Dr. Premkumar Balachandran Explains “The changing scenario in the management of Hernia”
A hernia is a condition in which the internal contents of the body protrude out of the body through the wall of the cavity containing it. The different types of hernia can be groin (inguinal, femoral) hernia, umbilical (navel) hernia and ventral or incisional hernia (following weakness of a previous surgical scar).
The causes of these could be congenital (since birth), muscle weakness disorders, excessive smoking, chronic cough, lifting of heavyweights without adequate groin support, and early return to work and strenuous activity following abdominal surgery.
Conventional treatment of hernia used to be an open surgery. The protruding content was replaced in its original cavity and the weakness or defect was sutured closed using sutures. As time went by artificial prosthesis called meshes were used to reinforce and strengthen the repaired defect.
In the case of small defects, the treatment was straight forward. However, in large incisional hernia where multiple previous surgeries were done and the defects were large with weakness of muscle wall, the procedures were quite extensive with increased postoperative morbidity and high recurrence rates. The meshes available also are very expensive and not affordable by all.
The management of hernia has now undergone a paradigm shift. The advent of minimal access or laparoscopic surgery has been a boon to both the surgeon and the patient. The nomenclature of ventral hernia management is now referred to as “abdominal wall reconstruction”.
Complex reconstructions, abdominal wall component separation surgeries, regular groin, and ventral hernia are nowadays being done with minimal morbidity by the laparoscopic and robotic technique. The need for an expensive dual-layered prosthesis which were used to prevent adhesions to underlying bowel is also reducing due to the newer techniques.
A variety of new techniques such as SCOLA (subcutaneous Onlay mesh repair), laparoscopic E TEP repair with TAR (enhanced view extraperitoneal repair with transverses abdominal release), TARM (Trans abdominal retro muscular), IPOM and IPOM plus (intraperitoneal only mesh) repairs, to name a few are being performed nowadays.
The future is looking bright for patients suffering from all types of hernia, as the surgeons now have a replenished armamentarium of technology and techniques to produce a good outcome.
(The author is Dr.Premkumar Balachandran. He is a Senior consultant laparoscopic and abdominal wall reconstruction surgeon in Apollo hospitals, Chennai.)