Dr. Kundan Kharde — Complex Ventral Hernia & Advanced Laparoscopic Surgeon, Pune

Experience at a glance

Which hernias I treat (and which cases I take referrals for)

The practice covers the full range of abdominal wall hernias — inguinal, umbilical, epigastric, spigelian and hiatal — alongside routine laparoscopic hernia surgery. The focus of this page is the harder end of that spectrum:

• Large ventral and incisional hernias — defects wider than about 4 cm, or hernias through old surgical scars
• Recurrent hernias — hernias that have come back after one or more previous repairs, including failed mesh repairs
• Hernias with loss of domain — where a large volume of abdominal contents sits outside the abdominal cavity
• Hernias in higher-risk patients — obesity, diabetes, smoking history or previous wound infection

I also accept referrals from other surgeons and physicians for recurrent and complex abdominal wall cases, including patients who have been advised that their hernia is "too difficult" for a standard repair. If you are unsure whether your hernia falls in this category, start with the hernia symptoms guide or simply bring your previous records to a consultation.

My approach to complex ventral hernia

Complex ventral hernia repair is planning-led surgery. Before deciding the technique, I assess the defect size and location (with a CT scan where needed), the quality of the abdominal wall muscles, previous operation notes and mesh position, and patient factors such as weight, diabetes control and smoking.

• Laparoscopic vs open: smaller defects with good tissue quality are usually suited to laparoscopic repair (eTEP or IPOM-Plus). Very wide defects, dense adhesions or loss of domain generally need open reconstruction (Rives-Stoppa or TAR). The technique is chosen to fit the hernia — not the other way around.
• Mesh selection: the plane the mesh sits in (behind the muscles rather than simply inside the abdomen where possible), its overlap beyond the defect, and its fixation matter more than the brand. I explain the choice to every patient before surgery.
• Defect closure philosophy: wherever feasible, the defect itself is closed and the midline restored — mesh reinforces a reconstructed abdominal wall rather than bridging a hole. Closing the defect restores core muscle function and lowers recurrence and seroma rates.

Advanced laparoscopic hernia surgery — what "advanced" actually means

"Advanced laparoscopic" is not a marketing phrase — it refers to specific techniques that go beyond the basic patch-over-the-hole repair:

• eTEP (extended totally extraperitoneal repair): the mesh is placed in the retromuscular plane — behind the muscles but outside the abdominal cavity — through small incisions, so no mesh touches the intestines.
• TAR (transversus abdominis release): a posterior component separation that creates space for a wide retromuscular mesh in large defects, allowing tension-free midline closure. It can be combined with eTEP in selected cases.
• Defect closure before mesh: suturing the hernia defect closed laparoscopically before reinforcing it, instead of merely bridging it with mesh.
• Mesh fixation without tacks: using sutures and the natural holding force of the retromuscular plane instead of metal tacks, which reduces chronic post-operative pain.

For the benefits of the laparoscopic route in general, see laparoscopic vs open hernia surgery and the overview of hernia types.

When a hernia should NOT be operated laparoscopically

Patients often arrive asking specifically for "laser" or "keyhole" surgery. Honest answer: laparoscopy is a tool, not a goal, and there are situations where insisting on it raises risk instead of lowering it:

• Very large defects or loss of domain, where the abdomen cannot safely accommodate the contents being returned under laparoscopic conditions
• Dense adhesions from multiple previous operations, where laparoscopic dissection risks bowel injury
• Previously infected or exposed mesh that must be removed as part of the repair
• Emergency presentations with obstructed or strangulated bowel needing open assessment
• Skin and soft-tissue problems over the hernia (thinned scar, ulceration) that need open excision anyway

In these cases a well-planned open reconstruction — Rives-Stoppa or TAR — is the safer and more durable operation. Being trained in both approaches means the recommendation you get is based on your anatomy, not on the limits of the surgeon's technique.

Second opinion for recurrent hernia — what to bring, what I check

If your hernia has come back after a previous repair, a second opinion is worth the visit before any re-operation. Bring:

• Your previous operation notes (which technique and which mesh were used, and in which plane)
• Any imaging — CT scan or ultrasound reports and films
• Discharge summaries and records of any wound infection or prolonged healing after the first surgery

At the consultation I examine the defect and the whole abdominal wall (recurrences are often accompanied by additional defects along the old scar), review which tissue planes have already been used, and check the risk factors that caused the first repair to fail. The plan for a recurrent hernia is always plane-based: the new mesh must go into fresh, unscarred tissue planes — which is exactly why the old operation notes matter. See also: signs a hernia needs surgery.

Qualifications & affiliation

• MBBS, MS (General Surgery), FMAS, FIAGES
• 17+ years of surgical practice; 1,200+ hernia repairs within 5000+ total procedures
• Full-time surgical practice at Sharvari Hospital, Pimple Nilakh, Pune — an ISO 9001:2015-certified hospital with 24×7 admission, in-house operation theatres and 50+ insurance empanelments with cashless treatment
• Consultation clinics in Wakad, Baner and Hinjawadi

Patient outcomes & what I tell every patient about recurrence risk

No honest surgeon promises a zero-recurrence hernia repair. Every hernia repair carries some recurrence risk, and that risk rises with defect size, previous failed repairs, obesity, smoking and poorly controlled diabetes. What surgery controls is the technique side of that equation: correct mesh plane, adequate overlap and true defect closure. What you control is the patient side: weight, sugar control, stopping smoking, and respecting the lifting restrictions during healing. I discuss both sides with every patient before surgery — including a realistic recurrence estimate for their specific repair, not a generic percentage.

Typical recovery after laparoscopic repair is discharge within 24–72 hours and desk work within 1–2 weeks; see the recovery guide and cost overview for details.

Frequently asked questions