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Beware of the Bulge:Successful Repair of Recurrent Hernia @OASIS

Hernias are one of the most common surgical procedures to be performed, but recurrent hernias are quite a bit more tricky.

Def: A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of different types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most common of the inguinal type but may also be femoral.

The breakdown of a hernia repair is called recurrent hernia. The bulge returns at or near the site of the prior hernia which greatly increases the complexity of subsequent repair. If left untreated, severe complications can result such as the intestines being trapped known as an incarcerated hernia, digestive obstruction, or a loss of blood supply to the intestines known as a strangulated hernia. Highly complex abdominal surgery is often required to repair recurrent hernias, which our team of surgeons at OASIS International Hospital were successfully able to see through for one of our patient.

Just recently, OASIS’s surgical team under the leadership of Dr. Guo Limin (one of our latest additions to the OASIS surgical team) successful performed an umbilical hernia repair using a tension-free mesh repair technique known as a Sublay patch.

The patient was an American 39 year old male who had moved to Beijing to live and work. He had underwent hernia surgery initially in the US 14 years prior. It was only in February of this year that he noticed a bulge near the previous hernia site which was then accompanied by obvious pain and discomfort alerting him to seek medical attention.

In his search for a suitable hospital to undergo treatment, he was met with many obstacles:

  • Language Barrier: The patient did not speak Chinese, so communication with most hospital physicians and nurses was almost impossible. Without the capability to inquire about his past surgical history, reasons for the initially cause of his hernia and no obvious reason for recurrence….. hospital staff were reluctant to take his case.

  • High risk, Highly Complex Procedure: With having no possibility to contact the hospital and surgeon of the previous procedure, there was no way for the current surgeons to better understand the past operation to provide guidance to make clear judgments for the current treatment plan. Therefore, the operation is high risk and more complex, requiring a highly capable and skilled surgeon able to deal with emergencies, and a hospital with a sound risk emergency assessment capability.

After many setbacks in his search for a capable surgeon and hospital, he met with Dr. Guo Limin at OASIS International Hospital. His surgical consult was conducted in English with Dr. Guo, removing any previous language barriers allowing for a comprehensive examination of his condition, combining Ultrasound, CT and MRI, he was diagnosed with a recurrent abdominal hernia. Dr. Guo advised immediate hospitalization and treatment to avoid the enlargement of the hernia mass further adding to the difficulty of repair.

The patient, in recalling his previous issues with hospitals, expressed: “Through Dr. Guo’s professionalism, meticulousness and patience, I felt very confident in my decision to choose Dr. Guo Limin and OASIS to undergo my procedure.”

Dr. Guo upon comprehensive and systematic evaluation decided on an open surgery tension-free Sublay mesh method for this patient’s surgical treatment plan. Dr. Guo expressed: “In comparison to laparoscopic surgery, open surgery would be more beneficial to the patient here, the risks are lower for adhesions and recurrence.”

Dr. Guo specializes in multi-disciplinary consultation. The patient, weighing over 200kg posed a level of technical difficulty for anesthesia during surgery, but under the leadership of Dr. Guo, consultation between two disciplines with the head of Anesthesiology, Dr. Wu Qiwei and experienced anesthetist Dr. Ge Juying, allowed for a sound plan of action for the operation and anesthesia plan.  Under general anesthesia, the first Sublay Patch repair was performed successfully at OASIS with the patient recovering well post-op and discharged smoothly from the hospital.

Hernia Health Advice

Dr. Guo Limin has laid out a few guidelines to help those who find themselves in this unfortunate predicament, as well as ways to maintain a healthy hernia free life. See below:

  1. Hernias are a serious matter requiring immediate attention.

    Hernias for most people may seem like a non-life threatening disorder, therefore choosing to put treatment on the long finger or not seek treatment altogether. Quite the opposite is true.

    Adult hernias will not heal on their own or with medication, surgery, as soon as possible, is the only option. Severe complications can result from an untreated hernia such as the intestines being trapped known as an incarcerated hernia, digestive obstruction, or a loss of blood supply to the intestines known as a strangulated hernia.

  2. Minimally Invasive surgery is not the be all and end all of surgery options.

    Laparoscopic surgery has been very much in the spot-light of recent years, with its fast recovery rates and minimal scarring winning this surgery choice great favor over open surgery.

    Dr. Guo wished to emphasize here, both open and minimally invasive surgery are essentially the same. Both options can be applied here, both with the same low recurrence rate post-surgery. They only difference being, the field of vision. So in regards to choosing your method of surgery, its best left to the medical professionals to judge the best method forward for a patients treatment and recovery to health.

  3. Life-long healthy habits are all that is needed to keep hernias at bay.

    Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Below are 4 key points for the prevention of hernias:

    1. Maintain a healthy weight.

    2. Avoid excessive pressure on the abdomen:

      1.  Lifting heavy objects without stabilizing the abdominal muscles

      2. Constipation

      3. Persistent coughing, such as from smoking

    3. Exercise to strengthen core muscles

    4. Self-examination

Inguinal hernias are of the most common of hernias. Through self-examination, if you notice a bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain, or experience a burning or aching sensation at the bulge, pain or discomfort in your groin, especially when bending over, or coughing or lifting, you may have a hernia and should seek medical attention.

Dr. Guo Limin
English, Chinese

Dr. Guo Limin is an experienced surgeon of over 10years specializing in hepatobiliary surgery. As a General Surgeon, Dr. Guo is proficient in many areas such as the diagnosis, treatment, surgical procedures and post-op care of common and difficult diseases as well as emergency case critical care and treatment. He is adept in such surgical procedures such as cystectomy, laparoscopic appendectomy, laparoscopic inguinal hernia repair, laparoscopic gastroduodenal perforation repair, ultrasound-guided radiofrequency ablation of liver cancer, breast lobectomy, thyroidectomy as well as many other third-level surgical procedures. As the first assistant, he participated in radical gastrectomy, radical resection of colorectal cancer, radical pancreatoduodenectomy and right hepatectomy.