Hyderabad: The poor quality of meshes and their inadequate size are some of the surgery related reasons which are leading to recurrence of hernia apart from patient related issues of weak muscles, stated surgeons in the city.
The number of recurrence cases have jumped by 50 per cent of late, they said. In the surgical world hernia operations are known as a surgeon’s bread and butter because of the high number of cases every year. In Hyderabad, around 3,000 hernia surgeries are done every year. Of these there is recurrence in 50 per cent of the cases.
Dr K.S. Lakshmi, a consultant for minimal access and metabolic surgery at Global Hospitals said, “We have patients coming with recurrent hernia where the technique of tensionless repair of the tissues was not followed. The quality and size of the mesh is also very important along with surgical expertise. It has been seen that even if a patient has good quality muscles the mesh used is not proper. This leads to shrinkage after a while, leading to recurrence.”
Good quality meshes shrink less. Low quality meshes can shrink by 50 per cent and this leads to reoccurrence of hernia.
However, Dr K.A. Muqeet, consultant general and laparoscopic surgeon at Maxcure Hospitals said, “There are no inferior quality meshes. There are absorbable meshes, semi-absorbable meshes and non-absorbable meshes. There are other reasons like sterilisation techniques which are also found to play a major role in these surgeries. If proper techniques of sterilisation are not followed than the mesh can get infected and that causes complications and surgeries will be required.”
Every year, there are multiple CMEs on the standards and types of mesh that should be used and the techniques they should practice.
A senior city surgeon said, “Meshes are now completely dependent on the package provided to the patient. There is a lot of pressure on doctors to provide treatment at lesser costs due to which the quality of mesh used for surgery differs and this in turn leads to poor surgical outcome.”
But the patient is often not aware about these conditions and reoccurrence is taken as a part of the hernia problem.
Exercise can beat hernias
Many women develop from hernia after a Caesarian section or after open abdominal hysterectomy. This is because with pregnancy and age, the muscles become weaker.
“In women, the problems seen are lack of rest after C-section, which does not give enough healing time for the muscles. Other problems are failure of the surgeon in closing the C-section properly which causes hernia,” Dr S. Chandrika, a general surgeon practising in the city said.
Post-operative counseling for women after Caesarian section is most important but that is usually missing.
A senior gynecologist on condition of anonymity said, “There are many patients who completely rely on their mothers or grandmothers for dealing with post-operative conditions, which is not correct. A proper counseling stressing adequate rest, not lifting heavy weights for a year and later opting for muscle strengthening exercises is very important. There are physiotherapists who help women with Swiss ball abdominal exercises, which if done once a week, will help strengthen abdomen muscles. But it has to be done only after a year or after completely weaning the baby from mother’s milk. This guidance is lacking now and there is a need to take this up if cases of hernia are to be brought down substantially.”
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