Doctors treat 70-year-old man with severe abdominal hernia

New Delhi: Doctors in Gurugram successfully performed surgery on a 70-year-old man suffering from a large, recurrent abdominal hernia, compounded by severe cardiac issues.

The patient, Ghanshyam Thakur, was presented with an incisional hernia in March 2024. The hernia had grown so large that the overlying skin began ulcerating, necessitating immediate surgical intervention. However, Thakur's severe heart condition, with an ejection fraction of only 25 per cent, made him a high-risk candidate for surgery. Not operating posed the risk of skin rupture and exposed bowel loops.

“These hernias aren't like conventional hernias, these are huge hernias, and the surgery done for these is also unlike other hernias. Just pushing the intestines back into the abdomen would cause a catastrophe. Hence, we do a special procedure known as Posterior Component Separation with Transversus Abdominis Release (PCS TAR),” explained Dr Mriganka Sekhar Sharma, Manipal Hospital, Gurugram.

PCS TAR is a surgical technique for repairing large, complex ventral hernias. It involves separating the layers of the abdominal wall and releasing the transversus abdominis muscle to create more tissue for closure.

“This allows us to pull the separated muscles together over the hernia defect, creating a stronger and more durable repair,” Dr Sharma added. “PCS TAR is often preferred for large hernias as it reduces the risk of recurrence and improves abdominal wall function.”

Dealing with such large abdominal hernias poses a significant clinical challenge due to the "loss of domain." Achieving a tension-free closure of the abdominal muscles is technically demanding, especially in patients with cardiac or lung problems.

The surgery required a multidisciplinary approach, with critical roles played by both the cardiologist and anesthesiologist.

Despite a prolonged hospital stay due to his cardiac condition, Thakur was discharged smoothly and was able to walk out of the hospital, doctors said.