Redo Hernia Repair Unilateral

Redo unilateral hernia repair surgery

A redo unilateral hernia repair is an operation under the same side (unilateral) where an earlier hernia repair has been carried out but the hernia has reoccurred either due to incomplete healing, tension, mesh failure or otherwise.

Overview

A recurrent hernia is hernia which recurs in the same or close to the same location where a previous repair has been done. It can be inguinal, femoral or incisional. The redo operation is more technical as compared to the first repair due to scar tissue and distortion of anatomy by the old surgical process.

Causes of Recurrence

Ordinary causes of hernia recurrence include:

• Infection or failure to heal a wound following the initial surgery.
• Poor fixing of the mesh or inappropriate positioning.
• Raised pressure in the abdomen (chronic cough, constipation, heavy lifting)
• Obesity or smoking
• Poor quality of tissue or connective tissue disorders.
• Absorbable suture/small mesh used in the last operation.

Diagnosis

Diagnosis involves:

• Examination: Lump or bulge in the same location of hernia, pain, or discomfort.
• Ultrasound or CT scan: It can be used to determine the size of hernia, hernia contents and placement of the mesh.
• History: Review: Type of prior surgery (open or laparoscopic) and complications.

Revision unilateral hernia surgery India

When hernia returns on the same side following a previous surgery (either laparoscopic or open), a revision unilateral hernia surgery is done. It is also referred to as recurrent or redo hernia repair and it needs special surgical skills as there are scar tissues and distorted anatomy after the initial surgery.

Overview

The purpose of the revision unilateral hernia repair is to repair the integrity of the abdominal wall and strengthen the weakened tissue. The revision strategy relies on, to a great extent:

• The kind of surgery (open or laparoscopic) primary.
• Topography and magnitude of the recurrence.
• Condition of previous mesh
• General health and tissue of patient.

Surgical Options

• Their preference of technique would be based on the former repair method.

Open Revision Hernia Repair

• Compensated by the preference of the first operation being laparoscopic.
• The surgeon cuts an opening where the old one was and removes the old defective mesh where necessary and seals the defect with a new mesh.
• Most appropriate with big or complicated recurrences.

Laparoscopic Revision Hernia Repair

• Desirable in case the initial operation was open.
• Less invasive technique of TAPP (Transabdominal Preperitoneal) or TEP (Totally Extraperitoneal).

Provides:

• Less postoperative pain
• Shorter hospital stay
• Quicker recovery

Robotic Hernia Repair (not mandatory, only in advanced centers)

• It is more accurate and has fewer recurrence rates.
• Appropriate when the hernia is complicated or when it reoccurs.

Step-by-Step Surgical Process 

• Anaesthesia: General anaesthesia was done.
• Incision or port position: According to the methodology (open or laparoscopic).
• Dissection Vital structures are carefully dissected away and scar tissue is separated.
• Identification of Hernia sac: The recurrent pathology is isolated.
• Reinforcement: A larger grid is fastened over the loose areas.
• Closure: Incision or ports are neatly closed.

Redo laparoscopic unilateral hernia repair

Redo laparoscopic unilateral hernia repair is used to treat recurrence of an inguinal or femoral hernia on one side (right-left) of the abdomen that has previously been repaired by laparoscopic hernia repair (TEP Totally Extraperitoneal Repair) or (TAPP Transabdominal Preperitoneal Repair).

Due to the fact that recurrence following laparoscopic repair is quite uncommon (approximately 1-3 percent), redo operation needs a highly qualified hernia surgeon conversant with the reoperative minimum invasive surgery.

Surgical Approaches

• Since it has been a laparoscopy surgery, an open surgery is normally the preferred mode of redo repair.
• Nevertheless, laparoscopic fixation can be redone under other specific instances when:
• The last repair was a TAPP and this current repair can be TEP (different plane).
• The incidence is both local and minimal.
• Laparoscopic dissection can be done safely in the anatomy of the patient and the location of the mesh.
• We shall examine the procedure of redo laparoscopic repair.

Redo Laparoscopic Unilateral Hernia Repair Procedure

Step 1: Anaesthesia

• No general anaesthesia is done.

Step 2: Port Placement

• Trocars are also placed far away past the scarred parts to prevent adhesions.

One applies either TAPP or TEP:

• TAPP (Transabdominal Preperitoneal Repair): Surgeon accesses the abdominal cavity and then works towards the hernia on the inside.
• TEP (Totally Extraperitoneal Repair): Surgeon works on the surface of the layers of the muscles without a cut in the stomach.

Step 3: Dissection

• The surgeon will go to great care to dissect old mesh and scar tissue.
• The recurrent hernia sac is distinguished and corrected.

