Incisional Hernia Repair
Incisional hernias are hernias that may occur anywhere in the abdomen in the area of a prior surgical incision (wound). Once any incision is made through the abdominal wall, that area is always weaker than other areas of the abdominal wall. Thus, the fascia at an incision is more prone to hernia formation. Hernias of this type usually present with a bulge at or near the area of the prior incision. Incisional hernias usually result from 1) too much tension placed on the abdominal wall when the hernia was repaired initially, 2) poor healing whether from infection, obesity, poor nutrition, or certain medications (most commonly steroids), and 3) repeated wear and tear to the surgical incision. Incisional hernias may cause a bulge or pain. These hernias can develop at any time after the original surgery.
Incisional hernias can range in size from very small to large and complex and are often identifiable as a bulge at or near the area of prior incision. Nearly any prior abdominal operation can develop an incisional hernia.
An incisional hernia can occur immediately following surgery or may not become apparent for years after the procedure.
Treatment
Incisional hernias are generally the largest and most complicated of hernias. Many of these, however, can be repaired laparoscopically.
If an incisional herna develops, it should not be repaired by using the same techniques used at the original operation. In other words, if a hernia developed after a simple suture repair of the wound, then the hernia should be closed another way. Most commonly, these hernias are repaired with the use of mesh. The mesh allows a tension-free repair. By using mesh, much less tension is placed on the closure and there is a much higher chance of the hernia being repaired.
The mesh is placed underneath the defect or hole (the hernia) in the abdominal wall. By placing the mesh so it reaches well beyond the edges of the entire hole, a stronger more lasting repair is created.
When a mesh is used, it can either be placed by one of two methods: laparosocpically or through an open incision. In the laparoscopic repair, the hernia is fixed through two or three small incisions using a video camera. In an open repair, the entire previous incision is opened.
A laparoscopic repair is the preferred method of repair by offering these advantages to an open repair:
- offers a quicker recovery
- shorter hospital stay
- less pain
- quicker return to normal activity
- less chance of recurrence
- improved cosmesis
Laparoscopic Incisional Hernia Repair Video
The above video demonstrates the technique of laparoscopic repair of an incisional hernia. To perform the surgery, two trocars (small tubes where surgical instruments are passed through) are first inserted. One of these is seen being placed in the beginning of the video. Next the hernia is found and the hernia defect is measured. The mesh is then placed in to the abdomen and opened. It is placed to span the hernia defect. The mesh is then fixed into place by absorbable tacks, which are placed around the mesh circumference. At this point, the mesh is held in position and residual gas is removed.
