SINGAPORE: Bus driver Lee Chiow Jin left his hernia untreated for more than two years and it developed into a potentially life-threatening situation.
In a hernia, part of an organ, such as the intestine, protrudes through the wall of a body cavity. Causes include congenital defects, obesity and previous operations.
The 48-year-old Singaporean PR man, who lives in Johor Bahru and travels to Singapore daily for work, had to rush to a hospital emergency room in February 2024 when the symptoms became unbearable.
“I had a pulling sensation in my abdomen and felt extremely bloated and uncomfortable. I had not been able to have a bowel movement for two days,” Lee said in an interview with The Straits Times in Mandarin.
It turned out that Lee, an extremely rare case, had not just one but three hernias.
Two of them, so-called inguinal hernias, had developed in the groin area on the left and right side.
The other was an incisional hernia, where Lee’s intestines became trapped in the weakened area of the scar from a previous colon surgery, causing pain and discomfort.
His intestine became blocked and inflamed and almost burst, causing a serious infection.
In March, Lee underwent an eight-hour operation to repair all three hernias, using a new surgical technique by Dr Marc Ong, a consultant in the Department of General Surgery at Khoo Teck Puat Hospital (KTPH).
This method, called eTEP (Enhanced View Totally Extraperitoneal Technique), involves closing the hernia defect and then inserting mesh into the layers between the muscles to reinforce the repair.
“It was the most difficult surgery I have ever performed,” said Dr. Ong, referring to the number and location of the hernias.
KTPH is one of two public hospitals with a dedicated hernia surgery department, and Ong has performed nearly 20 surgeries using the new eTEP technique in Singapore since 2020.
National University Hospital is the other hospital that offers such a service.
“Mr Lee was lucky and did not need emergency surgery because his bowel somehow calmed down after he was admitted to the hospital,” Ong said.
Although Lee was at risk of incisional hernia due to his previous colon surgery, he was not obese and was generally healthy.
Commenting on the rarity of triple hernias, Ong said: “He was just unlucky that the three hernias occurred at the same time. This is a very rare occurrence that occurred because he had previous abdominal surgery which made him more susceptible to incisional hernias.
“People who suspect they have an inguinal hernia should seek medical attention early and not wait until the hernia becomes larger or causes symptoms.”
For two years, Lee lived with a hernia on his right side because it did not affect his daily life and he wanted to avoid the pain of surgery. He also did not know about the other two hernias.
“The hernia only bulged when I ran or coughed, and I could still push the bulge back with my fingers,” Lee said.
In traditional surgery, the mesh is placed in the abdominal cavity or peritoneum – a space in the abdomen and pelvis. This can lead to complications such as scar tissue formation as the mesh comes into contact with organs such as the intestines.
Conventional surgeries are more costly because coated meshes, which are three times more expensive than uncoated meshes, must be used to prevent the organs from sticking to the mesh.
In contrast, with the eTEP technique, the surgical mesh can be held in place by the muscles.
Ong, who went to Japan for a six-month training stint to learn the new technique, said the hardest part was learning how to separate the muscle layers.
“It’s difficult because you need to have a deep understanding of the anatomy to know where to create new spaces between muscles. You also need to make sure you protect muscle function,” said Ong, who is also chief of hernia surgery at KTPH.
“Although the operation with the eTEP technique takes longer than with the conventional method, postoperative pain is minimal and long-term mesh complications are said to be rare.”
To prepare for Lee’s surgery, Dr. Ong planned the complex procedure with his Japanese mentor, Dr. Kiyotaka Imamura.
The operation should be performed via a minor surgical procedure, with incisions ranging from 5 mm to 1 cm. In case of complications, open surgery is an option, but this would result in a much larger scar and longer downtime for the patient.
“During the surgery, I found it difficult to split the muscles at one point. I actually considered changing it to open surgery, but I decided to go for the surgical procedure as the surgery was progressing well,” said Ong, who also attributed the success of the surgery to the team he worked with.
Lee was discharged four days after his surgery and has since made a full recovery.
“After about a month, I was able to return to my normal exercise routine, such as walking,” he added. – The Straits Times/ANN
