Hybrids, when created with care, typically bring together the best of different individuals with the aim of creating a better car, cow or corn plant.
Now a surgeon at Creighton University Medical Center-Bergan Mercy is preparing to offer a hybrid surgical technique pioneered in Germany to repair abdominal hernias. The new technique is expected to reduce the recovery time that comes with a traditional open surgery and lessen the likelihood of complications.
The procedure can be used for both congenital hernias that occur between the breastbone and bellybutton and those that form there after an incision for a previous operation. An estimated 359,000 such repairs will be performed in the United States this year.
For years, surgeons repairing such hernias have chosen either an open or laparoscopic procedure, said Dr. Robert Fitzgibbons Jr., professor and chairman of the Creighton University School of Medicine’s surgery department.
Both involve patching the hernia with surgical mesh. But with the laparoscopic procedure, done with slender tools inserted through tiny incisions, the mesh ends up inside the abdomen, tacked to the abdominal wall.
There, it comes in contact with the bowel and other organs. The mesh is designed to be safe and includes a barrier to keep it from adhering to organs.
“But increasingly, people are becoming less confident that the adhesion barriers work as well as they should,” Fitzgibbons said.
Adhesions are a kind of scar tissue that can form after almost any surgery. They can cause chronic pain, infertility and life-threatening bowel obstructions and even delay or complicate future surgeries.
The new procedure is intended to eliminate that contact. It adds a small incision to the laparoscopic operation, just enough to allow surgeons to place the mesh between the rectus muscle, better known as the “six-pack abs muscle,” and the abdominal cavity.
“The lining of the abdominal cavity is left intact so the mesh isn’t in contact with organs,” Fitzgibbons said.
Fitzgibbons recently practiced the new procedure at CUMC-Bergan Mercy with developer Dr. Wolfgang Reinpold, a surgeon at the Gross-Sand Hospital in Hamburg, Germany. The two have done missionary work together in the Dominican Republic and South America.
An open procedure, by contrast, requires a large incision. Surgeons also take apart layers of muscle to slide the mesh in. Patients typically spend three to four days in the hospital.
“This operation accomplishes the exact same thing with this hybrid approach with these minimally invasive instruments,” Fitzgibbons said.
Both the patients who underwent surgery during Reinpold’s visit, he said, went home the next day.
Fitzgibbons said the laparoscopic procedure is still acceptable, although surgeons are moving away from it. Concerns about isolating mesh from abdominal organs were discussed at a recent meeting of the American Hernia Society in Miami, which he attended. Fitzgibbons is a past president of the organization and editor of its journal, Hernia.
Reinpold and others recently published a study involving 615 of the procedures in the Annals of Surgery. Patients who had the hybrid procedure reported fewer complications after surgery and fewer hernia recurrences after a year than did those who underwent either the laparoscopic or open procedures.
Fitzgibbons said surgeons plan to begin offering the procedure at CUMC-Bergan Mercy within the next six weeks. They’re still awaiting the tool they’ll need to do it. They also plan to explore doing the procedure robotically.
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