because of a hernia. A general recommendation is, if it hurts, don’t do it. Many people with hernias do have to limit their activities due to discomfort. The best fix for this is repair of the hernia. There are also support systems that can be temporary solutions. These are known as abdominal binders and hernia “truss” belts and can be found at medical supply stores. A hernia does not get better over time, nor will it go away by itself. There are no exercises or physical therapy regimen that can help. While it may be safe to watch some hernias, the only way a hernia can truly be repaired is with surgery. If you and your surgeon decide that a surgical hernia repair is right for you, ask about all of your options, including a traditional open procedure with a large incision versus a minimally invasive procedure. A minimally invasive procedure is performed through several smaller incisions and leads to less pain and quicker recovery

Following a minimally invasive or robotic hernia repair operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake. Once you are awake and able to walk, drink liquids, and your pain is controlled you will be sent home. With any hernia operation, you can expect some soreness, mostly during the first 24 to 48 hours. You are encouraged to be up and about the day of surgery and slowly get back to your usual activities. With minimally invasive or robot-assisted hernia repair, most patients are able to get back to their normal activities within a week. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse

Return to work can be highly dependent on your particular work situation and hernia repair. The best advice is to ask your surgeon. Generally, return to work is rapid following minimally invasive repair. Patients with desk jobs may return 2-3 days following repair. Those who perform light, physical labor should plan for 7-10 days off from work. Patients with jobs requiring heavy labor may need to take up to 3-6 weeks off from work, however, we find that most can return much sooner with some restrictions.

The use of mesh has revolutionized hernia repair over the last several decades. By using mesh we can drastically reduced the chance of the hernia coming back (recurrence). That being said, we are open and understanding about the criticism that some mesh has received and now offer a variety of options including no mesh repair, biologic reinforced repair and traditional mesh repair. Ultimately this will be a choice made between your surgeon and you. Please see our section All About Mesh for more details.

Our goal is to make your hernia experience as easy and smooth as possible. This starts with preparation. Our team may be reaching out to you to help gather any relevant data prior to your visit. Be sure to browse this website, talk to friends and have any questions or concerns handy on the day of your visit.

Telehealth Visit
Our goal is to make access easy and personalized. We are glad to offer telehealth visits or in-person, traditional visits. Often, we can proceed forward with surgery after a telehealth visit alone. However, in certain cases an in-person physical exam will be necessary prior to surgery.

Other Useful Info
Your previous medical and surgical history is very important to consider when planning for hernia repair. Important records include any CT scans, operative reports and surgical consults you have had in the past. Our staff can help gather these if you are having difficulty.

We encourage you to explore this website to learn more about your options for hernia repair. You can also complete the SCAFFOLD Guide and bring it with you to your appointment. This guide acts as a tool to help clarify your opinions on the shared decision making process and hernia repair.

We love to talk about hernias and your options. Please feel free to research more about hernias on this website, on the web, or by talking with your friends and family. Be sure to write down your questions so you don’t forget them at the time of your visit.

Please select your procedure below to view the relevant post-op instructions. A handout will also be provided to you the day of surgery but it is a great idea to preview these instructions so that you can come up with questions for the day of surgery.

Robotic Assisted Inguinal Hernia Repair

Robotic Assisted Ventral Hernia Repair

Fellowship Trained Surgeons

Meet our dedicated team of experts

From evaluation and diagnosis, to treatment and recovery, our team of experts work with you to provide specialized care for your unique hernia condition getting you back to enjoying what you love.

Evan Kelly, MD

Tim LeMieur, MD, FACS

Andrew Loveitt, DO

Shawn Roberts, MD, FACS

Meet the Hernia Team

Thomas (TJ) Hirsch, PA-C

Take a video tour of our state-of-the-art surgery expansion.

Hernia Blog

Real patients. Real stories.