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Hernias – a Challenge!

Other Hernias – a Challenge : Groin hernias is perhaps the commonest surgical operation performed by any general surgeon. Failures or recurrence of hernia after surgery is 2-5%. Such recurrent groin hernia has to be reoperated ; this is often far more difficult and needs an expertise of an experienced surgeon and possibly one has to use an implant – usually a Prolene Mesh to get a successful result.

Other Hernias: Other hernias generally tend to occur in the midline of the abdomen either in and around the umbilicus or at other weak points like sites of previous abdominal surgery like Caesarian section, hysterectomy, puerperal sterilisation or tubectomy, open appendicectomy , open cholecystectomy or any other operation including laparoscopic 10 mm port sites. Some of these hernias, also called collectively as ‘Ventral Hernias’ can assume massive proportion, if neglected for a long time. Usually these massive ventral hernias often become complicated, like irreducibility, obstruction or even the life threatening complication of strangulation. Some of these patients, mostly women, have other medical problems like obescity, diabetes, high blood pressure, asthma or heart disease. Successful and surgery without major complications in these patients is highly challenging even in the hands of highly skilled and experienced surgeons. If emergency surgery is needed for any complication, results of surgery may not always be successful. But planned surgery after proper evaluation and control of associated diseases like B.P., Diabetes, heart disease etc. gives the best results.

Evaluation and pre operative preparation of Ventral Hernia Patients: Full investigations to assess heart and lungs functions, diabetic state and other general tests are done. Sometimes special tests like ‘Echocardiogram’ or ‘Treadmill test’ and ‘Lung function tests’ may be necessary. Proper control of these medical problems and if and when possible reduction of obescity ( often difficult) are undertaken . The physician and anaesthesiologist would examine and evaluate patient’s fitness for major surgery and type of anaesthesia to be given. The patient is admitted a day or two earlier in cases of massive hernias or in patients having complicating medical problems.

A woman with a massive ventral hernia
Before surgery
After surgery

Technique of surgery: Good anaesthesia and complete muscular relaxation during the entire operation is very essential. Each surgeon may follow some technique he has found good in his hands; but basic principles are same. Careful dissection without damaging intestines or other contents within the hernia, clear dissection and definition of hernial defect and closure of defect and adequate strengthening of muscle weakness are important steps. Quite often in large hernias we may have to use a foreign material like a ‘Prolene Mesh’ to give additional strength. Recovery from anaesthesia should be smooth.

Immediate & later Post operative precautions: Measures to avoid or minimise cough, abdominal distension and excessive straining after surgery are very important. Patient is fitted with an abdominal belt before being allowed out of bed. The broad velcro type of adjustable abdominal belt is very useful and not too uncomfortable. It has to be worn continuously, day and night for 6 months to one year in all patients. Rarely in an old individual or someone who has undergone several abdominal operations earlier resulting scarring and muscle weakness we advise use of belt permanantly. The reason is that any abdominal wound particularly a midline wound (which has least supply of blood), takes 6 months to gain maximal strength (tensile strength) and even this is less than the original before surgery. Also the patient must avoid any excessive straining of any kind for about one year. Before finally discarding the belt, abdominal muscle strengthening exercises are done while wearing the protective belt , for about 2-3 months.

Observing all these precautions generally results in successful outcome most of the time. Recurrences are still possible and are unpredictable. Chances of failure are more in cases of massive hernias, in patients who have obescity, asthma, long standing cough or those who do not follow proper post operative precautions.

Cosmetic benefits: Most abdominal hernia patients are women who have had one or more pregnancies and therefore have extra loose skin hanging in folds. A cosmetic lipectomy with or without liposuction is often combined with hernia repair to give better cosmetic result.

Our HERNIA Centre: Our Hospital, the old “Surgical Clinic” and the present Dr. U.Mohan Rau Memorial Hospital is virtually a HERNIA CENTRE because we treat a large number of various types of Hernias. We have achieved a high degree of success in these hernia surgeries.

THIS IS AGAIN ONE OF OUR STRENGTHS !

With Best Wishes to Be Healthy,

Yours Sincerely,

Dr. M.Mohan Rao, MBBS, MS, FICS, MCH,
M.D. & Chief Surgeon,
Dr. UMR Memorial Hospital.
962, Poonamallee High Road, Chennai 600084.
Tel. 6424396, 6411621, 6412474.
E-mail: mmr@mohanraohospital.com

 

Updated on 15.04.2002.
 

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