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A 50-year-old man who underwent a previous intestinal resection presented with a large mid-abdominal hernia. Two previous hernia repairs had failed and resulted in hernia recurrences. At presentation to the UH Comprehensive Hernia Center, he was experiencing significant abdominal discomfort and couldn't exercise or perform his usual daily activities. Dr. Yuri Novitsky performed abdominal wall reconstruction and ventral hernia repair. The patient had a successful recovery and resumed his usual activities four weeks after surgery. Dr. Rosen and Dr. Novitsky specialize in the treatment of recurrent and failed hernia repairs. In fact, Dr. Rosen's practice is focused almost 100 percent on repairing recurrent hernias. Recurrent hernias occur from an incisional wound infection, improper healing or inadequate or incorrect repair during the initial procedure. The most complicated recurrent hernias require abdominal wall reconstruction. This used to be done through a large abdominal incision, which had substantial morbid- ity. Dr. Rosen, however, developed minimally invasive techniques for fascial advancement procedures to reconstruct a functional dynamic abdominal wall. "The goal is to bring back together the patient's muscles the way they were meant to be, so the patient can lead a much more functional normal life. This involves layer-by-layer remodeling of the diseased abdominal wall and the use of the newest mesh materials to promote reliable reinforcement of the tissues," says Dr. Rosen, who has taught literally hundreds of surgeons from around the world the 'component separation' technique he pioneered. A hernia is actually a disease that afflicts 1 in 10 people, 4 in 10 over the age of 50. For the most part, most people with hernias are generally in poor health and suffer from afflictions such as obesity, diabetes, chronic constipation, and prostate problems. "We've had obese patients whose organs are pushing through a rupture in their abdominal wall or diaphragm," says Dr. Rosen. "Many doctors incorrectly think there's no hope for these patients. We take them on, no matter how chal- lenging the case, and we have a track record of succeeding. We get the best outcomes you can get for both routine and challenging cases." For obese patients with hernias, the Comprehensive Hernia Center surgeons work closely with bariatric surgeons. They also work with other specialists as needed to support their patients before and after surgery with smoking cessa- tion, nutrition optimization, and other healthcare programs. In the research lab, Dr. Rosen and Dr. Novitsky are investigating implant- able bio-materials and novel bio-adhesives to improve outcomes. Dr. Rosen has been researching several novel meshes, includ- ing an antibiotic-releasing mesh to reduce post-operative infections. Dr. Novitsky, who is director of Surgical Research at 32 | Cleveland-Akron-Canton MD NEWS ■ MDNEWS.COM ■ SEPTEMBER-OCTOBER 2012 UH Case Medical Center, is studying the optimization of biologic mesh and bio- adhesives for less painful mesh fixation in hernia repairs. His research is supported by an NIH-funded grant. In the lab, as well as in the OR, the objective is to provide a durable and lasting repair with minimal discom- fort and a fast and complete recovery. By striving for the best results the first time, Dr. Rosen believes the risks of chronic pain and longterm recurrence problems for patients are drastically reduced. "The best time to fix a hernia is the first time you fix that hernia. That's one of the advantages of having a comprehensive hernia center," he says. "The hernia gets fixed right the first time, and the patient goes on to live a normal life." The Comprehensive Hernia Center at University Hospitals is located at UH Case Medical Center with a satellite center at UH Geauga Medical Center. Patients can also be seen on an outpatient basis at UH Chagrin Highlands Health Center, UH Westlake Health Center and UH Twinsburg Health Center. For more information, visit www.UHHospitals.org. To refer a patient, call the Comprehensive Hernia Center at 216-844-2763. ■ PHOTOS COURTESY OF DR. YURI NOVITSKY, UNIVERSITY HOSPITALS CASE MEDICAL CENTER