Mr. Mehta, a 62-year-old retired government employee, had undergone surgery to remove gallbladder stones few years ago. For the past few months, he was experiencing mild discomfort in his abdominal area. The pain grew in intensity during any manual activity. Initially, he didn’t pay heed to it, only to receive a shock when on one fine morning his wife noticed a bulge around his navel area.
They reported it to a physician who examined the affected area and recommended a CT Scan. And as the doctor had suspected, he was suffering from a Ventral or Incisional hernia. He was advised surgery to which he agreed as his symptoms were discerning. A Laparoscopic ventral hernia repair (LVHR) was performed on him and he was discharged in couple of days from the hospital. After a week rest at home he was back to his usual activities.
An estimated 11—20% abdominal incisions may lead to incisional hernia. While 50% of these occur within the first 2 years, 74% develop after 3 years due to progressive weakening of the scar tissue.
Before the advent of Laparoscopy & LVHR , Open ventral hernia repair i.e. traditional repair (OVHR) was used to treat hernia defects. OVHR is achieved through suture approximation on each side of affected part. However, the biggest problem with this technique was recurrence which was reported in 41—52% cases. However studies recommend laparoscopic ventral hernia repair( LVHR) as a better technique due to faster recovery and many other benefits. It is associated with less post surgery pain and discomfort, less chance of infection and also higher success rates ( less than 10% ).
“When compared to the open hernia repair, the laparoscopic ventral hernia repair offers a host of advantages including a reduced hospital stay, fewer perioperative complications and low hernia recurrences. Also, it can significantly bring down the surgical complications related to wound and mesh infection,” says Dr. Pradeep Sharma, Senior Laparoscopic General Surgeon, Jehangir Hospital & Noble Hospital.
Studies reported higher incidences of cellulitis and mesh infection in case of open technique of ventral hernia repair. While open prosthetic reported a 12—18% rate of wound infection, mesh infection rate was 0.6% after laparoscopic repair. Similarly, the incidence of cellulitis of the trocar sites treated with antibiotics was found to be as low as 1.1%.
The major technical advantage with laparoscopic approach is that the hernia defect is completely visible during the procedure thereby allowing a perfect placement of the mesh. In addition with LVHR, it is also possible to uncover occult hernias not detected at the time of preoperative procedure. It has been found thatpatients experience better quality of life after laparoscopic repair. Though the laparoscopic procedure involves higher operative cost compared to open repair, advantages in terms of reduced morbidity, shorter admission period, and significantly lower mortality may make it cost-effective in the longer run.
There are little doubts about the laparoscopic ventral hernia repair as an effective technique to treat incisional hernia. However it is important to take care of contraindications associated with this technique. It should not be performed on patients having multiple scars on the abdominal wall. It should not be used in cases where it is not possible to get safe intraperitoneal access. It is also contraindicated in patients who have large defects and it is not possible to overlap a mesh of 3 to 5 cm intra-abdominally. LVHR should not be attempted on patients who have high amounts fat and redundant skin on the abdominal wall. Instead they should undergo Abdominoplasty procedure. Poor cardiovascular or respiratory reserve, coagulation defects, bleeding disorders are other contraindications, as they are for even open surgeries.
Thus LVHR is found to be a better alternative to treat Ventral and Incisional hernias and most of the scientific studies support it.
“In LVHR, hernia defect is adequately repaired using intraperitoneal mesh fixation involving minimal soft tissue dissection, which causes less postoperative pain, reduces the period of hospital stay and convalescence and ensures earlier recovery. Moreover, it allows the patient to tolerate oral intake comparatively earlier than the open procedure,” concludes Dr.Sharma
Dr. Pradeep Sharma
Jehangir Hospital & Noble Hospital.
Senior Laparoscopic General Surgeon
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