MELBOURNE HERNIA CENTRE

Uncompromising Excellence. Commitment to Care.

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Approximately 50,000 Australians have their hernias surgically repaired each year. Hernias occur when an organ like the intestines or fatty tissue protrude through a weakened area or defect in the abdominal wall or groin. Hernias can cause a noticeable bulge under the skin, as well as pain and discomfort. Most hernias need to be surgically repaired to prevent complications, reoccurrences and other serious problems. Hernia repair is one of the most common operations in Australia.

At Melbourne Hernia Centre, our Principal Surgeon Mr Steven Karametos has extensive experience evaluating and repairing all types and stages of hernias, including the most common inguinal hernia, umbilical hernia as well as very complex cases such as multiple recurrent hernias, sports hernia and those requiring complete abdominal wall reconstructions. He is always investing in training to offer the most up-to-date surgical techniques, such as hernia repair with absorbable mesh and robot-assisted hernia surgery. Mr Karametos is first hernia surgeon who is internationally accredited in Robotic Hernia Repair in Melbourne. Physician from across the country and around the world refer patients to us for hernia treatments based on our experience, outcomes and innovative management.

Expertise You Can Count On

Experience. Hernia surgery is what we do, and we do it well. Mr Karametos has personally performed and supervised more than 5,000 hernia repairs over the past decade. He is truely passitionate about hernia repair and has devoted the majoriy of his career to treating hernias. His patients include elite athletes and medical colleagues from around the country.
Recognised leadership. Regularly asked to share surgery best practices, Mr Karametos has trained hundreds of surgeons in Australia on simple and highly complex hernia procedures. He is an active member of several major global organisations for hernia surgeons.
Innovation treatments. Mr Karametos specialises in minimally invasive surgery, robotic surgery, and complex hernia repair such as recurrent incisional hernias. He offers the latest Laparoscopic Hernia Repair techniques including Robotic Hernia Repair to achieve superior, long-lasting results using a minimally invasive approach. He is also a leading hernia surgeon in Australia who performs Non-Mesh Hernia Surgeries using the revolutionary Biosynthetic Absorbable Mesh, this new mesh dissolves completely after hernia repair.
Comprehensive care. Under our care, patients receive the highest quality hernia evaluation and treatment. For complex hernia cases, we work closely with radiological and medical specialists to ensure the best outcomes.
Personalised care and planning. Surgery is only one part of the treatment plan we provide. Mr Karametos take the time to understand each patient’s needs and help them prepare for surgery so they understand what to expect before, during and after the procedure. A team of dedicated office staff is ready to assist and only a phone call away.

Meet Your Surgeon

I am a surgeon with a major interest in hernia surgery. Whilst I have embraced hernia as a speciality, I also maintain a practice in upper gastrointestinal surgery, weight loss surgery and all aspects of general surgery.

After graduating with Honours from Monash University Medical School in 1997 and completing surgical training at the Austin hospital in Melbourne, I obtained my Fellowship in General Surgery with the Royal Australasian College of Surgeons in 2007. I went on to complete advanced training in Upper Gastrointestinal Surgery at Queen Mary Hospital, Hong Kong. Since returning to Australia in 2009, I have trained in various specialised hernia centres in the United States, Europe and Australia.

Since I devoted the majority of my career to treating hernias, I have become a leading surgeon in laparoscopic hernia repair and I have taught the latest techniques to current surgeons as well as surgical trainees. Over the years, I have performed and supervised more than 5,000 hernia repairs.

With over 15 years experience in managing hernia surgical patients, I endeavour to provide a comprehensive and personalised service of the highest standard to each of my patient.

Publications:

In addition to operating, Mr Karametos is the author and co-author of a number of book chapters and articles in medical/ surgical journals covering a range of topics in general surgery.

Memberships & Positions Held:

European Hernia Society
AWR Surgeons (Abdominal Wall Reconstruction Surgeons)
Hernia U
Robotic Surgery Collaboration
International Hernia Collaboration
ANZGOSA
OSSANZ
IFSO
SAGES

Advanced Hernia Surgery

We offer 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:

The location and type of hernia
The extent of the weakness/tear
A patient’s unique needs and health status

Laparoscopic Hernia Repair

Mr Karametos performing a Laparoscopic Hernia Repair

During a Laparoscopic 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. These minimally invasive procedures can result in:

Less pain
Shorter hospital stays
Faster recoveries
Fewer complications, including a decreased risk of wound infections and chronic nerve pain

In the last 15 years, only 30% of surgeons adopted the laparoscopic approach internationally due to its high level of skill required and lengthy learning period. Most general surgeons are not trained in more advanced laparoscopic surgery and did not have the time to learn.

