Mr Ganesh works out at least four times a week, playing tennis or hitting the gym. Last November, when he felt discomfort in his lower left abdomen after exercising, he knew something was wrong.
The pain would flare up after an intense workout and last until the next day. This prompted him to go for a check-up, and scans revealed that he had early-stage hernia.
A hernia occurs when an organ pushes through an opening in the muscle or tissue holding it in place. If not treated, a hernia can cause severe pain and lead to potentially more serious problems that could require emergency surgery.
Mr Ganesh’s options were to either reduce his physical activities or to go for surgery.
He said: “My GP told me that the condition was not critical and to take it easy. But a hernia doesn’t go away on its own and it has to be treated eventually. I also wanted to continue my active lifestyle.”
Mr Ganesh, who is 37 and works in marketing technology sales, asked around his network of friends who previously had hernias and was recommended Dr Ravishankar K Diddapur, a specialist surgeon at SILS Centre at Mount Elizabeth Novena Specialist Centre.
“Dr Ravi was very transparent and told me my options. I could either undergo conventional laparoscopic surgery, which involves making a few cuts into the abdomen and which has possibly a longer recovery period, or single incision laparoscopy (SILS), a more minimally invasive procedure with a shorter downtime,” adds Mr Ganesh.
Single incision laparoscopy surgery (SILS), as the name suggests, involves making a single incision in the body instead of multiple small cuts.
Organs such as the gallbladder and appendix, as well conditions such as hernia, can be removed through a single cut at the belly button, where the surgical instruments and scope are inserted.
Why is SILS better than traditional surgical procedures?
SILS is gaining ground over traditional laparoscopic or keyhole surgery as it decreases postoperative pain and leaves less scarring.
“Making one cut instead of multiple ones also means less risk of surgical site infection, which means an easier recovery,” says Dr Ravishankar who was the first in Singapore, and one of the first in South-east Asia, to perform SILS in 2009.
Dr Ravishankar, who has performed more than 350 SILS, prefers that procedure to traditional surgeries because of the benefits to the patient. He adds that the minimal pain and downtime post-surgery and not having a scar helps a lot with the fear of undergoing surgery.
Another benefit of SILS is that in the event of a recurrent hernia, it is easier to repair as the doctor can make an incision at a different site from the first one.
The cost is also lower in most cases as the duration of hospitalisation is lesser when you undergo SILS as compared to a conventional surgery. However, it costs an additional $3,000 more for the SILS instruments which are disposable unlike instruments used in procedures such as multiple key hole surgery which are not disposable.
However, the procedure is not without its own challenges. It requires the surgeon to use both hands, crossing them so that the right hand operates with the left instrument, and the left hand operates with the right instrument. This is done while the doctor looks at the procedure on a screen which is magnified eight to 10 times.
Other uses for SILS
The procedure has also become more applicable for different conditions over the years, says Dr Ravishankar.
Besides treating hernias, SILS can also be used for the removal of acute and complicated gallstones and small nodules in the liver. It can also treat acute and complex apendicitis, certain colon surgeries, small bowel surgery and omentectomies – the removal of a fold of fatty tissue in the abdomen.
“There have been a variety of instruments developed for SILS, thus increasing the scope of this technique. It is best to check with a surgeon who practices SILS to explore your options,” adds Dr Ravishankar.
Fast recovery for Mr Ganesh
As for Mr Ganesh, since it was his first time going under the knife, he opted for SILS after hearing about its benefits.
Dr Ravishankar says: “The best surgical option to resolve a hernia is through single incision laparoscopic surgery. Compared to open repair surgery or making four keyhole incisions, a single keyhole incision causes less pain and the patient can recover quicker.”
In July this year, Mr Ganesh went ahead with the surgery under Dr Ravishankar, reassured that the procedure had a high success rate.
However, he was more concerned about potential infection post-surgery as he did not know how he would react to anaesthesia or the time it would take him to get back on his feet.
Fortunately, he was fit to return home after one night in the hospital and apart from mild soreness in the abdominal region, he was able to walk around his house and take slow walks outside within 72 hours.
The scarring was also very minimal.
“I had a small cut at the belly button, and the stitches are self-dissolving. It’s also easy to maintain the wound as I have to change the dressing just once a week. I was very happy with the quick recovery period,” says Mr Ganesh.