Precision in Every Repair.
Advanced Techniques for Modern Hernia Care.
A hernia may begin as a small swelling, but the underlying problem is a weakness or defect in the abdominal wall.
Modern hernia surgery is no longer simply about “putting a mesh.”
The surgical approach, anatomical plane, mesh characteristics and fixation method can all be selected according to the type of hernia, size of the defect, previous surgery, abdominal-wall anatomy and individual patient factors.
At Laprocare Hospital, advanced laparoscopic and minimally invasive techniques are used for appropriately selected inguinal, ventral, umbilical, incisional, recurrent and complex hernias.
WHAT IS A HERNIA?
A hernia occurs when an internal organ, intestine or fatty tissue pushes through a weak area or defect in the abdominal wall.
The abdominal wall normally provides strong support to the organs inside the abdomen.
When a weak point develops, pressure from inside the abdomen can push tissue through that area, producing a visible bulge or swelling.
A hernia may become more noticeable when:
- Standing
- Coughing
- Sneezing
- Straining
- Lifting weight
- Exercising
It may reduce or disappear when lying down, particularly in an uncomplicated reducible hernia.
A hernia is an anatomical defect.
Medicines, belts and lifestyle measures may sometimes help with symptoms or risk management, but they do not generally close an established adult abdominal-wall defect.
WHY DOES A HERNIA DEVELOP?
Hernia formation is often the result of a combination of abdominal-wall weakness and increased intra-abdominal pressure.
Common contributing factors include:
Previous Surgery
An incision can create an area of weakness that may later develop into an incisional hernia.
Obesity
Increased abdominal pressure and altered abdominal-wall mechanics can contribute to hernia development and recurrence risk.
Chronic Cough
Repeated increases in intra-abdominal pressure can stress a vulnerable abdominal wall.
Constipation & Straining
Repeated straining can increase pressure on the abdominal wall.
Heavy Physical Activity
Repeated high intra-abdominal pressure may reveal or aggravate a pre-existing weakness.
Pregnancy
Pregnancy stretches and changes the abdominal wall.
Ascites
Persistent abdominal fluid and increased intra-abdominal pressure may contribute to abdominal-wall herniation.
Age-Related Tissue Weakness
Connective tissue strength can change with age.
Congenital Weakness
Some patients have an anatomical weakness present from birth.
TYPES OF HERNIA
INGUINAL HERNIA
A hernia occurring in the groin region.
It may present as a groin swelling that becomes prominent during standing, coughing or straining.
FEMORAL HERNIA
A hernia occurring through the femoral canal.
It has distinct anatomical characteristics and may have a higher risk of complications in some patients.
UMBILICAL HERNIA
A hernia occurring at or around the navel.
It can range from a small defect to a larger abdominal-wall defect.
EPIGASTRIC HERNIA
Occurs through the upper midline of the abdominal wall, between the breastbone and umbilicus.
VENTRAL HERNIA
A broad term used for hernias occurring through the anterior abdominal wall.
INCISIONAL HERNIA
Develops through or around a previous surgical incision.
The previous operation and any existing mesh are important considerations when planning repair.
RECURRENT HERNIA
A hernia that returns after previous repair.
Recurrent hernia surgery can be more complex because of scar tissue, altered anatomy and previous mesh.
BILATERAL HERNIA
Hernias occurring on both sides of the groin.
Selected patients may be suitable for bilateral minimally invasive repair.
COMPLEX HERNIA
Large, recurrent, multiple or anatomically difficult abdominal-wall defects may require advanced reconstruction.
WHAT ARE THE SYMPTOMS?
A hernia may cause:
Visible swelling or bulge
Groin or abdominal discomfort
Pain while coughing or straining
Heaviness or dragging sensation
Pain during physical activity
Swelling that increases on standing
Swelling that reduces on lying down
Some hernias can remain relatively painless despite increasing in size.
WHEN IS A HERNIA AN EMERGENCY?
An uncomplicated hernia may be soft and reducible.
However, a hernia can become incarcerated, meaning the contents become trapped and cannot be reduced.
In some cases, the blood supply to the trapped tissue may become compromised. This is known as strangulation.
Warning symptoms include:
- Sudden severe or increasing pain
- A swelling that becomes firm and cannot be reduced
- Persistent vomiting
- Abdominal distension
- Significant tenderness
- Redness or skin changes over the swelling
- Difficulty passing stool or gas in an appropriate clinical setting
These symptoms require urgent medical assessment.
DOES EVERY HERNIA NEED SURGERY?
Treatment depends on the individual situation.