Step 4: Mesh Assessment

• In case the old mesh is in good condition and it is correctly installed, it can be left.
• In case of its displacement, infection or destruction, it is partially or completely removed.

Step 5: New Mesh Placement

• The defect is then reinforced with a new larger mesh which has a wide overlap.
• Mesh is secured with tackers, glue or sutures to ensure that mesh does not migrate.

Step 6: Closure

• The preperitoneal or peritoneum is cautiously sealed to avoid the recurrence of the same or adhesions.

Factors Affecting Cost of redo hernia repair unilateral India

The redo laparoscopic unilateral hernia repair in India has a very high cost depending on various factors. Here's a detailed breakdown:

Type of Surgery

• Laparoscopic Surgery: It is usually more costly because it has highly developed technology and seems minimal invasive.
• Open Surgery: It is usually cheaper but can take a longer period to recover.

Hospital Location

• Metro Cities: Delhi, Mumbai, Bengaluru and Hyderabad among other cities are likely to have a larger cost of surgery because of the superior medical care and expensive cost of living.
• Tier 2/3 Cities: Hospitals in such cities as Pune, Jaipur and Kochi might provide cheaper alternatives.

Hospital Type

• Private Hospitals: More expensive and offer faster services.
• Super-Specialty Hospitals: include the latest and best facilities and skilled surgeons which also increase the price.

Surgeon’s Expertise

• Very practiced or surgeons that have a specialized skill in hernia repairs are likely to charge more.

Mesh Type

• Standard Mesh: Both cheaper and more common.
• Advanced Mesh: Like 3D or biological mesh are more costly, yet can possibly have better results.

Severity and Complexity

• Recurrent Hernias: will need more complicated surgery, thereby increasing expenses.
• Simple Hernias: They are not complicated and therefore less costly to treat.

Best hospital for redo unilateral hernia surgery India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Recovery after redo hernia surgery unilateral

Redo (revision) unilateral hernia repair recovery is contingent upon the mode of operation (open or laparoscopic), the complexity of the recurrence, and the health of the patient. Redo surgery is a little longer and more cautious to recover than initial hernia repair due to the presence of scar tissue and the potential of old mesh.

Immediate Postoperative Period (Day 0-3)

Hospital Stay:

• Laparoscopic: 1–2 days
• Open surgery: 2–4 days

Pain Management:

• Oral or IV analgesics
• Slight to moderate pain is within normal limits, particularly around the incision or groin.

Activity:

• On the first day, it is advised to walk to avoid blood clots.
• Nothing to bend, raise or strain.

Early Recovery (Week 1–2)

Wound Care:

• Maintain a clean and dry incision.
• Observes the signs of infection (redness, swelling, discharge)

Activity:

• Normal day-time activities are permitted.
• After lifting anything heavier than 5 kg avoid it.

Diet:

• Consistent diet except when otherwise recommended.
• Fiber diet to avoid constipation and strain.

Intermediate Recovery (Week 2–4)

Work:

• Desk or light work can be resumed by most patients after 1 2 weeks.

Exercise:

• Light stretching or walks should be encouraged.
• Avoid heavy lifting, running or strenuous exercising.

Pain:

• Typically resolves; the slight groin pains can be left behind.

Full Recovery (Week 4–6)

Return to normal activity:

• Gradual full physical activity, lifting.

Follow-up:

• Surgeons typically make appointments 2-4 weeks later and 6 weeks later.

Watch for complications:

• The new bulge, persistent swelling, pain, fever, etc. are to be reported immediately.

Conclusion

Redo unilateral hernia repair is a surgical procedure that is conducted in the case of a hernia on the same side that has already been repaired. It may be performed through laparoscopic or open surgery, based on the form of original repair, the point of recurrence and the size, and the state of the old mesh. Redo unilateral hernia repair is safe, effective, and has a high success rate when done by an expert surgeon who has the necessary postoperative care. A very attentive choice of the surgical method, an improved position of the mesh, and the maintenance of the recovery rules will help a lot to decrease the possibility of the further recurrence and complications.

Redo hernia repair unilateral in India with GetWellGo

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FAQ

1. During redo surgery, is the old mesh taken off?

• Not always. Mesh is also removed when it is infected, torn or problematic. In many cases, the new mesh is over or close to the old one.

2. What is the success rate of redo surgery of hernia?

• The success rate is 90-95 percent and the probability of recurrence after redo surgeries is minimal (less than 5 percent) when they are performed by an expert surgeon.

3. Is it possible for a hernia to reoccur following redo surgery?

• Although infrequent, it can recur. This risk is reduced by proper mesh positioning, surgery, and lifestyle (avoiding heavy lifting, cough control, constipation and healthy weight maintenance) precautions.