Dr. Rafael Reisfeld is a board certified surgeon who has been performing hernia repair surgeries for the last 20 years in the Los Angeles area.
When Dr. Reisfeld started working on hernia repair, the surgery was carried out on an inpatient basis under general anesthesia. However tremendous changes have been made since the 80’s that have enabled more simple techniques. These techniques have led to the ease of hernia repair that Dr. Reisfeld is now able to perform.
The first change in the process of hernia repair was the incorporation of a synthetic net (mesh) made of specialized synthetic material to bridge the defect in the tissues. By using the mesh the tension on the tissues is reduced and the amount of pain is much less. Additionally, with the mesh, the strength of the repair is increased. Due to the special architecture of the synthetic net there is growth of tissue into the net which in turn increases the strength of the repair. Most of the mesh types today are defined as “light mesh” which means light weight compared to the previous versions. Also the hole size is somewhat increased to allow better tissue growth into the mesh. These new changes do not mean that the mesh is weaker.
The mesh, a crucial aspect of hernia repair, comes in a few shapes and forms. The type of hernia of the intra operative findings dictate what kind of a mesh should be used. There are different types of mesh with different weights and hole sizes. Among them is the Prolene hernia system. This particular system is made of two layers of the mesh that makes the repair even stronger. The amount of sutures applied with this method is also reduced and this in return reduces the amount of pain. Obviously the type of hernia found dictates the type of synthetic mesh to be used. Dr. Reisfeld continually reviews and carefully evaluates new materials as they are made available to the medical community. Dr. Reisfeld is careful not to use any mesh which were recalled or had serious issues.
The operation is carried out on an outpatient basis. This means that the patient is able to go home 2-3 hours after the operation. In most of the cases the operation is done with sedation and local anesthesia. After the repair, oral medications are given to help with pain control. Antibiotics are given intravenously before the operation to pre-empt any infection.
Improvements in the anesthetic methods and materials are making the operations even easier to tolerate and the down time relatively short. Obviously, each patient has a different threshold for pain, so recovery may differ from one patient to the next.
Another method that is being used is the endoscopic repair of a hernia. Presently Dr. Reisfeld prefers the open method which enables performance of hernia repair under local anesthesia and sedation, whereas the endoscopic repair demands general anesthesia.
As with any other operation the patient should discuss his or her findings with the surgeon and at the same time possible complications and side effects should be discussed.
The operation has an excellent success rate with a very low recurrence rate.
To set up an appointment or seek the advice of Dr. Reisfeld, please contact the Pacific Hernia Center at: 310 557 3037
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