More Effective Hernia Operations

Hernias are defects in the muscular wall of body cavities which allow the organs contained by the cavity to protrude through their usual confines into the space under the skin. The major complication of hernias is that the protruding organ can become trapped in this abnormal position, thereby incurring risk of perforation or rupture and the possible catastrophic consequences that follow. In the abdominal wall, the common places for hernias to occur are the groin or inguinal region and the midline at the front of the abdomen.

What is a Ventral Hernia?

Hernias which occur along the front of the abdomen (excluding inguinal hernias) are called ventral hernias. These hernias are mainly of two types: (1) those that are present from birth and usually occurring at the navel and (2) those occurring after abdominal operations when the surgical wound fails to heal properly.

Age Old Problem with Ventral Hernia Operations

For many years in the previous century, ventral hernias were operated on (surgically repaired) by suturing (stitching) the edges of the defect together. This repair did not work very well, with recurrence of the hernia after as much as half of the operations.

Mesh Used in Hernia Operations

Subsequently, with the invention of synthetic meshes constructed from a variety of materials related to plastics, surgeons found that recurrence rates fell dramatically if mesh was stitched into the hernia defect and so mesh repair became the standard operation for ventral hernias.

Using the Mesh Effectively

The mesh may be placed in front of, within or behind the abdominal wall (but in front of the internal lining of the abdominal cavity, called the peritoneum). There is now general agreement among surgeons that the most effective place for the mesh (the position that achieves the lowest recurrence rates) is behind the abdominal wall. The problem is that traditional operations to place the mesh in this position require extensive dissection to open up the space (and therefore general anaesthesia and long operating time) as well as placement of large sheets of mesh which can make the abdominal wall stiff.

UWI Doctor Identifies a New Method

Dr. East in his research describes a new way to tuck the mesh into this space behind the abdominal wall without dissecting into it at all. There are many advantages to this new operation. It is much less tedious to perform than the traditional approach and therefore requires less operating time. It does not involve dissection into the plane behind the abdominal wall and can therefore be performed under local anesthesia when the hernia is not large and requires much smaller pieces of mesh.

Important Breakthrough

Importantly, in a research paper published in the West Indian Medical Journal in 2007, in which Dr. East reported on 61 cases of the mesh tuck repair performed by him, the recurrence rate was at the lower end of the range of recurrence rates reported in the international medical literature for the traditional mesh repair.

Dr. Jeffrey East is an Associate Lecturer in Surgery in the Faculty of Medical Sciences, UWI, Mona. He is also Deputy Dean in charge of the Faculty of Medical Sciences at the Western Jamaica Campus in Montego Bay and Chief of Surgery at the Cornwall Regional Hospital. jeast@cwjamaica.com