Hernias are abnormal protrusion of an organ or tissue through an opening that should not be there – for example the inguinal hernias found in the groin region. Incisional and umbilical hernias are hernias that result from a defect in the abdominal wall. For incisional hernias, this defect is through a weakening at the site of a surgical incision used for a previous operation. This can therefore be found anywhere on the abdominal wall. For umbilical hernias, the defect is through an opening for the umbilical cord that did fuse completely after birth.
All incisional and umbilical hernias need to be repaired by elective surgery. There is no other successful treatment for this and the hernia will only get bigger with time if left alone. Most patients will also want surgery as the hernia can cause symptoms such as discomfort, a burning sensation or a bulge. Acute complications can also happen. If the intestines get trapped in a hernia and cannot be reduced back into the abdominal cavity, it can get strangulated or obstructed. The warning signs of this happening are severe pain, vomiting and abdominal distension. Emergency surgery is then required as soon as possible.
The principles of hernia surgery are to reduce the hernia contents and to repair the hernia defect by either direct closure or by mesh reinforcement. Unless the opening is very small we prefer the mesh repair as the risk of recurrence is much lower. The operation can be done either by conventional open surgery or laparoscopically.
Instead of making a large incision over the hernia (or over the line of the previous surgical scar in the case of an incisional hernia), we make a 1 cm incision far away from the hernia to insert a telescope into the abdominal cavity. Two to three other 5 mm incisions are used to insert the instruments needed to perform the operation – the entire operation is done from within the abdominal cavity. The contents of the hernia are dissected free, reduced and a mesh is used to repair the defect. This is a special double-sided mesh, the inner lining is inert and does not adhere to the bowel which it may be in contact with. The mesh is secured with strong sutures placed in a circle around the defect and reinforced with surgical tacks.
Since the approach to the hernia is from the inside we do not need to cut through the hernia or the previous scar tissue as we would in conventional open repair. Healing is therefore much faster. There is less pain and the risk of wound infection is also reduced. The laparoscopic repair also seems to be a superior repair. In the long term, the risk of developing a recurrent incisional hernia has been found to be less than after open repair.
Most cases of Laparoscopic Repair can be done as Day Surgery or overnight admission. The only disadvantage of the Laparoscopic Repair is the high cost of the special mesh used. A medium sized piece may cost about S$1000.
"I went for a colonoscopy, gastroscopy, and hemorrhoidectomy procedure with Dr Melvin Look. It was nerve wrecking for me to go under general anesthesia (GA) but Dr Look eased my fears with his calm and confident demeanour along with his funny disposition. Had a smooth and successful procedure with attentive pre- and post-op care from Dr Look who has been very patient with all my questions before and after the surgery!"
I met Dr Sam Peh in 2018 when I was admitted to parkway east hospital for acute unrinary retention . Subsequently in the same year I had TURP procedure .Some tissues from TURP was found to be cancerous . We just monitor the situation on 6 monthly psa reading In 2020 the psa reading spiked and am MRI scan shows 2 lesions in the prostate Dr. Peh give me the option to burn the 2 lesions using the HIFU technology. I’m glad to use HIFU as the downtime was like only a day. Dr Peh always explain the procedures to me using simple layman’s language and with drawings as illustrations. I feel safe and confident with Dr Peh as my urologist.
I was worried about my constant bloatedness , nauseous & poor appetite in eating . I was not eating well at all for 4 months. I decided to seek help from Dr Melvin Look and was scheduled very quickly for a scope - to give me a peace of mind. Nursing team was also assuring and patient with me when I had questions on insurance & costing . I was very well advised at every step of the way! Thank you Dr Look and to the nurses who attended to me at pan asia!