A surgeon may consider:
Type of hernia
Size of the defect
Symptoms
Progression
Reducibility
Previous operations
Previous mesh
Patient factors
Abdominal-wall anatomy
Risk of complications
Some minimally symptomatic hernias may be managed with observation in selected patients, while symptomatic, enlarging or complicated hernias may require operative treatment.
OPEN VS LAPAROSCOPIC HERNIA REPAIR
There is no single operation that is appropriate for every hernia.
OPEN REPAIR
The surgeon reaches the hernia through an incision over the affected area.
LAPAROSCOPIC REPAIR
Small access ports are used with a camera and specialised instruments.
ADVANCED MINIMALLY INVASIVE REPAIR
Selected ventral and incisional hernias can be treated using extraperitoneal, preperitoneal or retromuscular approaches.
The choice depends on the patient’s anatomy, hernia characteristics, previous surgery and surgeon assessment.
ADVANCED LAPAROSCOPIC TECHNIQUES
TAPP
Transabdominal Preperitoneal Repair
The abdominal cavity is accessed laparoscopically to reach the preperitoneal space.
The hernia is reduced and the relevant groin anatomy is reinforced with mesh.
TEP
Totally Extraperitoneal Repair
The surgeon works in the preperitoneal space without routinely entering the abdominal cavity.
This approach can provide excellent access to the groin anatomy in appropriately selected patients.
eTEP
Extended Totally Extraperitoneal Repair
An advanced minimally invasive approach that allows access to broader abdominal-wall planes.
It can be used in selected ventral and incisional hernias.
eTEP-RS
Extended Totally Extraperitoneal Retromuscular Repair
A minimally invasive approach that can facilitate mesh placement in the retromuscular plane for appropriately selected abdominal-wall defects.
PREPERITONEAL REPAIR
The mesh is positioned in the preperitoneal plane, providing reinforcement while avoiding direct visceral contact when the anatomy and procedure permit.
RETROMUSCULAR REPAIR
Mesh is positioned within the abdominal-wall reconstruction plane behind the rectus muscles.
This is an important concept in modern ventral and incisional hernia reconstruction.
THE RIGHT MESH FOR THE RIGHT HERNIA
MESH IS NOT ONE-SIZE-FITS-ALL
Different hernias and different surgical planes may require different mesh characteristics.
LIGHTWEIGHT MESH
Lower material burden with appropriate reinforcement and tissue-integration characteristics.
MACROPOROUS MESH
Designed to allow tissue incorporation and commonly considered for suitable extraperitoneal repairs.
COMPOSITE MESH
Designed with a visceral-facing barrier for selected situations where mesh may otherwise contact abdominal viscera.
ANATOMICAL MESH
Specific shapes may assist coverage in particular anatomical locations.
SELF-GRIPPING MESH
Certain meshes contain gripping elements that can assist positioning and fixation in selected repairs.
RETROMUSCULAR MESH
Mesh placed in the retromuscular plane can provide reinforcement in selected ventral and incisional hernia repairs.
THE PRINCIPLE
The goal is not simply to use mesh.
The goal is to select the appropriate mesh and place it in the appropriate anatomical plane.
HOW IS THE MESH FIXED?
Mesh fixation depends on the procedure, mesh, location and surgical strategy.
GLUE FIXATION
Surgical adhesive can be used for mesh fixation in selected procedures.
Potential advantages include avoiding some penetrating fixation devices and potentially reducing early postoperative pain in certain repairs.
ABSORBABLE TACKERS
These fixation devices provide mechanical fixation and are designed to be absorbed over time.
PERMANENT TACKERS
Mechanical fixation devices that remain in place.
They may be used selectively depending on the repair.
SUTURE FIXATION
Sutures may be used for mesh fixation or abdominal-wall reconstruction when appropriate.
COMBINATION FIXATION
Some repairs may require a combination of fixation methods.
FIXATION SHOULD BE INDIVIDUALISED.
The decision should consider:
Anatomical structures
Mesh position
Defect characteristics
Required stability
Potential postoperative pain
Type of hernia repair
RECURRENT HERNIA
WHEN A PREVIOUS REPAIR HAS FAILED
Recurrent hernia surgery is often more complex than primary repair.
The surgeon may need to evaluate:
Previous surgical approach
Previous mesh
Mesh position
Scar tissue
Previous fixation
Current defect
Available anatomical planes
The previous operation therefore becomes an important part of planning the next repair.
COMPLEX ABDOMINAL-WALL HERNIA
Large or complex defects may require reconstruction rather than simply placing a piece of mesh over the opening.
Advanced abdominal-wall surgery may involve:
RETROMUSCULAR REPAIR
Placement of mesh in the retromuscular plane.
RIVES–STOPPA PRINCIPLES
A well-established approach to retromuscular ventral hernia reconstruction.
eTEP-RS
Minimally invasive access to the retromuscular abdominal-wall plane in selected patients.
