Hernia is a weakness in the abdominal wall (tummy) which leads to a bulge in the area. Most hernias are in in the groins or the middle of abdomen; around Umbilicus or upper abdomen.
Hernia may not give any problems to a person initially; however, pain and enlargement of the hernia lump generally occurs over some period of time. Some small hernias can give pain without any obvious lump.
A hernia can present at any age; in new born or elderly.
Its recommended that a person should get advice from a surgeon with specialist interest experience in hernia surgery. The hernia diagnosis will be confirmed and appropriate advice regarding conservative or surgical management will be provided to the individual.
In the past hernia surgery was carried out by trainee surgeons without supervision, which led to a high recurrence (hernia reappearing after the initial operation) of hernias.
Hernia surgery is considered as real art among surgeons. It’s not uncommon to hear from surgeons themselves in surgical fraternity meetings, “I know 500 surgeons who can do my Gall Bladder surgery, but only one surgeon who can do my hernia operation.”
Groin or Inguinal hernia surgery is one of the commonest operations performed in NHS, United Kingdom. More than 100, 000 operations are carried out yearly.
NICE (National Institute of Clinical Excellence), United Kingdom guidelines in 2002 advised surgeons and patients:
Professor Amir Nisar conducted a randomized trial as the sole operating surgeon operating on 40 patients in Royal Surrey County Hospital, Guildford, Surrey, England, United Kingdom under Professor Michael Bailey, the leading Hernia surgeon in Europe. The aim of the study was to assess the efficacy of laparoscopic and open approaches in unilateral inguinal hernias in the young, office going adults.
The outcome of the trial confirmed the superiority of the Laparoscopic approach over the open approach.
The results were presented to NICE (National Institute of Clinical Excellence), United Kingdom. These positive outcomes regarding the safety and efficacy of Laparoscopic TEP approach led to the next guidelines from NICE in 2004.
NICE (National Institute of Clinical Excellence) final guidelines; 22nd September 2004, are strongly in favor of Laparoscopic Hernia Surgery.
Current NICE recommendations for Inguinal / Groin hernia surgery are:
Laparoscopic Hernia surgery uptake among surgeons in United Kingdom, Europe, United States and Asia has been low. In United Kingdom and other countries dedicated training centers have offered courses and master classes to train the surgeons to be able to offer this surgery safely.
Minimal Access Therapy Training Unit (MATTU), Guildford, Surrey, United Kingdom has been the leading centers in training for Laparoscopic Hernia surgery, under the leadership of Professor Michael Bailey. This center not only trained surgeons of future from Europe, Asia, United States, Australia, and Africa, but also guided NICE (National Institute of Clinical Excellence), United Kingdom.
Professor Bailey’s Classic technique with some modification and improvements is “now” only” practiced in Dubai, by his prodigy, Professor Amir Nisar.
Laparoscopic approach is the gold standard for:
The available options for Laparoscopic hernia repair are:
Laparoscopic TEP (Totally ExtraPeritoneal) repair – The PREVIOUS Gold Standard
Laparoscopic TAPP (Trans Abdominal Pre-Peritoneal) repair
Needlescopic TEP (Totally ExtraPeritoneal) repair
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. However, accumulative incision length is 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
Amir’s MSL TEP repair
*Unilateral and *Bilateral Herniae
Standard TotallyExtraPeritoneal (TEP) repair
Unilateral and Bilateral Herniae
Open Mesh Hernia repair
Open Mesh Hernia repair
*Unilateral; one sided hernia
*Bilateral; Hernias in both groins (2 hernias)