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Robotic Abdominal Wall Reconstruction Performed to Treat Incisional Hernia
A 65-years-old female visited Max Super Speciality Hospital, Patparganj, with a huge lump over the abdomen for the last 3-4 years. She was morbidly obese (BMI- 47.4 Kg/m2), diabetic and hypertensive, and was on medication. The patient had a history of previous multiple abdominal surgeries, including two LSCS, incisional hernia repair, Bariatric Surgery (gastric bypass) and multiple failed Laparoscopic Ventral Hernia repairs.
She also had a recent history of aortic valve replacement. The patient has diagnosed with a large Re-recurrent complex Incisional Hernia with loss of domain, for which she was being denied surgery by almost every center in the region. It was a high-risk case because of obesity, loss of domain, old age, comorbidities, recent Valve Replacement Surgery and complexity of Hernia. CT Abdomen revealed a large umbilical and infra-umbilical defect (13 x 10 cm) with bowel and omental content and divarication of recti. Doctors at Max Institute of Minimal Access, Bariatric and Robotic Surgery, Max Hospital, Patparganj decided to perform a Robotic Abdominal Wall Reconstruction (AWR) Surgery using various techniques. Under the guidance of a Bariatric Nutritionist, she was kept on a weight reduction diet for a month and successfully reduced her weight by 10 kg and BMI to below 40.
The patient was admitted for final surgery after optimization, and a Robotic AWR was done with successful outcomes. Five hours post-surgery, the patient was ambulated. She was discharged on 2nd day of the operation and was able to consume a normal oral diet. The patient is under follow-up at regular intervals and is doing well now.
Management of complex Re-recurrent Hernias in high-risk cases gives a narrow range of error. These patients require meticulous pre-operative evaluation, careful intra-operative and post-operative management. Da Vinci Xi system offers the advantage of dissection in narrow spaces, especially in these cases with complex hernias.
She also had a recent history of aortic valve replacement. The patient has diagnosed with a large Re-recurrent complex Incisional Hernia with loss of domain, for which she was being denied surgery by almost every center in the region. It was a high-risk case because of obesity, loss of domain, old age, comorbidities, recent Valve Replacement Surgery and complexity of Hernia. CT Abdomen revealed a large umbilical and infra-umbilical defect (13 x 10 cm) with bowel and omental content and divarication of recti. Doctors at Max Institute of Minimal Access, Bariatric and Robotic Surgery, Max Hospital, Patparganj decided to perform a Robotic Abdominal Wall Reconstruction (AWR) Surgery using various techniques. Under the guidance of a Bariatric Nutritionist, she was kept on a weight reduction diet for a month and successfully reduced her weight by 10 kg and BMI to below 40.
The patient was admitted for final surgery after optimization, and a Robotic AWR was done with successful outcomes. Five hours post-surgery, the patient was ambulated. She was discharged on 2nd day of the operation and was able to consume a normal oral diet. The patient is under follow-up at regular intervals and is doing well now.
Management of complex Re-recurrent Hernias in high-risk cases gives a narrow range of error. These patients require meticulous pre-operative evaluation, careful intra-operative and post-operative management. Da Vinci Xi system offers the advantage of dissection in narrow spaces, especially in these cases with complex hernias.
