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Prehabilitation, New Techniques improving Outcomes For Hernia Patients

Advance With MUSC Health
October 19, 2021
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An emphasis on abdominal core health focusing on prehabilitation and the use of novel techniques are improving outcomes for hernia patients at MUSC Health.

“Abdominal core health is a big change in the way we approach hernias and a key initiative of the Americas Hernia Society,” says Dr. Colston Edgerton, an MUSC Health board-certified general surgeon and assistant professor of surgery.

“We realize that emphasizing prehabilitation to optimize health before surgery, as well as the technical aspects of surgery and recovery pathways, all go into improving our patients’ outcomes and functional quality of life.”

Because a significant number of abdominal wall hernia patients have had prior surgeries and have underlying health conditions such as diabetes, obesity and are smokers, hernia surgery has expanded well beyond the surgery suite to manage these challenging cases.

MUSC Health has established the MUSC Abdominal Core Health and Hernia Center to optimize patient health before surgery. Instead of focusing only on the surgery, a team comprising surgeons, dietitians and physiotherapists considers modifiable risk factors, as well as functionality and quality outcomes, when evaluating a patient. Recommendations can range from smoking cessation to weight loss procedures in extreme cases.

Colston Edgerton

Novel minimally invasive techniques are also being used for increasingly complex cases.

“Robotic surgery has increased in popularity over the past decade. Hernia surgeons have embraced this technology to use abdominal wall anatomy to repair hernias in a durable but still minimally invasive fashion.”

The technology has been particularly useful for inguinal hernias and component separation in abdominal wall hernias because it facilitates primary fascial closure without risking the potential for morbidity from a larger incision required of open surgery, he says.

“Although a lot of these techniques were available in laparoscopic fashion, they are being adopted more widely with the robotic platform and offer advantages for patients and surgeons,” Dr. Edgerton says.

Specifically, the robot’s articulating instruments facilitate dissection and improve dexterity in suturing techniques, while improving ergonomics for the surgeon.

Minimally invasive surgery in hernia repair gets patients out of the hospital quicker, leads to faster recoveries, and minimizes the use of pain medications and post-operative complications.

Dr. Edgerton says the surgical community at large has embraced minimally invasive surgery, particularly as surgical education and training for the new techniques have become more formalized and structured.

He and his team also are using Botox to perform chemical component separations in giant hernias to decrease the size of the hernia defect. He injects it into the abdominal wall several weeks before surgery to paralyze and relax the muscles. The Botox facilitates primary fascial closure during surgery to decrease recurrence rates.

“It improves and facilitates what we can do in terms of abdominal wall reconstruction in extremely large hernias, with more data coming out on its effectiveness in the appropriate patient population” he says.

Dr. Edgerton says it’s an exciting time in hernia repair. “Hernia surgery has benefited from recognition as its own dedicated subspecialty with focused training paradigms and an explosion in research in the field,” he says.

“Because of the development of advanced minimally invasive techniques and the introduction of abdominal core health, we have the ability to individualize every patient’s treatment and help ensure that each patient has the best hernia repair possible. Our surgeons have broad training for a variety of techniques so that we can fit our skill set to the patient, not the patient to our skill set.”

In addition to hernia repair, Dr. Edgerton specializes in bariatric and metabolic surgery, foregut and anti-reflux surgery, as well as benign biliary disease. To make an appointment, call 843-792-8999.

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Keywords: Surgery