Dr Deepak Varma Gastro Surgeon Cochin

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Hernia Surgery

A surgical operation conducted to correct a bulge caused by internal organs protruding through the wall that holds it back. Hernias occur in the abdomen, groin, umbilicus and diaphragm. Hernias also occur at the site of a previous abdominal surgery and are called incisional hernia. There are several approaches to hernia surgery such as herniorrhaphy, hernioplasty and herniotomy.

Older repair techniques included the open tension repair, which required a 3 to 6 surgical incision. Nonabsorbable sutures were used to close the incision. Modern day surgeries involve the non-tension mesh repair and the laparoscopic repair.

  • Non-tension mesh repair reinforces the area by placing a flexible mesh, fixed with sutures or other fixation devices. It reduces the incidence of recurrence compared to open tension repairs.
  • The laparoscopic repair requires 0.25 to 0.5 incisions in the abdomen. With the help of tiny surgical instruments, the hernia sac is pulled back into the abdominal cavity and a mesh is fastened in place, and the incisions closed with sutures or surgical tapes.

Herniorrhaphy:  The healthy ends of the muscles are stitched together to repair the hernia defect. The surgery simply repairs the defect in the posterior wall causing the herniation without using a mesh. A Shouldice repair is performed double-breasting the layer of the fascia transversalis. The contents of the hernia sac are returned to their places and obliterating the hernia sac.

Hernioplasty:  The contents of the sac are reduced, and the hernia is excised (if the sac is very large). A polypropylene mesh (synthetic material) is then inserted to cover the defect and strengthen the posterior wall.

Herniotomy: The hernia sac is simply removed after reducing its contents. This is usually done for hernias occurring in children.

A mesh is a sterile, synthetic plastic-type woven material that is placed under or over the defect. In certain repair techniques, it can be used to plug the defect so that the contents from the abdomen do not protrude out again. Depending on the technique used, the mesh is cut to the required measurements. A few sutures hold the mesh in place, and it acts as scaffolding aiding in the growth of new tissues which are strong enough to reinforce the defect.

Some mesh products are:

Mesh used in inguinal hernia repairs are:

– Versatile and flexible partially absorbable lightweight mesh

– Three-dimensional and lightweight hernia system. Which is partially absorbable

– Partially absorbable inguinal hernia plug

– Onlay patch, a three-point connector with a revolutionary 3-in-1 design

Mesh used to repair a ventral hernia:

– Tissue-separating multi-layered mesh for both laparoscopic ventral hernia repair and tension-free repairs. Mesh used for laparoscopic ventral hernia repair is specially designed and uses special materials so that the mesh doesn't cause injury to the intestines.

We are one of the leading surgeons in the country using the latest laparoscopic techniques for hernia repair surgery. We have also conducted research in different techniques in laparoscopic groin hernia repair.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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