ADVANCEMENTS IN LAPAROSCOPIC HERNIA SURGERY

These days, Hernias have become a common problem in people of all ages, including children. Hernias occur when a section of the intestine protrudes through a weakness in the muscle wall of the abdomen. People with hernia may experience pain, swelling, and discomfort in the area where the hernia is located. Hernias are diagnosed using imaging tests such as an ultrasound or CT scan.

There are many different types of hernias, and they can occur in a variety of places. A groin hernia is when an organ like the stomach or intestines pushes through the muscle wall near the groin area. A ventral hernia is when an organ pushes through the muscle wall near the ribs. In some cases, a surgery is needed to repair a hernia. Laparoscopic hernia repair is an increasingly popular option for patients who are looking to avoid the risks and pain associated with open surgery, while still receiving the benefits of small incisions, smaller scars, faster recovery time, and less pain.

TAPP vs TEP

The most advanced laparoscopic techniques for inguinal hernia repair are Transabdominal Preperitoneal (TAPP) repair and Totally Extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different in that the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the peritoneum (the thin membrane covering the organs in the abdomen).

INTRAPERITONEAL ONLAY MESH

The IPOM (Intraperitoneal Onlay Mesh) technique is a special repair procedure where a mesh is introduced into the abdominal cavity and placed from the inside over the hernia opening. To conduct this endoscopic IPOM technique, a small incision is first made in the scar-free abdominal wall.

ABDOMINAL WALL RECONSTRUCTION (AWR)

AWR is a surgery that helps repair reoccurring hernias, ventral hernias, large hernias, and parastomal hernias. It is also used to repair surgical trauma and rebuild the broken abdominal wall. A mesh is often inserted to strengthen the hernia repair and avoid recurrences. The critical goal of reconstruction is to restore the abdomen’s shape, functionality, and strength.

SCOLA: Subcutaneous Onlay Laparoscopic Approach is a safe, reproducible and effective alternative for patients with abdominal wall hernia. It is new technique that involves a mesh repair of Umbilical and other Midline hernia with the repair of diastasis recti. 

eTEP: Extended Totally Extraperitoneal is an alternative strategy where a mesh is placed in retromuscular space by minimal access technique. This procedure involves opening of retro-rectus spaces along with the preperitoneal spaces of Retzius and Bogros at the groin level.

Retrorectus Hernia Repair: It allows for creation of a well-vascularized sublay space for mesh placement. This procedure offers further improvements to retromuscular hernia repair while relying on the foundations of a tissue-based, tension-free hernia repair.  

PREVENTIVE MEASURES

Hernias are a common problem for both men and women, especially after the age of 40. They can be caused by a number of different factors, including strenuous physical activity, poor eating habits, and pregnancy. By taking some simple preventive measures, you can do a lot to reduce your risk of developing a hernia. First and foremost, make sure to maintain an appropriate diet and exercise routine. Also, try to avoid any activities that put excessive strain on your abdomen, such as heavy lifting or heavy coughing. Finally, get plenty of rest and avoid straining yourself when you're pregnant. If you are at risk for developing a hernia, these simple steps can go a long way towards reducing that risk.

Dr. T. Lakshmikanth
MS, FAIS, Dip. LS (France), FISG (NIMS)
FIGS (Japan), FIBC 9Duke, USA)
Consultant Surgical Gastroenterologist, Star Hospitals

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