Please visit Melbourne Hernia Centre
Understanding Hernias
A Hernia is an out-pouching of intra-abdominal contents through a defect, or hole in the muscle. The abdominal muscles and bones of the pelvis prevent abdominal contents from drooping out under normal circumstances. The skin and fat below the skin do not provide any strength and stretch if there is a hernia present. Hernias can occur anywhere in the abdomen, but most commonly occur at weak points where a small tear can start, and enlarge over time.
Hernias can develop due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age.
Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. The common areas where hernias occur are in the groin (inguinal and femoral), belly button (umbilical), and the site of a previous treatment or surgical operation (incisional). Both men and women can get a hernia. It does not get better over time, nor will it go away by itself.
It is usually easy to recognise a hernia. Common symptoms are:
If you have any symptoms of a hernia or are concerned you might have one, see your GP and they can decide if you need to see a surgeon. You will need a GP referral to see Mr Karametos at Melbourne Hernia Centre for specialist assessment and treatment.
Hernias do not repair themselves. Over time hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the hernia will develop a complication.
Hernias can develop due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age.
Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. The common areas where hernias occur are in the groin (inguinal and femoral), belly button (umbilical), and the site of a previous treatment or surgical operation (incisional). Both men and women can get a hernia. It does not get better over time, nor will it go away by itself.
It is usually easy to recognise a hernia. Common symptoms are:
- A bulge or bump in the groin area or at the belly button or abdomen
- Pain, discomfort or 'dragging' sensation at the site, especially after working, straining, lifting or bending
- Burning or gurgling sensation in the groin or abdominal wall
- Pressure sensation in the abdominal wall or groin
If you have any symptoms of a hernia or are concerned you might have one, see your GP and they can decide if you need to see a surgeon. You will need a GP referral to see Mr Karametos at Melbourne Hernia Centre for specialist assessment and treatment.
Hernias do not repair themselves. Over time hernias tend to get bigger as the defect in the muscle stretches to allow more abdominal contents to slip in and out. As time goes on there is a risk that the hernia will develop a complication.
- Incarceration occurs with a long term hernia where the contents come out and stay out and are unable to be pushed back in. This often causes discomfort or mild to moderate pain.
- Strangulated hernia is a medical emergency and requires prompt attention at hospital. Strangulation is where in the short term the contents come out and can not be pushed back in, and where the defect causes such pressure on the blood vessels that the contents are starved of blood supply. This causes swelling, and severe pain.
Hernia Risk Factors
Many hernias are the result of a defect or weakness in the abdominal wall that was present at birth. There are also conditions and habits that can increase one’s risk of developing a hernia.
Potential risk factors for a hernia include:
Potential risk factors for a hernia include:
- Chronic cough
- Smoking
- Obesity
- Repetitive lifting of heavy objects
- Straining when lifting heavy objects
- Straining during bowel movements or urination
- Pregnancy
- Certain medications, such as steroids
- Previous abdominal surgery
Types of Hernias We Treat
Hernia in General: Hernias are considered as a weakness, defect, or 'hole' in the abdominal wall or other structure through which tissue or organs can move outside from their normal location. Mr Steven Karametos individualises each hernia and its treatment according to its location, contents, the age and medical status of the patient, symptoms it may be causing including pain or intestinal issues, and an assessment of the hernia's risk to the patient and the risk of surgery to repair it.
The key reason to repair a hernia in an adult is that they so not heal themselves, they tend to get larger with time, they often become painful and can strangulate. Strangulation is where bowel, organs or tissue become trapped in the hernia, gets starved of blood supply then becomes ischaemic or dies. Strangulation is life threatening and requires an emergency operation. Upon your initial consultation with Mr Steven Karametos, he will assess all these considerations especially the latter one and discuss with you.
