Mini-Scar-Less Totally ExtraPeritoneal repair (Amir’s MSL TEP repair) – The New Gold Standard

This has by far the best cosmetic results, quickest and relatively pain free recovery.

The accumulative length of the incisions for this operation is 1.1cm (11mm or 0.4 Inch) *.

In Amir’s MSL TEP repair the surgery inside is the same as the standard Totally Extra Peritoneal (TEP) repair, which is minimal invasive and generally considered as a Gold standard globally; accumulative incision length of 4 cm (40mm or 1.6 inches) *.

Amir’s MSL TEP repair is the only surgical approach for hernia repair which generally does not require any post-operative restriction on mobility, exercise or lifting weight.

*Comparison of Incision lengths

Open / Laparoscopic TEP / Amir’s MSL TEP repairs 

*Unilateral; one sided hernia

*Bilateral; Hernias in both groins (2 hernias)

Professor Amir Nisar’s Innovations in Laparoscopic Hernia surgery. The Gold Standard of Inguinal Hernia Surgery. Professor Nisar’s latest technique developed in Dubai, is another world’s first.

It is being offered at Fakeeh University hospital, Dubai to the patients with Inguinal / Groin hernias with great success.

The accumulative length of cuts in the abdomen is 11mm (nearly just one cm), instead of the standard 30-35mm incisions as in standard Laparoscopic TEP or TAPP repairs.c

Other Innovations in hernia surgery over the last quarter of century:

• Laparoscopic TEP hernia repair for Sliding Inguinal-Scrotal incarcerated Hernias
• Laparoscopic TEP hernia approaches for Incarcerated hernias
• Sac ligation techniques in continuity for long hernial sacs
• Inferior Epigastric vessel’s sling technique
• Needlescopic hernia repair
• Modified open operative approach for Large Sliding hernias

The journey continues for painless and safe hernia surgery for the benefit of patients.

Historic Background: Professor Amir Nisar while working in Somerset, United Kingdom was advised by Professor Robin Kennedy to attend the inaugural annual meeting of AESGBI – Association of Endoscopic Surgeons of Great Britain and Ireland (now ALSGBI- Association of Laparoscopic surgeons of Great Britain and Ireland), in Worcester in 1994.

Professor Chris Royston from Hull performed live Laparoscopic Hernia repair in the meeting and presented the outcomes of his first 1300 Laparoscopic Hernia surgeries, with excellent outcomes. The performance was beautiful, results outstanding, and the fire that it ignited is still heart-warming, 26 years on.

Professor Nisar having had the solid foundation and experience with open hernia operations (a few thousand by then) and having performed Bassini’s, Darning, Shouldice, Halstead, Mayo’s and Lichtenstein’s repairs knew the potential of the new “keyhole”/ “minimally invasive” approach and was quick to adopt it.

Professor Amir Nisar’s Hernia Training at Specialist Centre: Professor Amir’s move to Royal Surrey County Hospital, Guildford, England in 1996 and working with Professor Michael Bailey was a God send’s gift that changed the course of his training to an upward and forward trend. This center was very well known for advances in laparoscopic hernia surgery dealing with first time and recurrent complex hernias from the United Kingdom and other countries. 

Some of the achievements over the eight years of work in Surrey involved:

• Professor Amir Nisar: a keen student, later became a teacher and trainer at the highest level in the United Kingdom, Europe (especially France and Italy), and Asia in the technique of Laparoscopic hernia surgery in the years to come.
• Live surgery for teaching courses in various centers in the United Kingdom, France, Italy, and for teaching; MATTU, IRCAD, IMACS, ALSGBI annual meeting, and other international conferences.
• Setting up many centers offering Laparoscopic hernia surgery in the United Kingdom, Europe, and Asia by mentoring, proctoring, and supporting the surgeons.

• Contribution to NICE (National Institute of Clinical Excellence), guidelines; 2002 about Laparoscopic Hernia Surgery being superior to open hernia surgery
• Professor Amir conducted a randomized trial as the sole surgeon operating on 40 patients in Royal Surrey County Hospital, Guildford, Surrey, England, the United Kingdom under Professor Michael Bailey.

The aim of the double blind randomised trial was to assess the efficacy of laparoscopic and open approaches in unilateral inguinal hernias in the young, office going adults. It confirmed the superiority of the Laparoscopic approach over the open approach hence the next guidelines from NICE in 2004.

Contribution to NICE (National Institute of Clinical Excellence) final guidelines to date; 22nd September 2004, in favor of Laparoscopic Hernia Surgery.

Current NICE recommendations are:

• Laparoscopic TEP repair is the best approach for unilateral inguinal Hernia (first time hernia on one side)
• Laparoscopic approach is best for primary bilateral hernias (first time hernias on both sides)
• Laparoscopic approach is the best for a recurrent hernia (hernia reappearing after surgery)