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Hernias present a challenging problem with high recurrence rates. Put it simply, hernia repairs have high chance of failure in the short and long run. It could be a daunting and humbling experience for both the patient and the surgeon alike. Most hernias - if not repaired appropriately first time around - could set off a series of operations with even less chance of successful repair with every attempt. A classic randomized controlled trial by J. Burger, R.W. Luijendijk et al has demonstrated that recurrence rate for incisional hernia at 10 years could be as high as 63%.

It is generally well accepted that utilization of mesh reinforcement provides superior results to primary repair with suture - only joining of the tissues. Not all hernias are the same, and not every method of repair is similar or appropriate for a given patient or hernia. There are several issues that require attention before repair is attempted.

What kind of reinforcement should be used - synthetic or biologic? Which synthetic mesh or biologic matrix to choose from? Where to place it - above, within, or on top of abdominal wall? Tension- vs tension-free repair? What's the optimal technique of repair - laparoscopic vs open? Is it worthwhile to reconstruct retracted and scarred down abdominal wall through complicated component separation? What type of component separation - lateral or posterior, open or laparoscopic?

While the jury is still out on many of these issues, the wealth of scientific evidence published to date allowed our group to offer the most optimal and physiologic solution for even the most challenging and recurrent hernias.