Professor Amir Nisar's Expertise in Hernia Surgery
Historic Background:
Professor Amir Nisar while working in Somerset, United Kingdom was advised by Professor Robin Kennedy to attend the inaugural annual meeting of AESGBI – Association of Endoscopic Surgeons of Great Britain and Ireland (now ALSGBI- Association of Laparoscopic surgeons of Great Britain and Ireland), in Worcester in 1994.
Professor Chris Royston from Hull performed live Laparoscopic Hernia repair in the meeting and presented the outcomes of his first 1300 Laparoscopic Hernia surgeries, with excellent outcomes. The performance was beautiful, results outstanding, and the fire that it ignited is still heart-warming, 26 years on.
Professor Nisar having had the solid foundation and experience with open hernia operations (a few thousand by then) and having performed Bassini’s, Darning, Shouldice, Halstead, Mayo’s and Lichtenstein’s repairs knew the potential of the new “keyhole”/ “minimally invasive” approach and was quick to adopt it.
Training & Teaching
Professor Amir Nisar’s Hernia Training at Specialist Centre: Professor Amir’s move to Royal Surrey County Hospital, Guildford, England in 1996 and working with Professor Michael Bailey was a God send’s gift that changed the course of his training to an upward and forward trend. This center was very well known for advances in laparoscopic hernia surgery dealing with first time and recurrent complex hernias from the United Kingdom and other countries.
Some of the achievements over the eight years of work in Surrey involved:
- Professor Amir Nisar: a keen student, later became a teacher and trainer at the highest level in the United Kingdom, Europe (especially France and Italy), and Asia in the technique of Laparoscopic hernia surgery in the years to come.
- Live surgery for teaching courses in various centers in the United Kingdom, France, Italy, and for teaching; MATTU, IRCAD, IMACS, ALSGBI annual meeting, and other international conferences.
- Setting up many centers offering Laparoscopic hernia surgery in the United Kingdom, Europe, and Asia by mentoring, proctoring, and supporting the surgeons.
Contribution to NICE Guidelines
Professor Nisar’s Contribution to International Hernia Guidelines
- Contribution to NICE (National Institute of Clinical Excellence) guidelines 2002 about Laparoscopic Hernia Surgery being superior to open hernia surgery; 4,200 cases short, medium and long term outcomes were presented to NICE.
- Professor Amir conducted a randomized trial as the sole surgeon operating on 40 patients in Royal Surrey County Hospital, Guildford, Surrey, England, United Kingdom under Professor Michael Bailey.
The aim of the double blind randomised trial was to assess the efficacy of laparoscopic and open approaches in unilateral inguinal hernias in the young, office going adults. It confirmed the superiority of the Laparoscopic approach over the open approach hence the next guidelines from NICE in 2004.
Professor Amir Nisar’s Contribution to NICE (National Institute of Clinical Excellence) reflected in the final Hernia guidelines to date; 22nd September 2004, in favor of Laparoscopic Hernia Surgery.
Current NICE recommendations
- Laparoscopic TEP repair is the best approach for unilateral inguinal Hernia (first time hernia on one side)
- Laparoscopic approach is best for primary bilateral hernias (first time hernias on both sides)
- Laparoscopic approach is the best for a recurrent hernia (hernia reappearing after surgery)
Innovations
Professor Amir Nisar’s Innovations in Laparoscopic Hernia surgery
Professor Nisar has developed many innovative techniques in United Kingdom and Dubai to deal with some complex scenarios. His latest innovation which he has successfully used on his patients for the last 5 years is Laparoscopic MSL (MiniScarLess) Inguinal hernia repair. Professor Amir Nisar considers this to be the Gold Standard of Inguinal Hernia Surgery.
This latest technique developed in Dubai, is another world’s first by Professor Amir Nisar.
Mini ScarLess Hernia Surgery
Mini Scarless Hernia Surgery is being offered by Professor Amir Nisar in Dubai to the patients with Inguinal / Groin hernias with great success.
In Laparoscopic MSL (MiniScarLess) Inguinal hernia repair the accumulative length of cuts in the abdomen is 11mm (nearly just one cm), instead of the standard 30-40mm incisions as in standard Laparoscopic TEP or TAPP repairs. In comparison, the length of the cut required to do one sided open Hernia Operation is 10-12 cms, and for bilateral Hernias is 20 to 24 cms.
Comparison of size of Incisions:
| Surgical Approach for Inguinal Hernia Repair | Size of incision | Type of Hernia |
| Laparoscopic MSL (MiniScarLess) Inguinal hernia repair | 1.1 cm | Unilateral/ Bilateral |
| Laparoscopic TEP & TAP Inguinal Hernia repairs | 3-4 cm | Unilateral/ Bilateral |
| Open Inguinal Hernia surgery | 10-12 cm | Unilateral |
| Open Inguinal Hernia surgery | 20-24 cm | Bilateral |
Laparoscopic MSL (MiniScarLess) Inguinal hernia repair offers excellent cosmesis, less post-operative pain, and no exercise restriction during the recovery phase.
Other Innovations in hernia surgery over the last quarter of century:
- Laparoscopic TEP hernia repair for Sliding Inguinal-Scrotal incarcerated Hernias
- Laparoscopic TEP hernia approaches for Incarcerated hernias
- Sac ligation techniques in continuity for long hernial sacs
- Inferior Epigastric vessels sling technique
- Needlescopic hernia repair
- Modified open operative approach for Large Sliding hernias
The journey continues for “painless” and safe hernia surgery for benefit of the patients