Duke recently established a hernia surgery center dedicated to offering high-quality, multidisciplinary care to patients with abdominal wall defects, particularly those with challenging presentations.
 
“Hernia has become an increasingly complex problem,” says Jacob A. Greenberg, MD, EdM, director of the Duke Surgery Comprehensive Hernia Center established in the fall of 2022. “Patients are having more surgeries over the course of their lifetimes, with the defects becoming increasingly complex and difficult to fix. We felt we could achieve better outcomes and improve patient care by bringing together a group of specialists in a cohesive program where we can monitor quality, make sure we are doing a good job, and standardize care.”
 
Hernia repair has become more challenging because more patients are presenting with obesity and other co-morbidities, an increasing number of older patients are seeking surgery, and more patients with prior hernia surgeries are returning because of continuing problems.

Despite those trends, surgical advances such as minimally invasive techniques have improved outcomes. Laparoscopic and robotic techniques allow surgeons to perform complex operations via a 0.5-cm incision and minimize internal injuries. Patients can often return home the day of or the day after surgery, with recovery times shortened from months to weeks.
 
Greenberg, who also heads Duke’s Division of Minimally Invasive Surgery, says that an important focus of the center is optimizing a patient’s preparation for successful surgery. An increasing number of patients face additional hurdles to success because they are severely obese, have poorly controlled diabetes, are smokers, or are immunosuppressed after organ transplants.
 
“If we operate on those patients without improving their co-morbidities beforehand, our risk of failure is incredibly high,” Greenberg says. “So we spend a lot of time working with people in the weight management program, the smoking cessation program, or in other ways to mitigate their risk factors before we go to the operating room.”
 
“The hernia center team includes minimally invasive surgeons, plastic surgeons, and trauma and clinical care surgeons who meet twice a month to discuss complex patients, review our outcomes, and work to improve them,” Greenberg says. This case-by-case analysis by a team of specialists offers hope for the successful repair of recurrent hernias among patients who have experienced failed surgeries elsewhere and were told nothing more could be done.
 
The center is based in Durham at Duke University Hospital, but surgeons who participate in the center practice at Duke Raleigh Hospital, Duke Regional Hospital, and Cone Health Moses Cone Hospital in Greensboro.