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• Incisional Hernia

Incisional hernias are an extremely common occurrence just second to inguinal hernias. This hernia is caused due to an unhealed wound of an abdominal exploratory surgery with median incisions in the abdomen. Due to their location, incisional hernias are also called ventral hernias. Most often incisional hernias are a result of vertical cuts of a prior surgery. It can be large and painful.

Causes and risk factors

Incisional hernias are a result of:

• Weakness of surgical wounds
• Infection, haematoma and seroma leading to decreased wound healing
• Intra-abdominal pressure caused by COPD, urinary obstruction, constipation, pregnancy, ascites

Risk factors are:

• Obesity
• Aging
• Intake of steroid medications
• Lung problems
• Post-surgical wound infections

Signs and Symptoms

• Present as a bulge or protrusion near the area of the incision: visible lump of organ, internal tissue, muscle, intestine, and fatty contents
• Strangulation of the intestines or bowel obstruction
• Digestive disorders if the incisional hernia becomes obstructed
• Nausea and vomiting

Diagnosis

• Incisional hernia is diagnosed, most often by clinical examination. Additional tests are required in complex cases.
• Blood tests: evaluate infections due to necrosis and intestinal blockage
• Imaging tests performed to identify the blockage or location of protrusion: MRI & CT scan

Treatment

Due to the risk of incarceration or strangulation, laparoscopic repair of incisional hernias is performed with a no-tension, mesh repair. The number of trocars used is relative to the location of a hernia and its size. The basic principles of surgery are adopted such as adequate triangulation, traction and counter traction. In the first step of the operation, intra-abdominal adhesions are lysed along with the reduction of the hernial sac. After that, the mesh is placed and oriented with the surface with a smooth layer facing inside. An absorbable or non-absorbable tacker acts as a fixation device. Strong trans fascial sutures are used to prevent migration of the mesh.

Open repair done by dissecting clear the hernial sac, then reducing the contents back into the abdomen and a non-absorbable mesh is placed over the muscle layer and stitched on to it to prevent migration of the mesh. The advantage of laparoscopic repair is that the recovery is faster, less of fluid accumulation and drain tubes are not required.

We usually perform both open and laparoscopic repair of incisional hernias.