TAR
Transversus Abdominis Release
An advanced component-separation technique used for selected large or complex abdominal-wall defects.
ABDOMINAL-WALL RECONSTRUCTION
The objective can be restoration of abdominal-wall anatomy, function and reinforcement.
WHAT HAPPENS DURING LAPAROSCOPIC HERNIA SURGERY?
01 — CONSULTATION
The hernia is clinically assessed and imaging may be recommended when required.
02 — SURGICAL PLANNING
The approach, mesh, anatomical plane and fixation strategy are determined.
03 — MINIMALLY INVASIVE ACCESS
Small ports are introduced when laparoscopic surgery is appropriate.
04 — ANATOMICAL IDENTIFICATION
The hernia defect and important surrounding structures are identified.
05 — REDUCTION
Herniated tissue is reduced where appropriate.
06 — DEFECT MANAGEMENT
The defect is addressed according to the chosen repair strategy.
07 — MESH PLACEMENT
The selected mesh is positioned with appropriate overlap and anatomical coverage.
08 — FIXATION
Glue, tackers, sutures or other fixation methods may be used when indicated.
09 — RECOVERY
The patient is monitored and receives postoperative pain control, mobilisation advice and follow-up.
RECOVERY AFTER HERNIA SURGERY
Recovery depends strongly on the type and complexity of the operation.
Patients receive advice regarding:
Mobilisation
Pain management
Wound care
Diet
Driving
Work
Exercise
Heavy lifting
Follow-up
A simple inguinal hernia repair and a complex abdominal-wall reconstruction have very different recovery pathways.
FREQUENTLY ASKED QUESTIONS
Can a hernia disappear by itself?
An established adult abdominal-wall defect generally does not spontaneously close. Management depends on the type and clinical circumstances.
Is mesh safe?
Mesh is widely used in modern hernia surgery. Like any implant, it has potential complications, and the benefits and risks should be discussed individually.
Is laparoscopic surgery always better?
Not necessarily. The appropriate approach depends on the hernia, patient factors, previous operations and surgical assessment.
TAPP or TEP?
Both are established minimally invasive approaches. The choice depends on anatomy, previous surgery and surgeon expertise.
Can recurrent hernia be operated again?
Yes, selected recurrent hernias can undergo re-repair. Previous surgery and mesh placement are important in planning.
Can both sides be repaired together?
Selected patients with bilateral inguinal hernias can undergo bilateral minimally invasive repair.
Does every mesh require a tacker?
No. Depending on the repair, fixation may involve glue, sutures, absorbable tackers, permanent tackers, self-gripping properties or combinations.
MODERN HERNIA SURGERY
PRECISION • ANATOMY • TECHNOLOGY • INDIVIDUALISED REPAIR
Advanced hernia surgery brings together:
Accurate diagnosis
Appropriate surgical approach
Advanced laparoscopic techniques
Individualised mesh selection
Correct anatomical mesh plane
Appropriate fixation
Abdominal-wall reconstruction when required
Structured postoperative care
MEET YOUR SURGEON
DR. VIMAL DETROJA
Gastro Surgeon
Advanced Laparoscopic, GI & Bariatric Surgeon
MBBS | MS (General Surgery) | DNB (General Surgery) | FNB – Minimal Access Surgery | FALS – Colorectal & Bariatric Surgery | FIAGES
Dr. Vimal Detroja is a Gastro Surgeon with a surgical practice focused on advanced laparoscopic, gastrointestinal, colorectal, bariatric and hernia surgery.
His advanced training includes FNB – Minimal Access Surgery, with training at Sir Ganga Ram Hospital, New Delhi.
Areas of Surgical Practice
Advanced Laparoscopic Surgery
Inguinal & Bilateral Hernia Surgery
Ventral & Umbilical Hernia Surgery
Incisional & Recurrent Hernia Surgery
eTEP & Advanced Abdominal-Wall Surgery
Gastrointestinal Surgery
Colorectal Surgery
Bariatric Surgery
Complex Abdominal Surgery
LAPROCARE HOSPITAL
Advanced Laparoscopy & Bariatric Centre
Advanced Hernia & Laparoscopic Surgery in Morbi
Dr. Vimal Detroja
4th Floor, Subham Hospital Building
Savsar Plot 15, Vodafone Store Street
Sanala Road, Morbi – 363641
Gujarat, India
PHONE / WHATSAPP
7984369579
ADVANCED HERNIA CARE IN MORBI
Your hernia deserves an individualised surgical plan.
Consult Dr. Vimal Detroja
Laprocare Hospital – Morbi
Advanced Laparoscopy & Bariatric Centre