Inguinal Hernia: Mr Steven Karametos manages inguinal hernias on a daily basis. Inguinal hernias are among the most common of the abdominal wall hernias accounting for almost 75% with a life time risk of 27% in men and 3% in women. These hernias tend to form in the area where the blood vessels to the testicles move through the abdominal wall in men or where a small ligament to the uterus attaches in women. This area is a persistent area of potential weakness throughout one's life. Inguinal hernia can also arise right beside this area, in the floor of the groin. The exact location of the hernia does not impact how the repair is initiated. The operation to repair both types is very similar.
Abdominal Ventral/Incisional Hernia: Ventral or abdominal hernias occur when the intestine or other abdominal contents push through a weakness or 'hole' in the abdominal wall. If the bulge occurs in the area of a previous surgical incision, these hernias are referred to as incisional hernias. Hernias can develop in these incisions during the weeks, months or even years after the initial operation. These are many factors that can affect the formation of an incisional hernia including smoking, being overweight, diabetes, and a person's genetics which dictates the type of healing tissue the patient naturally forms after a surgical incision.
Femoral Hernia: Femoral hernias are often categorised with and compared to inguinal hernias, but they occur just under the groin. They are most common in women, but men do develop them as well. They occur when there is a weakness near the blood vessels travelling from the abdomen to the upper thigh. They are hard to distinguish from inguinal hernias on a physical examination. They carry a significant risk of strangulation.
Hiatal Hernia: Hiatal hernias occur when the stomach slides up through the diaphragm into the chest. Paraesophageal hernias are more dangerous and occur when part of the stomach is free enough to twist on itself. This can lead to significant symptoms and even strangulation, which would require emergency medical care and surgical correction. These hernias are not abdominal wall hernias and are treated in a very different way from inguinal and ventral or incisional hernias. Hiatal hernia and Paraesophageal hernia are part of Mr Karametos's speciality and interest, please make an appointment for further assessment.
Umbilical Hernia: An umbilical hernia occurs in the naturally weakened area of the navel where the umbilical cord was attached as an infant. When seen in babies or small children these hernias frequently get smaller on their own as the child ages. In adults these hernias do not close on their own and the only way to treat them is through surgery.
Spigelian Hernia: Spigelian hernias are technically ventral hernias, as they form in the abdominal wall. These hernias are uncommon and unique because they form between the layers of muscle of the abdomen wall. They cary a high risk of strangulation. Mr Karametos has pioneered an endoscopic, keyhole technique for repairing spigelian hernia without entering the abdominal cavity.
The key reason to repair a hernia in an adult is that they so not heal themselves, they tend to get larger with time, they often become painful and can strangulate. Strangulation is where bowel, organs or tissue become trapped in the hernia, gets starved of blood supply then becomes ischaemic or dies. Strangulation is life threatening and requires an emergency operation. Upon your initial consultation with Mr Steven Karametos, he will assess all these considerations especially the latter one and discuss with you.
Inguinal Hernia: Mr Steven Karametos manages inguinal hernias on a daily basis. Inguinal hernias are among the most common of the abdominal wall hernias accounting for almost 75% with a life time risk of 27% in men and 3% in women. These hernias tend to form in the area where the blood vessels to the testicles move through the abdominal wall in men or where a small ligament to the uterus attaches in women. This area is a persistent area of potential weakness throughout one's life. Inguinal hernia can also arise right beside this area, in the floor of the groin. The exact location of the hernia does not impact how the repair is initiated. The operation to repair both types is very similar.
Abdominal Ventral/Incisional Hernia: Ventral or abdominal hernias occur when the intestine or other abdominal contents push through a weakness or 'hole' in the abdominal wall. If the bulge occurs in the area of a previous surgical incision, these hernias are referred to as incisional hernias. Hernias can develop in these incisions during the weeks, months or even years after the initial operation. These are many factors that can affect the formation of an incisional hernia including smoking, being overweight, diabetes, and a person's genetics which dictates the type of healing tissue the patient naturally forms after a surgical incision.
Femoral Hernia: Femoral hernias are often categorised with and compared to inguinal hernias, but they occur just under the groin. They are most common in women, but men do develop them as well. They occur when there is a weakness near the blood vessels travelling from the abdomen to the upper thigh. They are hard to distinguish from inguinal hernias on a physical examination. They carry a significant risk of strangulation.
