Robotic Abdominal Wall Reconstruction for complex Abdominal Hernia: Modern Hernia surgery

in Max Super Speciality Hospital, Mohali

Feb 02 , 2023

A middle-aged woman came to Max Super Speciality Hospital, Mohali, with abdominal wall swelling for the past 8 years, associated with increasing pain for last 3 months. She had undergone explorative laparotomy for intestinal perforation, followed by wound dehiscence 12 years back. On clinical examination, she was found to have multiple swiss cheese pattern defects in the midline from epigastrium to supra-pubic region, with bowel loop as contents in multiple hernia defects.

She was optimised medically and investigated with Contrast-Enhanced Computed Tomography (CECT) Abdomen, to assess abdominal musculature and hernia anatomy in detail. CT scan was suggestive of bowel loops being content of hernia defects with possible adhesions within anterior abdominal wall. Complex Ventral hernia (Incisional, Irreducible, Bowel as content, M1-5) was the final diagnosis. After pre-operative optimisation, she was planned for Robotic Abdominal Wall Reconstruction (e-TEP-RS +-TAR).

The patient was managed by Robotic Abdominal Wall Reconstruction (eTEP-RS) for Complex Ventral Hernia. She tolerated the Page No 06 procedure well, and surgery went uneventful, was ambulated 4 hours after the surgery and discharged from the hospital on 2 nd day post-operative. Her follow-up at one week and one month were both satisfactory.

Abdominal Wall Reconstruction (AWR) is Advanced Hernia Surgery that has recently gained popularity, especially in complex abdominal wall hernias. It is different from Laparoscopic Intraperitoneal Onlay Mesh (IPOM) Ventral Hernioplasty, where mesh, inspite of being placed in the peritoneal cavity, is placed between the abdominal wall layers. This prevents the usage of costly composite meshes and tacking devices used in Laparoscopic IPOM. Thus, implant cost involved in AWR is much less than Laparoscopic IPOM Ventral Hernia surgery.

Postoperative pain is less, and recovery is much faster in AWR, but it requires a surgeon's learning curve due to its complexity. Surgical Robot makes AWR surgery easier as instrument manoeuvrability is better while working in closed space, and surgeon's fatigability is less being in long surgeries. A further benefit of Surgical Robot is better precision, more safety, less blood loss and early recovery for the patient. An increasing number of surgeons are turning towards the Robotic or Laparoscopic Abdominal Wall Reconstruction technique to repair complex hernias, as it offers improved surgical outcomes as opposed to the conventional open surgical method.