His team cares for patients with complicated abdominal injuries, often from motor vehicle accidents or stabbings or shootings. “The challenges in managing such complex abdominal walls and open abdomens in our trauma population has helped us gain the experience to carry over into our complex hernia and fistula patients in general,” he describes.
Hernias develop when part of an organ protrudes from the wall of the cavity where it is contained. A fistula is an abnormal connection between hollow or tubular organs or the body surface.
In the past, patients who arrived at the Upstate University Hospital with major abdominal trauma would go straight to the operating room, where surgeons would work for hours to repair the injuries.
The outcomes were not great, so a “damage control” strategy has gained favor, Hassan says.
“We open the abdomen, go in and temporize, stop the bleeding, stop the contamination, temporarily take care of the injuries and leave the abdomen open and covered by a special dressing. The patients go back to the intensive care unit to be warmed, resuscitated, stabilized, and then come back to the operating room once, twice or many times until their abdomen is actually closed.”
This strategy can be employed for patients with complicated incisional or inguinal hernias, as well.
“We offer individualized treatment of different types of hernias based on each patient’s specific need and circumstance,” Hassan says.
Surgeons may offer traditional open surgery, minimally-invasive laparoscopic surgery or robotic-assisted laparoscopic surgery for hernia repair. They select the most appropriate reinforcement material for each patient — some receive mesh implants, while others will receive biological tissue grafts.
“The ultimate repair of the hernia is to be able to bring the patient’s muscles back together again, to give the patient the ability to function and move around, and also to reinforce the repair, usually from the undersurface. We assume at this point that the muscle is not strong enough and a hernia can occur again, so reinforcement is very important.”
Like many services at Upstate, care provided to hernia patients is multidisciplinary. Patients are likely to see not only their surgeon but also physical therapists, plastic surgeons, patient navigators and nutritionists.