Hernia disease is a paradox in India’s evolving medical landscape. Despite rapid advances in surgical technology and expertise, patient awareness and acceptance remains limited. In fact, hernias are often perceived as minor or non-emergency, which can be exacerbated by social stigma and embarrassment, leading to delays in seeking medical care.
As a result, surgeons frequently encounter advanced cases with severe complications such as occlusion and strangulation. In these situations, simple mesh repair is insufficient and often requires intestinal resection and complex abdominal wall reconstruction, increasing surgical risk, cost, and recovery time. Early intervention allows for safer, easier, and more cost-effective treatment.
Against a backdrop of delayed recognition and complex disease symptoms, Dr. Premkumar Balachandran has built his practice around early intervention and patient education, working to close critical gaps in hernia care and improve outcomes across India.
From insight to system
Dr. Balachandran’s path to hernia surgery began with the realization that hernia disease is much more than a normal surgical problem. Early in his career, he identified a wide range of complexities involved, including giant hernias, field-losing hernias, recurrent cases, and hernias at anatomically difficult sites. These conditions required a level of expertise unrelated to routine hernia care.
To address this, he pursued intensive training in complex hernia surgery and abdominal wall reconstruction at Anne Arundel Medical Center in Maryland, USA, where hernia surgery is recognized as a separate specialty. This experience was a decisive turning point in his career.
After his training, his institution supported his vision to establish a specialized institute for hernia surgery and abdominal wall reconstruction. Under his leadership, the institute developed into a high-volume referral center managing complex hernia cases from all over India and abroad.
Additionally, he works as an Associate Professor at the Apollo Hospitals Education and Research Foundation and is an international consultant to the Royal College of Surgeons of Glasgow.
“My clinical philosophy focuses on not only achieving anatomical repair, but restoring function and quality of life.”
Overcoming complex hernias
The doctor specializes in advanced hernia surgery and abdominal wall reconstruction. His research ranges from simple to complex hernias, using open, laparoscopic, and robotic approaches, with an emphasis on technically demanding cases.
Specifically, his expertise includes transperitoneal preperitoneal repairs, intraperitoneal onlay mesh repairs, extended view completely extraperitoneal repairs, and conventional open hernia surgery. Additionally, we perform advanced component separation procedures such as transversus abdominis release and manage lateral abdominal wall defects through peritoneal flap hernioplasty.
Additionally, we offer specialized management of complex parastomal hernias and domain-losing hernias. In selected cases, he used a Fasciotens device to facilitate abdominal wall closure. In contaminated or infected surgical fields, we employ bioabsorbable mesh to achieve safe and durable reconstruction.
clinical philosophy
“My clinical philosophy focuses on achieving not only anatomical repair but also restoring function and quality of life,” says Dr. Premkumar Balachandran, Senior Consultant, Institute of Hernia Surgery and Abdominal Wall Reconstruction, Apollo Hospitals, Chennai. He approaches each case with careful individualization, recognizing that hernia disease often affects mobility, self-image, and daily life.
In particular, we manage complex conditions that significantly compromise patient health, such as parastomal hernias, loss-of-area hernias, and complex hiatal hernias associated with gastroesophageal reflux disease. These cases often require advanced planning and coordinated multidisciplinary care.
Through this patient-centered approach, we aim to deliver long-term, durable, functional, and meaningful outcomes for even the most complex hernia scenarios.
irreparably restore one’s lifespan
The case arrived as an introduction from abroad, and its complexity immediately became apparent. An elderly patient had a massive area loss hernia in which the hernia sac had grown more than 20% larger than the abdominal cavity itself. Daily mobility became difficult and the visible deformity caused severe social distress.
The challenge was compounded when an infected mesh from a previous surgery was found to have eroded the skin, making traditional closure impossible and raising serious concerns about poor cardiopulmonary function.
Dr. Balachandran carefully planned a step-by-step solution utilizing advanced abdominal wall reconstruction strategies. He performed a component separation technique and reinforced the repair with bioabsorbable Phasix mesh, allowing for safe closure without adding physiologic burden. Recovery proceeded smoothly with no complications. Over time, patients regained physical function and confidence and experienced revolutionary improvements in their overall quality of life.
The road ahead
Dr. Balachandran observes that laparoscopic and robotic techniques have significantly advanced hernia surgery by increasing precision, reducing tissue trauma, and promoting recovery.
He highlights the impact of three-dimensional contoured composite meshes, as well as advanced fixation devices and bioabsorbable meshes, in improving outcomes. In the near future, he foresees greater use of robotics and AI-assisted image processing to enable more precise, personalized, and patient-centered care.
Dr. Premkumar Balachandran, Senior Consultant Surgeon – General, Gastrointestinal, Bariatric, Abdominal Wall Hernia Surgery
Dr Premkumar Balachandran is a senior consultant surgeon specializing in general, gastrointestinal, bariatric and abdominal hernia surgery. He completed his MBBS from PSG Medical College, Master’s degree in General Surgery from Sri Ramachandra Medical College, Chennai, and later Master’s degree in Minimal Access Surgery from the University of Dundee, Scotland. A Fellow of the Indian College of Surgeons and the Royal College of Surgeons of Glasgow, he practices at Apollo Hospitals, Chennai.