Hiatal Hernia: Hiatal hernias occur when the stomach slides up through the diaphragm into the chest. Paraesophageal hernias are more dangerous and occur when part of the stomach is free enough to twist on itself. This can lead to significant symptoms and even strangulation, which would require emergency medical care and surgical correction. These hernias are not abdominal wall hernias and are treated in a very different way from inguinal and ventral or incisional hernias. Hiatal hernia and Paraesophageal hernia are part of Mr Karametos's speciality and interest, please make an appointment for further assessment.
Umbilical Hernia: An umbilical hernia occurs in the naturally weakened area of the navel where the umbilical cord was attached as an infant. When seen in babies or small children these hernias frequently get smaller on their own as the child ages. In adults these hernias do not close on their own and the only way to treat them is through surgery.
Spigelian Hernia: Spigelian hernias are technically ventral hernias, as they form in the abdominal wall. These hernias are uncommon and unique because they form between the layers of muscle of the abdomen wall. They cary a high risk of strangulation. Mr Karametos has pioneered an endoscopic, keyhole technique for repairing spigelian hernia without entering the abdominal cavity.
Complex Hernia
Multiple hernia repairs? Mr Steven Karametos is a leading Australian surgeon who specialises in lasting, permanent complex hernia repair. In recent years, the complexity of patients and difficulty of hernia repair has dramatically increased. A growing number of patients have large or complex hernia and abdominal wall defects. These defects may be the result of an incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, or catastrophic injury or infection.
In cases of multiple previous failed hernia repairs or catastrophic injury to the abdominal wall, or for very large hernia, advanced hernia repair techniques are often required to reconstruct the abdominal wall properly.
The goal of complex hernia repair with abdominal wall reconstruction is to repair the hernia defect, reinforce the abdominal wall to prevent recurrences or other hernias from developing, recover abdominal wall functionality, prevent intraabdominal organs from protruding through the abdominal wall, and provide a cosmetically-pleasing appearance. During the procedure, the abdominal muscles may need to be rearranged in order to close the hernia defect. The abdominal wall is then reinforced with mesh which may be absorbable.
At Melbourne Hernia Centre, Mr Steven Karametos is highly skilled in the following world-leading techniques specifically designed to repair ventral and incisional hernia with abdominal wall reconstruction:
eTEP Rives-Stoppa - places mesh in retro-rectus position infront of posterior sheath and away from visceral bowel contents. Utilised for larger incisional ventral hernia.
eTEP TAR - An extension of the eTEP Rives-Stoppa where a transverses abdomens muscle release is incorporated into the repair.
TAPP/Plus - transabdominal preperitoneal with closure of defect. Reserved for ventral, incisional, and flank hernia. Involves lifting a flap of peritoneum, closing the fascial defect then placing and securing an uncoated mesh. The operation is finished with closure of the peritoneal defect. Probably best done robotically.
The end result of this complex abdominal wall reconstruction is a restored, physiologic and functional abdominal wall with enough strength and flexibility to withstand physical activity and to improve quality of life. When performed properly by specially trained surgeons, complex hernia repair generally has a low rate of relapse, resulting in a long-term functional repair with an aesthetically-improved result.
In cases of multiple previous failed hernia repairs or catastrophic injury to the abdominal wall, or for very large hernia, advanced hernia repair techniques are often required to reconstruct the abdominal wall properly.
The goal of complex hernia repair with abdominal wall reconstruction is to repair the hernia defect, reinforce the abdominal wall to prevent recurrences or other hernias from developing, recover abdominal wall functionality, prevent intraabdominal organs from protruding through the abdominal wall, and provide a cosmetically-pleasing appearance. During the procedure, the abdominal muscles may need to be rearranged in order to close the hernia defect. The abdominal wall is then reinforced with mesh which may be absorbable.
