The Iskandar Complex Hernia Center Releases Video of a Complex Hernia Surgery with Robotic Procedures

The Iskandar Complex Hernia Center, which is located in Waxahachie, TX, has recently published a video of Dr. Mazen Iskandar performing a robotic hernia repair. The patient had two previous surgeries to repair an inguinal hernia using both open and robotic procedures but his hernia recurred after just a few months. Recurring complex hernia surgery is complicated and challenging because of testicular, vascular, and bladder injuries due to scarring.

A complex hernia occurs due to a number of reasons: recurrent hernias; large hernias, which means they are bigger than 4 inches; and/or hernias that have mesh or wound infections. Hernias can also be considered as complex because of a previous surgery, their location, diabetes, obesity, and other medical conditions. The nature of the severity and complexity of the hernia worsens every time a surgical attempt to close the opening in the lining of the abdominal wall fails. This is because the surrounding tissues can become stretched and weakened, decreasing the chances of successful results.

As shown in the video, after laparoscopically lysing adhesions, they docked the robot and they observed a sliding type hernia. They noted the use of a ProGrip mesh in a previous hernia repair and started flap dissection above this mesh. They began dissection laterally in the space of Bogros, which looked like it was not scarred. The recurrence was noted to be possibly due to the mesh having moved anteriorly due to clamshelling or it had lifted posteriorly, allowing the peritoneum to pass below the mesh. Medially there was more scarring and fibrosis so Dr. Iskandar was very careful to remain as much as possible in avascular planes and minimize bleeding that can hinder the view. He also tried as much as possible to remain high and anterior above the bladder.

Dr. Iskandar noted that the bladder was quite adherent and stuck to Cooper’s ligament. All the adhesions seemed to be thick so he tried to thin all of those adhesions before cutting in order to prevent any bladder injury, which he was able to do. After finding some avascular plane to dissect and after dissecting the space of Retzius, he had sufficient space to work on the indirect sac. He reduced the hernia as much as possible before dissecting the cord structures away from the hernia sac. Next, he switched to the needle driver to be able to use the grasping function in order to do a blunt dissection to parietalize the cord structures.

As he as moving the peritoneum posteriorly away from the iliac vessels and the psoas, he found more adhesions between the peritoneum and the sac. After identifying the vas deferens, he continued to dissect the plane between the peritoneum and the vas, while remaining as close to the vein as possible. Next, he performed a little more media dissection until he was satisfied and reached the previous ProGrip mesh on the left side. To complete the surgery, he positioned the mesh in standard fashion and then closed the peritoneum.

Dr. Mazen Iskandar, MD, FACS, is a complex hernia surgeon who specializes in the repair of complex or reoccurring hernias. He is a board-certified general surgeon who has fellowship training in minimally invasive and bariatric surgery. He has a wide experience in handling complex hernia surgery and abdominal wall repair. He is currently recognized as one of the leading complex hernia experts in the US.

People with complex hernias have a lot of fears. These include the fear of: morbidity; limited mobility; a reduced quality of life; stress related to health and weight management; greater degrees of body pain; psychological well-being; lessened sexual activity; missed opportunities; diminished social and physical functioning; related health problems; loss of pastimes and hobbies; and occupational and career limitations. That is why Dr. Iskandar is solely focused on helping patients in getting an improved quality of life.

Those who are interested in learning more about complex hernia surgery can check out The Iskandar Complex Hernia Center website, or contact them on the phone or through email. They are open from 8:30 am to 5:00 pm.


For more information about The Iskandar Complex Hernia Center, contact the company here:

The Iskandar Complex Hernia Center
Mazen Iskandar
The Iskandar Complex Hernia Center
2460 I-35E Suite 215-B
Waxahachie, TX 75165