A hernia is a protrusion of an organ or tissue through an abnormal opening in the body. Most hernias occur when a piece of intestine slips through a weakness in the abdominal wall, creating a bulge you can see and feel. Some hernias are present at birth. Others develop slowly over a period of months or years. Hernias also can come on quite suddenly.

Types of Hernia:

• Inguinal/femoral Hernia – In the Groin Region
• Umbilical/ Para-umbilical Hernia – Around the belly button.
• Incisional Hernia – Around the site of an earlier surgery.
• Epigastric Hernia – In the Epigastric region

What does a hernia feel like?

A hernia can be both seen and felt. You may notice it as a lump in your abdomen or groin that may or may not disappear when you lie down. You also may be aware of a dull aching sensation that becomes more pronounced when you are active.

Does Hernia Always Hurt?

Most of the hernias do not hurt.

How Is Hernia Treated?

• Hernias usually need to be surgically repaired to prevent intestinal damage and further complications.
• Surgical procedures are done in one of the two fashions:-Your surgeon will determine the best method of repair for individual situation:-
•  The open approach is done from the outside through a 3 to 4 inch long incision in the groin. The surgeon may choose to use a small piece of surgical mesh to repair the defect.
• The laparoscopic hernia repair. In this approach, a laparoscope (a tiny telescope) connected to a special camera is inserted through a trocar, a small hollow tube, allowing the surgeon to view the hernia and surrounding tissue on a video screen. Other trocars are inserted which allow your surgeon to work “inside.”   Three or four quarter inch incisions are usually necessary.  The hernia is repaired from behind the abdominal wall.  A small piece of surgical mesh is placed over the hernia defect and held in place with small surgical staples.  This operation is usually performed with general anesthesia or occasionally using regional or spinal anesthesia

Bard 3D Max Mesh	Bard Fixation Devices	Sepramesh IP

Will My Hernia Go Away?

An untreated hernia will not get better on its own, although it may not get worse for months or even years. A hernia that can be easily pushed back or flattened (reducible hernia) is generally not an immediate danger to your health, although it can be painful. A non-reducible hernia, however, can become life-threatening if part of the intestine gets trapped, or strangulated in the opening. This is also called an incarcerated hernia and in an emergency situation may require immediate surgery.

Is It Risky For People With Other Medical Problems Like Diabetes, Hypertension & Morbid Obesity?

Not at all; On the contrary, absence of major trauma to the body causes minimal disturbance of normal physiology. Hence, there is no risk of aggravation of other conditions.

Facts on Hernia

If you suspect you have a hernia, but have avoided treatment because you are worried about the discomfort and recuperation time of surgery, talk with your doctor. You may discover there are now options available that may offer you less post operative discomfort and shorter recuperation than you might expect. A hernia can not only be painful, but also potentially life threatening. Therefore, it is important to see your doctor if you have signs of a hernia. While treatment is not always immediately necessary, a careful evaluation by your doctor will help safeguard your health and comfort. Your doctor can discuss with the various treatment options and the associated risks and benefits of each.

Robotic Abdominal Wall Reconstruction- EMBRACE THE FUTURE

Abdominal wall reconstruction is a newer form of abdominal wall repair for complex hernias. It is considered to be the most physiological form of repair for any type of abdominal wall hernia.

This procedure  involves access to the retro rectus space, dissection between rectus muscle and posterior rectus sheath, crossing to the retro rectus space on the opposite side (Cross over) and at times division of transverses Abdominis muscle (TAR) on one or both sides.

 This thereby opens up a large amount of space for reconstruction of abdominal wall thereby repair of hernia in an anatomical and physiological fashion and in a tension free manner without entering the peritoneal cavity. It also helps in providing very large amount of space for mesh placement (polypropylene) that is much cheaper compared to the standard composite mesh that is being used when it is placed intraperitoneally. No fixation is required as such when mesh is placed in this plane.

Major benefits thereby are reduced cost (secondary to decreased cost of mesh) and significantly less pain (no fixation). It contributes to early ambulation and discharge of patient thereby reducing morbidity.

Large amount of published data is available to support the fact that this is the most physiological form of hernia repair. It is also said to be the most durable form of repair as it has the least recurrence rate as per the available data.

However, each step mentioned above is challenging and requires training and expertise to perform. Robotic surgery is the best way to perform Abdominal wall reconstruction, especially in recurrent complex hernias. Robotic surgery helps in more precise dissection thereby reducing tissue trauma, more degrees of freedom even more than the human wrist so better movement provides three-dimensional vision with increased depth perception, no tremors thereby stable operative field and ergonomically more suitable as well. There is significant published literature available that shows it to be beneficial over the laparoscopic procedure.

Since the induction of Robotic Program, our team has been dealing with all kinds of complex hernias involving majority of high risk cases.

Case 1: Middle aged female/ Multiple abdominal surgeries with two being for failed hernia repair.

Case 2: Elderly female/ Poorly controlled Diabetes/Hypertension/ Chronic Kidney Disease/Coronary artery disease with PTCA/ Multiple abdominal surgeries including failed hernia repair

Case 3:  Middle aged female/ Diabetic/ Hypertensive/ multiple surgeries including failed hernia surgery/ atypical hernia location

Case 4: Middle aged male/ multiple failed hernia repairs

Case 5: Elderly Female/ multiple abdominal surgeries/ atypical hernia location

We tried to optimize all these patients as much as possible prior to surgery. All of them had an uneventful course and the majority were discharged within two days of surgery in a satisfactory condition. These patients have been operated in less than a month of the start of the robotic program at our center. We strive for excellence and will continue to deliver the same.