At Melbourne Hernia Centre, Mr Steven Karametos is highly skilled in the following world-leading techniques specifically designed to repair ventral and incisional hernia with abdominal wall reconstruction:
eTEP Rives-Stoppa - places mesh in retro-rectus position infront of posterior sheath and away from visceral bowel contents. Utilised for larger incisional ventral hernia.
eTEP TAR - An extension of the eTEP Rives-Stoppa where a transverses abdomens muscle release is incorporated into the repair.
TAPP/Plus - transabdominal preperitoneal with closure of defect. Reserved for ventral, incisional, and flank hernia. Involves lifting a flap of peritoneum, closing the fascial defect then placing and securing an uncoated mesh. The operation is finished with closure of the peritoneal defect. Probably best done robotically.
The end result of this complex abdominal wall reconstruction is a restored, physiologic and functional abdominal wall with enough strength and flexibility to withstand physical activity and to improve quality of life. When performed properly by specially trained surgeons, complex hernia repair generally has a low rate of relapse, resulting in a long-term functional repair with an aesthetically-improved result.
Advanced Hernia Surgery Options
Mr Steven Karametos offers a range of both traditional (open) and minimally invasive surgical procedures for hernia repair. Mr Karametos tailors the treatment approach for each patient. How a hernia is fixed will depend on:
Laparoscopic Hernia Repair or Robot-assisted Hernia Repair
Several tiny incisions or keyholes are made in the abdomen. Small instruments guided by a camera are used to repair the hernia with mesh, stitches and/or mechanical fixation. Laparoscopic and robotic hernia repair procedures can result in:
Open Surgery
An incision is made near the hernia or through a previous incision. If there is protruding tissue, it will be pushed back into place, and Mr Karametos will repair the weak spot where the hernia occurred. More complex hernia procedures may involve reconstructing and/or rearranging muscles and connective tissue in the abdomen to repair the hernia. In these cases Mr Karametos may use a patient’s own tissue (called flaps) and surgical mesh to help strengthen the abdominal wall, restore function and prevent another hernia.
Biosynthetic Absorbable Mesh
In recent years, biosynthetic absorbable mesh has become available for some types of hernia surgery. Mr Karametos is one of the leading hernia surgeons in Australia who specialises in using the absorbable mesh. After surgery, It disappears completely leaving behind collagen that strengthens the repair. Its key benefits include:
Traditional Mesh
The traditional mesh is a woven sheet of surgical-grade material – is often used to strengthen or repair weakened areas in the abdomen and reduce the chances the hernia will come back. Using mesh also reduces pain and tension on the surgical wound. It can be placed through both laparoscopic and open procedures. Mr Karametos has extensive experience safely using these materials in thousands of patients. We also follow up with patients to make sure what we do today and long-term is safe, prevents hernias from happening again and preserves quality of life. Help Shaping the Future of Hernia Repair - Biosynthetic Absorbable Mesh
Mr Steven Karametos is dedicated to providing excellence in hernia repair, and continually invests in training to offer the most up-to-date surgical techniques. Mr Karametos also studies new approaches and repair devices that are helping to advance the field and benefit patients. For instance, the Biosynthetic Absorbable Mesh was first introduced in 2008 as GORE® BIO-A® Tissue Reinforcement. It is composed of a bioabsorbable material which has years of positive outcomes data supporting its use. The Biosynthetic Absorbable Mesh is now available in Australia, and Mr Karametos is one of the leading hernia surgeons in Melbourne who utilises it for some types of hernia surgery. It is designed for performance in complex hernia repairs.
GORE® BIO-A® Tissue Reinforcement is a unique biosynthetic web scaffold made of 67% polyglycolic acid (PGA) : 33% trimethylene carbonate (TMC) designed for soft tissue reinforcement procedures.
