A team headed by Dr Kedar Patil, Lead Bariatric, Hernia & Advanced Laparoscopic Surgeon at Apollo Spectra Hospitals successfully treated an 80-year-old elderly man with a large incisional hernia. The patient, who was also detected with rectal cancer previously, resumed his daily routine after the TAR procedure for hernia repair.
Ashok Jadhav (name changed) *, an 80-year-old gentleman from Pune experienced abdominal pain, fatigue, and irregular bowel movements, and couldn’t do his daily activities with ease. He underwent surgery for rectal cancer with a diversion ileostomy a year ago followed by ileostomy reversal 6 months ago. He had developed a large incisional hernia at the ileostomy site in right lower abdomen since 4 months. However, the patient was referred to Apollo Spectra Hospitals, Pune to repair the hernia and avoid serious complications.
Dr Kedar Patil, Lead Bariatric, Hernia & Advanced Laparoscopic Surgeon at Apollo Spectra Hospitals, Pune said, ‘‘Patient had a large Incisional Hernia which was causing discomfort and interfering in his daily activities. A CT scan of the abdomen was done that showed a 8.5 cm by 6 cm hernia with bowel loops as content. Since this hernia was large, he was planned for an open transversus abdominis release (TAR) and hernioplasty with mesh. TAR is a relatively new procedure that is done for large hernias. When the size of the hernia increases significantly pushing back the contents of the hernia, usually the small and large bowel back into the abdomen increases the intraabdominal pressure and subsequent adverse effects on the kidneys and heart.’’
Dr Patil added, ‘‘TAR is the latest armamentarium in the field of hernia surgery for such large hernias , which has become a well-accepted norm worldwide. In this procedure the layers of abdomen are dissected and mesh in sandwitched in between the layers of abdomen ,usually the procedure lasts of 6-7 hours and patient needs to be hospitalized for 5-6 days .Patient being elderly and diabetic took a bit longer to recover and was discharged on day 10. The patient recovered well after the surgery with a good functional outcome. He required deep breathing excercises ,high protein diet and ambulation post operatively and advised not to lift heavy weights he developed minor wound related problems which settled Not treating him in time would have lead to an even bigger hernia which would have required Botox injection or creating a progressive pneumoperitoneum to create space inside abdomen to accomodate his bowel which are additional procedures . The bowel may be obstructed anytime causing an emergency situation and unplanned surgery which may not be good for such hernias.’’
“My world came crashing down after the detection of rectal cancer and hernia. I was always active but suddenly I needed help to do my daily chores. I was shocked to know that I will have to undergo surgery for hernia repair to get rid of the constant abdominal pain. But, I didn’t lose hope. I thank the doctors at Apollo Spectra Hospital for helping me to get back on track. I am able to do my daily chores with ease now. I urge other patients like me to take utmost care of themselves and not to ignore any changes in the body,” said the patient Ashok Jadhav (name changed)*.
Hernia surgery has rapidly developed over the last 3-4 years and newer concepts of placing the mesh in between the layers of the abdomen or inside the abdomen with laparoscopic or open surgeries are being practiced worldwide as against placing the mesh over abdominal muscles as it was done in the past. For incisional,ventral, epigastric, and inguinal hernias there are an array of procedures like TARM, ETEP, IPOM, etc. But, sometimes open surgeries are required for large hernias. The treatment has to be individualized and tailor-made to each patient.
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