Hernia repair, weight loss surgery in one go

Lucknow: People who are overweight and have a bulge in their belly (called a ventral hernia) may not need two separate surgeries to lose weight and fix the hernia. Doctors at King George’s Medical University (KGMU) have devised methods to perform hernia repair and weight-loss surgery simultaneously in one go.

These new approaches were described in a research paper published in May, led by Prof Awanish Kumar from KGMU’s surgery department. The paper, titled ‘Innovative approaches to address the technical challenge of hernial sac distension due to pneumoperitoneum in the synchronous management of complex hernias in individuals with morbid obesity,’ appears in the renowned medical journal ‘Cureus.’ Prof Awanish highlighted that ventral hernias are prevalent among overweight patients undergoing weight loss surgery or those who have had previous abdominal surgeries, with occurrences in about 30 per cent of such cases. Typically, addressing this issue requires two separate laparoscopic procedures: one for weight loss and another to mend the hernia.

Performing both surgeries at one go poses a challenge. When surgeons inflate the belly with gas to create working space for a large hernia, the gas might leak, complicating the procedure. Doctors explored two innovative methods, one involving placing a special cloth, akin to a ‘mop,’ over the hernia externally and stitching it to stabilise the area. Another approach was moving any obstructing organs or scar tissue and then stitching across the belly hole to hold it temporarily. Afterward, they sealed the hole completely, facilitating the surgery.

The research paper detailed two cases where these methods were applied. In one instance, a 51-year-old woman with a high BMI and additional health conditions underwent the combined surgeries. The KGMU team placed a special cloth over her hernia, preventing it from enlarging when gas was introduced and maintaining a steady working space by preventing gas leakage.

In the second case, a 48-year-old woman faced similar health challenges. The surgical team moved obstructing organs or scar tissue and stitched across the belly hole temporarily. After completing the weight loss surgery, they removed the temporary stitches and placed a permanent patch with special stitches and tools to secure it.

Prof Awanish emphasised that these new techniques offer a viable and safer solution, making it easier to manage both conditions concurrently. Prof Akshaya Anand, also part of the surgical team, explained that addressing both issues simultaneously leads to fewer complications than treating them separately later on. This approach helps prevent problems such as hernia recurrence, bleeding, infections and fluid buildup. “So far, we have conducted five procedures with innovative techniques. Combining weight loss surgery and ventral hernia repair in specialised units is increasingly common. These units have specific methods to address the challenges of performing both surgeries at once, making it a practical and effective approach,” he said.

Dr Ankita Bajpai, another team member, highlighted that obesity can lead to various health problems like heart disease, diabetes and sleep apnea. Weight loss surgery can help alleviate these issues. The new techniques also help prevent the complications of untreated hernias, avoiding the subsequent surgeries.

Prof. Awanish and his team’s innovative approaches could change the way ventral hernias and obesity is managed, making the process less burdensome for patients. By addressing both the issues simultaneously, they hope to improve the quality of life for many individuals.