GORE® BIO-A® Tissue Reinforcement is a leading product for economic value, providing cost saving benefits and quality patient outcomes. Exceptional performance and features include:
The material is versatile and suitable for a variety of applications, including:
- The location and type of hernia
- The extent of the weakness/tear
- A patient’s unique needs and health status
Laparoscopic Hernia Repair or Robot-assisted Hernia Repair
Several tiny incisions or keyholes are made in the abdomen. Small instruments guided by a camera are used to repair the hernia with mesh, stitches and/or mechanical fixation. Laparoscopic and robotic hernia repair procedures can result in:
- Less pain
- Shorter hospital stays
- Faster recoveries
- Fewer complications, including a decreased risk of wound infections and chronic nerve pain
Open Surgery
An incision is made near the hernia or through a previous incision. If there is protruding tissue, it will be pushed back into place, and Mr Karametos will repair the weak spot where the hernia occurred. More complex hernia procedures may involve reconstructing and/or rearranging muscles and connective tissue in the abdomen to repair the hernia. In these cases Mr Karametos may use a patient’s own tissue (called flaps) and surgical mesh to help strengthen the abdominal wall, restore function and prevent another hernia.
Biosynthetic Absorbable Mesh
In recent years, biosynthetic absorbable mesh has become available for some types of hernia surgery. Mr Karametos is one of the leading hernia surgeons in Australia who specialises in using the absorbable mesh. After surgery, It disappears completely leaving behind collagen that strengthens the repair. Its key benefits include:
- Innovative material: Uniquely designed web of biocompatible synthetic polymers that is gradually absorbed by the body
- Alternative to biologics: As a biosynthetic tissue-building scaffold, it is not derived from human or animal tissue but engineered for uniformity, consistency, and versatility
- Consistent absorption: Absorbed within six to seven months, leaving no permanent material behind in the body
- Quality tissue fast: Facilitates rapid cellular infiltration and vascularisation
Traditional Mesh
The traditional mesh is a woven sheet of surgical-grade material – is often used to strengthen or repair weakened areas in the abdomen and reduce the chances the hernia will come back. Using mesh also reduces pain and tension on the surgical wound. It can be placed through both laparoscopic and open procedures. Mr Karametos has extensive experience safely using these materials in thousands of patients. We also follow up with patients to make sure what we do today and long-term is safe, prevents hernias from happening again and preserves quality of life. Help Shaping the Future of Hernia Repair - Biosynthetic Absorbable Mesh
Mr Steven Karametos is dedicated to providing excellence in hernia repair, and continually invests in training to offer the most up-to-date surgical techniques. Mr Karametos also studies new approaches and repair devices that are helping to advance the field and benefit patients. For instance, the Biosynthetic Absorbable Mesh was first introduced in 2008 as GORE® BIO-A® Tissue Reinforcement. It is composed of a bioabsorbable material which has years of positive outcomes data supporting its use. The Biosynthetic Absorbable Mesh is now available in Australia, and Mr Karametos is one of the leading hernia surgeons in Melbourne who utilises it for some types of hernia surgery. It is designed for performance in complex hernia repairs.
GORE® BIO-A® Tissue Reinforcement is a unique biosynthetic web scaffold made of 67% polyglycolic acid (PGA) : 33% trimethylene carbonate (TMC) designed for soft tissue reinforcement procedures.
GORE® BIO-A® Tissue Reinforcement is a leading product for economic value, providing cost saving benefits and quality patient outcomes. Exceptional performance and features include:
- Innovative material: Uniquely designed web of biocompatible synthetic polymers that is gradually absorbed by the body.
- Alternate to biologics: As a biosynthetic tissue-building scaffold, it is not derived from human or animal tissue but engineered for uniformity, consistency, and versatility.
- Consistent absorption: Absorbed within 6 to 7 months, leaving no permeant material behind in the body.
- Quality tissue fast: Facilitates rapid cellular infiltration and vascularisation.
The material is versatile and suitable for a variety of applications, including:
- Paraesophageal/ hiatal hernia repair
- Abdominal wall reconstruction
- Stoma reversal procedures
- Muscle flap reinforcement
- General tissue reconstructions
Recovery After Hernia Surgery
What to Expect
Most patients go home on the day of or the day after surgery. Sutures are dissolving and buried, dressings stay on for 7 days. You may eat and drink normally, and walk around straight away. A follow-up appointment with Mr Karametos is made for 1 week after surgery. You will need to wait 5 days before returning to driving. There will be lifting and exercise restrictions for a period of time after surgery that will vary according to the type of hernia repaired and technique used for repair.