As a world-class hernia specialist surgeon, Mr Karametos is highly skilled in the following advanced laparoscopic hernia repair techniques:

TEP - Totally extraperitoneal Repair. Surgical dissection and mesh placement is performed outside of the peritoneal cavity in the pre-peritoneal space away from the visceral contents. Mesh does not come into contact with bowel or visceral organs. Usually utilised for inguinal hernia or femoral hernia.
eTEP - Extended view totally extraperitoneal. Same as TEP, but can be utilised for other hernia such as spigelian, ventral, incisional and large inguinal hernia.
eTEP Rives-Stoppa - places mesh in retro-rectus position in front of posterior sheath and away from visceral bowel contents. This technique is often utilised for larger incisional ventral hernia with abdominal wall reconstruction.
eTEP TAR - An extension of the eTEP Rives-Stoppa where a transversus abdominal muscle release is incorporated into the repair. This technique is often utilised for larger incisional ventral hernia with abdominal wall reconstruction.
TAPP/Plus - transabdominal preperitoneal with closure of defect. This technique is reserved for ventral, incisional, and flank hernia with abdominal wall reconstruction. 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.
IPOM - Intraabdominal only mesh. This technique places a coated mesh in the abdominal cavity. A relatively quick operation utilised for ventral and incisional hernia, that is reserved for older/frail patients who cannot tolerate a lengthy anaesthetic.

Complex Multiple Hernia Repair with Abdominal Wall Reconstruction

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 esthetically-improved result.

Robotic Hernia Repair- The future of Inguinal Hernia Repair

It was first introduced in 2014 in the U.S, and proven to provide patient outcomes never would have been possible previously. Robotic Inguinal Hernia Repair has all the advantages of the minimally invasive laparoscopic technique: small incisions, minimal pain, no infections, quick recovery time. Yet it is suitable for highly complex cases such as large recurrent inguinal hernia which would only be repaired openly otherwise. Minimally invasive hernia repair with the da Vinci Robotic Surgical System truely takes the human hand to the next level. Melbourne Hernia Centre is currently the only specialist centre who provides advanced Robotic Hernia Repair in Metropolitan Melbourne.

What is Robotic Hernia Repair like for patients?
Your surgeon sits at a console next to you and operates using tiny instruments through a few small incisions. The da Vinci Robot provides him with enhanced capabilities, including high-definition 3D vision and a magnified view. The increased dexterity and visualisation that allows the surgeon to safely perform an operation through small incisions. Every hand movement your surgeon makes is translated by the da Vinci robotic surgical system in real time to bend and rotate the instruments with precision.

A review of published studies along with our experience at Melbourne Hernia Centre suggests potential benefits of a robotic hernia repair include:

Patients who had a robotic hernia repair with da Vinci had a lower rate of complications after surgery from the time they left the hospital through 30 days after surgery compared with patients who had an open procedure.
Patients who had a robotic hernia repair with da Vinci technology stayed in the hospital as an inpatient for a shorter amount of time than patients with similar characteristics who had an open procedure.
Patients experience less pain, smaller scars, and quicker recovery compared with patients who had an open procedure.

The following operating video demonstrates how Mr Karametos repaired a Recurrent (Revisional) Inguinal Hernia utilising the robot-assisted laparoscopic approach.

Biosynthetic Absorbable Hernia Mesh

GORE® BIO-A® Tissue Reinforcement

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 non-mesh hernia repairs 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

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

Traditional Hernia Mesh

Permanent Hernia 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.

Open Hernia 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.

Local or General Anaesthesia for Hernia Repair

There are different types of anaesthesia that may be used in cases of hernia surgery. Most repairs are performed under general anaesthesia, however, local anaesthesia or spinal anaesthesia can be used depending on the type of repair and patient general health. Mr Karametos will discuss the options with you during your consultation.

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 2 to 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. The usual rule is not to lift anything greater than 5kg for a total of 6 weeks.

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.
Do not lift anything greater than 5kg for a total of 6 weeks
Avoid strenuous activities, such as biking, jogging, weight-lifting, or aerobic exercise, until advised by Mr Karametos.
Most people are able to return to work within 1 after surgery. However, if your employment requires heavy lifting or strenuous activity, you may need to take 3 to 6 weeks off from work. Our office staff is able to issue you the Certificate of Capacity and Return to Work Certificate.
Take the dressings off on day 7 post surgery.
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.
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 24hrs
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.

Recovery After Laparoscopic/ Endoscopic 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.

Recovery After 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.

Further Reading (ref: American College of Surgeons)

There are many types of hernias and many types of hernia repair operations. We perform them all, but the right operation for you will depend on many factors. All operations should be individualised to meet your specific goals and expectations. Please read the following resources for a comprehensive overview of the most common types of hernias, which also include surgery preparation and recovery after hernia repair.

Inguinal Hernia Repair, Groin Hernia, Femoral Hernia- Patient Education
Ventral Hernia Repair- Patient Education
Umbilical (belly button) Hernia Repair- Patient Education