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Recurrent hernias can be dangerous: Laparoscopic surgery the way forward to correct complicated hernias

·         46-year-old with multiple recurrent hernias of the abdominal wall treated at Paras Hospitals, Gurgaon with laparoscopic repair

Gurgaon, 19 March, 2015: A common but understated health problem, hernias of the abdominal wall affect a large number of people and need surgical correction to prevent further complications. However, in some cases an abdominal wall tears up again after a surgery leading to serious potential complications on the health of the patient.

One such case was presented at Paras Hospitals, Gurgaon recently involving a 46-year-old man with recurrent hernias in the groin and umbilical areas. In fact, the hernias in the left groin and umbilical region had become so huge that the intestines were stuck, and threatened dangerous consequences if a permanent treatment was not initiated.

Prashant (name changed) had already been operated twice for the groin hernias and once for the umbilical hernia by the conventional open technique over the last three years. However his hernias reoccurred at all the three sites.

After examining his case, the doctors at Paras Hospitals, Gurgaon realized that conventional open surgery was not working in the case and decided to perform laparoscopic repair surgery (key hole surgery) for all the three hernias in the same sitting.

A hernia happens when an organ pushes and tears up a weak area, tissue or muscle and bulges out of its assigned space. Most common hernias happen in the abdomen. For example, intestines may break through the muscles in a weakened area of the abdominal wall.  Though most common in the abdomen, hernias also appear in the thigh and groin areas.

“The only way to effectively treat a hernia and provide lasting relief is to have it surgically corrected. Hernia surgery has undergone a major revolution because of the advent of laparoscopy especially in recurrent hernias which are considered as complicated hernias.  Laparoscopic repair has been proved to be having better results than conventional open surgery especially because of reduced post operative pain, post operative wound infection, reduced hospital stay and earlier return to work,” says Dr Meenakshi Sharma, Sr Consultant, gen & Laparoscopic surgery, Paras hospitals.

In conventional open surgery for hernia, an incision of three to four inches is made into the skin right down to the tear from which an organ is bulging out. The organ is pushed back to its place, and the tear or hole is repaired with the help of a surgical mesh.

 In the case of laparoscopic hernia repair, there is no need of a large incision. Rather, three tiny incisions are made in the abdominal wall through which a mini camera and surgical instruments are inserted into the hernia to repair the damage. This involves no cutting into the muscles and tissues and logically causes much less trauma and bleeding. It also leads to a much quicker recovery and return to normal life.

In the case of Prashant, three conventional surgeries had already failed to repair the hernia permanently. The complication in his case also arose from the presence of three synchronous hernias, which were recurrent as well as with badly stuck intestines. This required extensive dissection to free the intestines and to fix the mesh. Three large meshes were used in the surgery to repair the tear and push the intestines back to their rightful place. The major benefit of this surgery was quick recovery and absence of any major incisions. 

“With the abdominal wall already weak sue to three prior surgeries involving major cuts and stitches, we had to be extremely careful during this surgery so as to minimize the trauma. We made five tiny 5mm and a single 10mm incision over the abdominal wall to carry out the procedure. Once the surgery was complete, these incisions were sealed with tissue glue (requiring no stitches and no dressing). The patient was mobile after two hours, was allowed to eat orally after four hours and was discharged within two days. He resumed his normal activities within seven days. At present, he has no recurrence,” added Dr Meenakshi Sharma, Sr Consultant, gen & Laparoscopic surgery, Paras hospitals.

As demonstrated by this case, recurrent hernia can be dangerous as they put the internal organs of the body at major risk. Experts say in case of recurrent hernias laparoscopic surgery presents a better alternative to conventional open surgeries as it minimizes trauma to the abdominal tissue and prevents further weakening of the already weakened wall.