24 Aug,2023
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Hernia: Global Burden of Disease and Recent Advances in Management
Hernias are a prevalent medical condition characterized by the protrusion of organs or tissues through a weakened area in the body's muscular wall. They can occur in various regions, such as the abdomen wall, groin, or diaphragm. Hernias impose a significant burden on global health, affecting millions of individuals worldwide.
Global Burden of Hernias: Hernias have a substantial impact on global health, both in terms of prevalence and economic burden. According to the Global Burden of Disease Study, inguinal hernias alone accounted for 1.2% of global disability-adjusted life years (DALYs) in 2019. It is estimated that approximately 20 million hernia repairs are performed worldwide each year. Hernias not only affect the quality of life of individuals but also pose a significant economic burden due to healthcare costs, lost productivity, and disability
Recent Advances in Hernia Management:
1. Surgical Techniques
a. Tension-Free Techniques: Tension-free repair techniques, such as the use of mesh implants, have revolutionized hernia surgery. Meshes provide additional support and reduce the risk of recurrence. Advances in mesh design, such as lightweight and absorbable meshes, offer improved outcomes and patient comfort. Meshes can be placed laparoscopically or through open techniques, depending on the hernia type and surgeon's preference. The use of mesh has significantly reduced the rates of recurrence and improved long-term outcomes in hernia repair.
b. Laparoscopic Repair: Laparoscopic hernia repair has gained popularity due to its minimally invasive nature. It involves the insertion of a laparoscope and surgical instruments through small incisions, allowing for better visualization and precise mesh placement. This technique offers advantages such as reduced post-operative pain, shorter hospital stays, faster recovery, and improved cosmetic outcomes. Laparoscopic repair is particularly suitable for inguinal hernias, as it allows for the repair of both unilateral and bilateral hernias
c. Robotic-Assisted Repair: Robotic-assisted hernia repair combines laparoscopic techniques with robotic technology. Surgeons use robotic arms to perform intricate movements, enhancing precision and flexibility during the procedure. Although still evolving, this approach shows promise in complex hernia repairs. Robotic-assisted repair may be beneficial for large hernias, recurrent hernias, or patients with anatomical complexities. It offers advantages such as improved visualization, dexterity, and the ability to perform complex suturing in challenging cases
2. Non-operative Approaches
a. Watchful Waiting: In selected cases, particularly morbid, elderly and high risk patients with small asymptomatic hernias, watchful waiting may be an option. Regular monitoring is carried out to assess the hernia's progression and the need for intervention
b. Lifestyle Modifications: For individuals with risk factors contributing to hernia development, such as obesity and chronic cough, lifestyle modifications can play a significant role. Weight loss, smoking cessation, and proper management of respiratory conditions can reduce the risk of hernia progression. These lifestyle changes are particularly relevant in preventing or managing hiatal hernias, which are associated with gastroesophageal reflux disease (GERD) and obesity
c. Hernia Belts and Trusses: In rare situations, supportive devices like hernia belts and trusses may be used to provide temporary relief and prevent hernia worsening. These devices apply external pressure, offering symptomatic
Conclusion: Hernias impose a considerable global burden in terms of prevalence, healthcare utilization, and economic impact. Recent advances in hernia management have focused on improving surgical techniques. Minimally invasive procedures, such as laparoscopic and robotic-assisted repairs, offer advantages such as reduced post-operative pain, faster recovery, and improved cosmetic outcomes. Tension-free techniques utilizing advanced mesh designs have also contributed to better surgical outcomes. Continued research and innovation in hernia management are crucial to further enhance outcomes, reduce complications, and alleviate the global burden associated with hernias
