HSI 2010

'India would do as much Laparoscopy for Hernia as Japan'

Experts congregated to brainstorm on latest advances in treatment of hernia

With about 25 per cent of males and two per cent of females developing inguinal hernia (which is considered the most common hernia), management of hernias has always been an area of interest for surgeons. The evolution of hernia management techniques thus deserved a national forum and that's what ‘The Hernia Society of India’ (HSI) in its national mid-term conference HSI 2010, which was held in Bangaluru on 26th and 27th June, attempted by bringing in leading surgeons across the country to brainstorm on the latest advances in treatment of hernia.

The quality of mesh used and popularity of laparoscopy have given hernia management a thrust, said surgeon and also the organising chairman of HIS 2010, Dr MG Bhat. "The advantages of laparoscopic hernia repair are that it requires only three tiny cuts instead of the traditional 10 - 15 cm incision. As a result, patients experience much less pain after the operation, are able to perform their activities much sooner, and are able to return to work sooner than after the open operation," added Dr Bhat, also the Medical Director, Nova Medical Centre.

Speaking on 'Lessons learnt in hernia management: A lifetime experience', surgeon Dr CR Ballal from Mangalore, informed how the material for mesh changed from thread, silk and nylon to modern day polypropylene. "Today's meshes have become thin, bio-resorbable fabric layer that effectively separates its strong, supportive mesh from underlying viscera. With the size of the mesh becoming smaller, softer, tension-free, pliable, the recurrence of hernia has also reduced," said he.

Experts also debated on the use of laparoscopy for all kinds of hernia. Said Dr K Ravindranath, Chairman, Global Hospitals, "Laparoscopy results in small scars and patients going back home the same day and hence is preferred over open surgery.” He added that it is generally advisable to repair hernias quickly in order to prevent complications such as gangrene, multiple organ dysfunction syndrome, and death. He further added that most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. However, Dr CS Rajan, Head of Department of Surgery, St Martha's Hospital, Bangaluru, said, "Ninety per cent hernia patients can be treated by open surgery. In the mission's hospital that I work, people can't afford laparoscopy. Laparoscopy is promoted by corporates to earn more money." Dr Praveen Bhatia from Sir Gangaram Hospital, New Delhi, refuted this, saying, "Today, patients prefer laparoscopy over open surgery." Even Dr Bhat added, "Laparoscopy does not cost much more than open surgery. Laparoscopy requires training and expertise and thus not used by many. Also, laparoscopy requires general anaesthesia, and so not suitable for patients unfit for full anaesthesia."

Speaking on evolution of hernia repair, Dr T Udwadia from Mumbai, said, "With the mesh becoming softer, the result of hernia surgery has also improved." About his views on the raging debate of open surgery v/s laparoscopy for hernia, he said, "In recurrent hernia, laparoscopy should be preferred. In the years to come, India would do as much laparoscopy for hernia as Japan." According to Dr TH Anjanappa, "Laparoscopy should be done in three cases: when it is recurrent, inguinal hernia and also in cases of bilateral hernia."

Dr Pradeep Chowbey, Director of Minimal Access Surgery from Max Healthcare, said, "In the last decade, hernia management has become a super super specialisation." Speaking about the formation of HSI, he said, "The Asia Pacific Hernia Society was formed in 2004 in Bali. HSI is an off shoot of that."

The conference was attended by over 350 surgeons from across the country.

The second day had live surgeries relayed from Nova Medical Centre at Koramangala on open inguinal hernia repair, open incisional hernia repair, laparoscopy abdominal hernia repair, laparoscopy incisional hernia repair and laparoscopy inguinal hernia repair.

EH News Bureau