Excel Hospital
  • What is Complex Hernia?

    • A hernia becomes complex when repeated surgical attempts fail to repair it.
    • When a hernia repair operation breaks down (i.e. a 'recurrent' hernia) further repair operations are more difficult than the first and, to make matters worse, the chances of success actually diminish with each successive attempt at repair.
    • The same is true of the breakdown of the scar in the abdominal wall from an incision for a previous operation for some other problem. This is called an 'incisional' hernia.
    • Thus the 'recurrent' hernia and the 'incisional' hernia are very similar in many respects, including the difficulties in effecting a reliable repair.
    • Unfortunately, there are also cases of 'multiple hernias' and of combinations of all the above, such as 'multiple, RECURRENT hernias'. These cases pose many difficulties to most surgeons and are, all too often, not successfully repaired.
    • Complicated/complex hernias include those that have either been repaired before on multiple occasions, those associated with infections, or those that have resulted in bowel perforations or fistulas. Each of these hernias poses their own unique challenge.

  • Diagnosis

    • X ray
    • USG
    • CT Scan
    • MRI

  • Treatment

    Surgery
    • In the presence of ongoing infection or contamination, synthetic meshes should be avoided. In these cases, the repair of the hernia with a patient's own tissues is recommended, if possible. In many cases, hernias as large as 20 centimetres may be closed with this technique.
    • Hernias that are not amenable to this technique may be repaired with biologic meshes, which are more resistant to infection. These materials may be safely used in patients with active infections and can avoid the need to use a synthetic mesh that could become infected. Synthetic meshes should be avoided in patients with ongoing infection or contamination with bacteria.
    • Recurrent hernias may also be a significant challenge due to the placement of prior mesh and adhesions between the abdominal wall and intestines. Many recurrent hernias patients will have weakened abdominal wall tissues that do not hold sutures well. Techniques for repair of these hernias may involve placement of a single large sheet of synthetic mesh to repair the entire abdominal wall.
    • If the previous surgery is by open method , then generally we prefer to operate by Laparoscopy as here the operation is performed via an site higher than the previous one(s) and the hernia itself is approached from behind the weakness in the abdominal muscles. There is, therefore, no need to cut through scar tissue.
    • The hernia opening is then completely covered by a mesh applied from the inside, making it very successful against the further recurrence to take place.In effect, the whole area of abdominal wall surrounding the hernia site(s) becomes reinforced without really involving the area(s) previously operated upon.

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