After surgery to repair your hernia you may have discomfort that may be slight with keyhole surgery or greater with large open operations. Our team of anaesthetists will provide you with pain medication on discharge.
Care at Home
Laparoscopic or Robotic Hernia Repair
Most people who have laparoscopic hernia repair surgery are able to go home the same day. Recovery time is about 1 to 2 weeks. You most likely can return to light activity after 1 to 2 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Studies have found that people have considerably less pain after laparoscopic hernia repair than after open hernia repair. Laparoscopy surgery is also less likely to cause wound infections or chronic pain when compared to open surgery.
Open Hernia Repair
Most people who have open hernia repair surgery are able to go home the same day. Recovery time is about 3 weeks. You most likely can return to light activity after 3 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Don't do anything that causes pain.
Call our office if you have any of these symptoms:
Most patients go home on the day of or the day after surgery. Sutures are dissolving and buried, dressings stay on for 7 days. You may eat and drink normally, and walk around straight away. A follow-up appointment with Mr Karametos is made for 1 week after surgery. You will need to wait 5 days before returning to driving. There will be lifting and exercise restrictions for a period of time after surgery that will vary according to the type of hernia repaired and technique used for repair.
After surgery to repair your hernia you may have discomfort that may be slight with keyhole surgery or greater with large open operations. Our team of anaesthetists will provide you with pain medication on discharge.
Care at Home
- Rest when you feel tired. Getting enough sleep will help you recover.
- Drink plenty of fluids to keep yourself hydrated.
- Try to walk each day. Start by walking a little more than you did the day before and increase the amount you walk gradually. Walking boosts blood flow and helps prevent pneumonia and constipation.
- If you are given an abdominal binder to wear, use it as directed. This is an elastic bandage that wraps around your belly and upper hips. It helps support your belly muscles after surgery.
- Avoid strenuous activities, such as biking, jogging, weight-lifting, or aerobic exercise, until advised by Mr Karametos.
- Wait at least 5 days before returning to driving.
- Most people are able to return to work within 1 to 2 weeks after surgery. However, if your employment requires heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work. Our office staff is able to issue you the Certificate of Capacity and Return to Work Certificate.
- You may shower after surgery as you have waterproof dressings. Do not take a bath or swim for the first 2 weeks.
- It is common to experience irregular bowel movements after surgery. Avoid constipation so you may want to take a soluble fibre supplement such as Metamucil every day . If you have not had a bowel movement after a couple of days, take a mild laxative such as Movichol or Coloxyl with Senna.
- Mr Karametos will tell you if and when you can restart your usual medicines including any blood thinners. He will also give you instructions about taking any new medicines including antibiotics and painkillers.
- If you have dressings on the incision, leave them until you see Mr Karametos at the follow up appointment.
- Do breathing exercises at home as instructed. This will help prevent pneumonia.
- If you had laparoscopic surgery, you may also have pain in your left shoulder. The pain usually lasts about a day or two.
- It is important to attend the post op appointment with Mr Karametos on the scheduled date. Call our office if you are not able to.
Laparoscopic or Robotic Hernia Repair
Most people who have laparoscopic hernia repair surgery are able to go home the same day. Recovery time is about 1 to 2 weeks. You most likely can return to light activity after 1 to 2 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Studies have found that people have considerably less pain after laparoscopic hernia repair than after open hernia repair. Laparoscopy surgery is also less likely to cause wound infections or chronic pain when compared to open surgery.
Open Hernia Repair
Most people who have open hernia repair surgery are able to go home the same day. Recovery time is about 3 weeks. You most likely can return to light activity after 3 weeks. Strenuous exercise should wait until after 6 weeks of recovery. Don't do anything that causes pain.
Call our office if you have any of these symptoms:
- The incision is noticeably warm and red.
- A groin is hard and swollen.
- You have a fever.
