The correlation between obesity and hernias is a significant concern, particularly in India, where obesity rates are rising. Studies indicate that nearly half of urban Indian women are classified as obese, contributing to their higher prevalence of hernias than men. Hormonal changes during different stages of life, such as pregnancy and menopause, also play a role in weight gain and obesity. In addition to other risk factors, obesity significantly increases the likelihood of developing hernias by exerting pressure on the abdominal muscles and weakening them, creating potential sites for herniation.
Hernia Treatment: Medications Or Surgery?
Medications are ineffective in treating hernias, making surgery the primary remedy to prevent potential intestinal complications. Various surgical treatment modalities are available, including open and laparoscopic surgery and the increasingly popular robotic-assisted surgery (RAS), using the da Vinci surgical system. RAS offers numerous advantages, such as enhanced precision, dexterity, and visualization, enabling precise and controlled movements during the procedure. Moreover, it allows for smaller incisions, reducing scarring, less pain, and faster recovery. The robotic platform is especially beneficial in treating cases of recurrent hernias, as it provides improved access to the surgical site, extensive adhesiolysis, and facilitates the placement of larger meshes.
The Prevalence Of Recurrent Hernias
Approximately two-thirds of hernia patients, including ventral hernias, are women, highlighting the preponderance of hernias among women. Among hernia cases, 50 per cent are primary hernias, 30 per cent are incisional hernias resulting from inadequate closure of previous surgical incisions, and 20 per cent are recurrent hernias that require reoperation.
Symptoms And Risk Factors
Hernias may present with various symptoms, including a noticeable bulge, pain or discomfort, and a feeling of pressure in the affected area. Sometimes, a hernia may get complicated with intestinal obstruction resulting in acute pain and vomiting, requiring emergency intervention.
Treatment Modalities
Regarding hernia treatment, various modalities exist, including open surgery and laparoscopic procedures. However, robotic-assisted surgery (RAS) using the da Vinci surgical platform has emerged as a promising option, especially for obese patients.
RAS offers several advantages over traditional surgical approaches. The robotic platform provides surgeons enhanced precision, flexibility, and dexterity during the procedure. Contrary to popular belief, the surgeon controls the surgery, with the robot as an extension of their hands.
Another advantage of robotic-assisted surgery is its efficacy in recurrent cases requiring extensive dissection and larger mesh placement. The robotic platform provides surgeons with a larger space to access and place the mesh without encountering inherent surgical difficulties. This translates to improved outcomes, reduced pain, faster recovery, earlier discharge for patients and lesser chances of recurrence.
However, addressing patient concerns and anxiety regarding the surgeon’s involvement in the procedure is essential. Surgeons must reassure patients that they remain in control during robotic-assisted surgery, with the robot acting as a tool under their command.
Preventing Hernia Recurrence
To reduce the risk of hernia recurrence, patients, especially obese individuals, should adopt certain precautions and lifestyle changes, including a healthy diet and regular exercise to achieve a normal Body Mass Index. Additionally, avoiding heavy lifting and practising good posture can reduce the strain on the abdominal muscles. It is crucial for individuals who have undergone hernia repair to follow their surgeon’s post-operative instructions to minimise the risk of recurrence.
(This article is authored by Dr Randeep Wadhawan, Head of Department, Minimal Access Surgery, Bariatric and Metabolic Surgery and Gastrointestinal Surgery Manipal Hospitals, New Delhi)