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Friday, June 1, 2007

Ventral Hernia: Lap is the way to go!

Hernias that occur in front of the belly, commonly seen in obese or multiparous ladies, are called ventral hernias. They may variously be called 'umbilical', 'paraumbilical', 'epigastric', or 'incisional' hernias.
Open operation is the commonest way of tackling this problem, and I hate the damn operation. It is quite an extensive and traumatic procedure, and wound problems are very common.
The lap approach is so much better, though it is still not the perfect solution yet (pain, recurrence, etc. still being issues). In my own personal experience, I have seen four recurrences after around 200 of these cases. All of these patients had a Goretex DualMesh placed, though this was because I used this product most when I started doing lap hernioplasties. Nowadays, I am using the Proceed or Parietex tissue-separating meshes, and so far, so good!
A recent article talks of the results of lap ventral hernia repair, and I recommend that you read it here.
One thing I find funny no one has seemed to notice, is: when I went in laparoscopically to repair my own recurrences, I saw that there were multiple small defects at the site of the full-thickness sutures that I had placed to anchor the mesh previously. It is as if the muscle just shrank between the sutures, and created a hole again. The article does not deal with this at all. Rather, the authors advise us to "stretch the mesh taut", which seems to be overkill. If you over-stretch the mesh, you create tension, which, as all surgeons know, is not very good for long term integrity of the repair.
Anyways, the article will be good news for those of us who see ventral hernias on a daily basis, as the results keep getting better and better.

3 comments:

Rajdeep said...

Interesting, Ramana, regarding the formation of 'holes' by the sutures. Makes sense. I suppose lap is again better, as the wall is already stretched when you put in the mesh.
I prefer retromuscular mesh repair - open. Much less wound problems with excellent results. Why can't you do that with lap approach? May become standard for lap hernia surgery.

B. Ramana said...

Rajdeep,
Thanks for your comment. It hasn't yet started getting warm here ;-).
Essentially the lap repair, where the mesh is placed on the inner lining peritoneum, is a retromuscular approach. It saves extensive dissection that would otherwise be needed.

KAUSHIK said...

Interesting article..Its goes beyond any contention , that LAP VENTRAL HERNIA seeing might look a simple proceedure but it is not a one..
Carry on with your good job DOCTOR..