A decade ago, certain hernias were quietly categorized as unfixable. These included patients with large abdominal wall hernias that already failed one or more prior repairs, patients with significant comorbidities, and patients who had already undergone numerous operations who were then told there are no remaining options.
That framework has changed.
“The way we treat hernias has changed significantly over the last five to ten years,” says Andrew Robinson, MD, Director of the Atlantic Health Hernia Center at Overlook Medical Center.
For Dr. Robinson, the creation of the Hernia Center reflects a broader evolution in the field. Hernia surgery has matured into a focused subspecialty driven by advanced imaging, deeper anatomical understanding, and transformative technology.
A Specialty Within a Specialty
Dr. Robinson treats a wide spectrum of patients, from young individuals with small primary hernias to medically complex patients with large, recurrent defects who have often been evaluated elsewhere and declined.
Many of those patients, he explains, arrive after being told their hernia cannot or should not be repaired. Advances in technique and technology are changing that conversation.
Robotic platforms now allow surgeons to access anatomical planes that were previously difficult to visualize and dissect. Combined with a more refined understanding of abdominal wall physiology, these advances have expanded what is surgically feasible.
“Robotics has allowed us to dissect into planes and see anatomy that was truly invisible to the naked eye a decade ago,” Dr. Robinson notes.
At Atlantic Health, that capability is supported by a deliberate build-out of expertise. The Hernia Center includes fellowship-trained abdominal wall surgeons and a high-volume program capable of managing both straightforward and highly complex pathology.
The goal is not simply to repair defects, but to restore function with durability.
Changing the Risk Conversation
One of the most meaningful shifts in hernia care is the redefinition of candidacy. Patients previously considered too old or too medically complex for repair may now be appropriate surgical candidates.
“With minimally invasive approaches, patients do so well,” Dr. Robinson says, noting that procedures once associated with prolonged hospital stays can, in selected cases, now be performed on an outpatient basis.
This does not mean every patient should undergo surgery. The Hernia Center’s philosophy remains individualized and measured. In some cases, expert evaluation leads to reassurance rather than operative intervention.
“We may not always recommend surgery,” he says, “but we will always give our expert opinion and offer the best care available.”
Complex Abdominal Wall Reconstruction
For large ventral and incisional hernias, complex abdominal wall reconstruction often provides the most durable solution. These repairs involve separating the muscle layers of the abdominal wall to restore midline anatomy and placing mesh within those layers to reinforce the repair.
Without addressing the underlying physiology of the abdominal wall, recurrence risk increases. “If you were to just put a mesh above or below and not change the physiology of the abdominal wall itself, those hernias would generally recur,” Dr. Robinson explains.
Advanced imaging plays a central role in planning. High-definition CT scanning allows surgeons to visualize abdominal wall planes and often identify the precise location of previously placed mesh.
“We can look at a CT scan and essentially predict what that repair is going to look like,” he says. “We can decide which modality will best serve that patient.”
Some patients benefit from a complex robotic reconstruction. Others require an open approach to achieve durable restoration. The decision is guided by anatomy, prior operative history, and patient-specific risk factors.
Built Around Multidisciplinary Care
What distinguishes the Atlantic Health Hernia Center is not only surgical technique but infrastructure.
The program integrates radiology, infectious disease, dietetics, weight management, plastic surgery, and specialized perioperative nursing support. Data collection and outcomes monitoring are embedded within the structure.
“Not only do we have world-class surgeons,” Dr. Robinson says, “but we have world-class facilities, technology, and staff.”
This multidisciplinary model allows the Hernia Center to evaluate and optimize patients who might otherwise be deemed too high risk.
A True Partnership
Dr. Robinson views hernia care as a partnership among surgeon, patient, and referring physician.
“My treatment goals are first to understand the patient and second to understand their problem,” he explains. “Then I want everyone involved to understand and be confident in the plan.”
Communication with referring physicians is direct and ongoing, whether through the electronic medical record, phone calls, or secure messaging. Maintaining continuity is central to the program’s philosophy.
Referral criteria are intentionally broad. Confirmation of a hernia or even suspicion of a painful or potentially dangerous defect warrants evaluation.
“If there’s confirmation or even suspicion of a hernia,” he says, “that’s a reason to refer.”
Measurable Impact
When asked why he chose surgery, Dr. Robinson points to immediacy. He values the ability to make a meaningful difference in a patient’s life in a tangible way.
That impact is particularly evident in patients who have lived for years with complex abdominal wall issues. He recalls a long-standing patient with multiple prior operations and chronic bandaging needs who ultimately underwent definitive reconstruction.
After surgery, the change was dramatic. Less pain. Greater confidence. A return to normal daily life.
For Dr. Robinson, those outcomes underscore what the Hernia Center represents: a shift from limitation to possibility, grounded in advanced technique, disciplined planning, and collaborative care.
To refer a patient or discuss a complex case with our hernia specialists, contact the Atlantic Health Hernia Center at 908-522-5794.