There are many types of Hernias and many types of Hernia repair operations. We perform them all, but the right operation for you will depend on many factors. All operations should be individualised to meet your specific goals and expectations. Dr. Sourabh Damani individualizes each hernia and its treatment according to its location, contents, the age and medical status of the patient, symptoms it may be causing including pain or intestinal issues, and an assessment of the hernia’s risk to the patient and the risk of surgery to repair it.

The key reason to repair a hernia in an adult is that they will not heal themselves, they tend to get larger with time, and they often become painful and can strangulate. Strangulation is where bowel, organs or tissue become trapped in the Hernia, gets starved of blood supply then becomes ischaemic or dies. Strangulation is life threatening and requires an emergency operation.

Inguinal Hernia Repair

An inguinal hernia is a common type of Hernia where fat or intestine push through an opening in the groin region. They can occur in both men and women but they are much more in men due to the natural anatomy of the groin. Inguinal Hernias can cause a noticeable bulge in the groin are and can be uncomfortable or painful.

Dr. Sourabh Damani offers a range of minimally invasive surgical procedures for inguinal Hernia repair which include laparoscopic and robotic approaches depending on the complexity of the Hernia. He still offers open repairs in patients who cannot tolerate a general anaesthetic due to medical reasons.

Minimally invasive inguinal Hernia repair

Laparoscopic and robotic (when indicated) is the gold standard for inguinal and femoral hernia repair within all the international Hernia societies and specialised hernia units throughout the world.

Why Laparoscopic is inguinal hernia repair preferred over Open repair?

• Lower recurrence rates
• Lower rates wound morbidity – seroma, haematoma, wound infection and mesh infection
• Lower rates of chronic pain
• Less post-operative pain, especially in young patients and in bilateral cases
• It allows the surgeon to repair inguinal, femoral and obturator Hernias with one mesh.

History of Multiple hernia repairs ?

The goal of complex hernia repair with abdominal wall reconstruction is to repair the hernia defect, reinforce the abdominal wall to prevent recurrences or other hernias from developing, recover abdominal wall functionality, prevent intra-abdominal organs from protruding through the abdominal wall, and provide a cosmetically-pleasing appearance. During the procedure, the abdominal muscles may need to be rearranged in order to close the hernia defect. The abdominal wall is then reinforced with mesh.

Dr. Sourabh Damani is highly skilled in the following latest techniques specifically designed to repair ventral and incisional hernia with abdominal wall reconstruction:

• ETEP Rives-Stoppa : places mesh in retro-rectus position in front of posterior sheath and away from visceral bowel contents. Utilised for larger incisional ventral hernia.
• ETEP TAR : An extension of the eTEP Rives-Stoppa where a transverses abdomens muscle release is incorporated into the repair.
• TAPP/Plus : Transabdominal preperitoneal with closure of defect. Reserved for ventral, incisional, and flank hernia. Involves lifting a flap of peritoneum, closing the fascial defect then placing and securing an uncoated mesh. The operation is finished with closure of the peritoneal defect.
• IPOM : Intraabdominal only mesh. This technique places a coated mesh in the abdominal cavity. A relatively quick operation utilised for ventral and incisional hernia that is reserved for older/frail patients who cannot tolerate a lengthy anaesthetic.

The end result of this complex abdominal wall reconstruction is a restored, physiologic and functional abdominal wall with enough strength and flexibility to withstand physical activity and to improve quality of life. When performed properly by specially trained surgeons, complex hernia repair generally has a low rate of relapse, resulting in a long-term functional repair with an aesthetically improved result.

Latest Laparoscopic Hernia Repair Technique

As a world-class specialist Hernia surgeon, Dr. Damani is highly skilled in the following advanced laparoscopic Hernia repair techniques:

• TEP : Totally extra peritoneal Repair. Surgical dissection and mesh placement is performed outside of the peritoneal cavity in the pre-peritoneal space away from the visceral contents. Mesh does not come into contact with bowel or visceral organs. Usually utilised for inguinal hernia or femoral hernia.
• ETEP : Extended view totally extra peritoneal. Same as TEP, but can be utilised for other hernia such as Spigelian, ventral, incisional and large inguinal hernia.
• ETEP Rives-Stoppa : Places mesh in retro-rectus position in front of posterior sheath and away from visceral bowel contents. This technique is often utilised for larger incisional ventral hernia with abdominal wall reconstruction.
• ETEP TAR : An extension of the eTEP Rives-Stoppa where a transversus abdominal muscle release is incorporated into the repair. This technique is often utilised for larger incisional ventral hernia with abdominal wall reconstruction.
• TAPP/Plus : Transabdominal preperitoneal with closure of defect. This technique is reserved for ventral, incisional, and flank hernia with abdominal wall reconstruction. Involves lifting a flap of peritoneum, closing the fascial defect then placing and securing an uncoated mesh. The operation is finished with closure of the peritoneal defect. Probably best done robotically.
• IPOM : Intra-abdominal only mesh. This technique places a coated mesh in the abdominal cavity. A relatively quick operation utilised for ventral and incisional hernia that is reserved for older/frail patients who cannot tolerate a lengthy anaesthetic.

Recurrent Hernia Repairs

A recurrent Hernia is a Hernia that was repaired before has returned. Recurrent hernias do not necessarily mean a problem regarding the previous surgery. Hernia mesh can shrink in size or migrate, and hernia defects can increase in size overtime.

Risk factors of recurrent Hernia in patents are: Smoking, Diabetes, Obesity (BMI over 35), and sometimes Genetics. Recurrent Hernias are more complex to repair surgically, and they are best managed by surgeons specialised in Hernia surgery. If you think you have a recurrent hernia, please make an appointment with Dr. Sourabh Damani. We sometimes will need to obtain your original operating report from your previous surgeon. This document will state the surgical technique and products used, which can be very helpful to us. After the initial appointment, we are likely to send you for CT scans in order to identify the hernia size, contents, and other hernias you may or may not also have. During your next appointment, Dr. Damani will discuss the best surgery options with you, which may include:

• Laparoscopic repair.
• Abdominal wall reconstruction or Open repair.

Care at Home

• Rest when you feel tired. Getting enough sleep will help you recover.
• Drink plenty of fluids to keep yourself hydrated.
• Try to walk each day. Start by walking a little more than you did the day before and increase the amount you walk gradually. Walking boosts blood flow and helps prevent pneumonia and constipation.
• If you are given an abdominal binder to wear, use it as directed. This is an elastic bandage that wraps around your belly and upper hips. It helps support your belly muscles after surgery.
• Avoid strenuous activities, such as biking, jogging, weight-lifting, or aerobic exercise, until advised by Dr. Sourabh Damani.
• Do not lift anything more than 5kg within 4 weeks post hernia repair.
• Wait at least 7 days before returning to driving.
• Most people are able to return to work within 1 to 2 weeks after surgery. However, if your employment requires heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work.

You may shower after surgery as you have waterproof dressings. It is common to experience irregular bowel movements after surgery. Avoid constipation and if you have not had a bowel movement after a couple of days, take a mild laxative prescribed by our team.

Dr. Damani will tell you if and when you can restart your usual medicines including any blood thinners. He will also give you instructions about taking any new medicines including antibiotics and painkillers.

Do breathing exercises at home as instructed. This will help prevent pneumonia.

If you had laparoscopic surgery, you may also have pain in your shoulder. The pain usually lasts about a day or two