What is an incisional hernia?
A hernia is a bulge or protrusion of body tissue or an organ through the structure that normally contains it. A hernia usually occurs when an organ or fatty tissue pushes itself through a weak spot in a surrounding area.
In an incisional hernia, the intestine pushes through the abdominal wall from the site of previous abdominal surgery. Incision hernia is mostly seen in elderly or overweight people who are inactive after abdominal surgery.
Is incisional hernia serious?
- Usually, incisional hernias may occur months or years after an abdominal operation. Initially, the patient may have a small lump or swelling near the site of the scar. This lump usually appears when the patient coughs or strains and then goes away. Over time, it might get bigger and start hurting.
- Most incisional hernias do not cause any serious problems. In rare cases, parts of the bowel might get trapped in the opening of the hernia, blocking the passage of stool (obstruction) or cutting off the blood supply (strangulation).
- Large incisional hernias can also make it difficult for a person to breathe or move normally.
- The treatment options for incisional hernias are open surgery or minimally invasive surgery.
- Minimally invasive surgery is also called keyhole surgery or laparoscopic surgery.
How is laparoscopic incisional hernia repair performed?
Laparoscopic incisional hernia repair is usually performed under general anesthesia.
- After administering general anesthesia, patient vital functions are monitored during the procedure.
- The surgeon makes three incisions in the skin below the navel (in the inguinal region).
- The surgeon inflates the abdomen with carbon dioxide.
- The surgeon inserts the laparoscope through one of the incisions and uses the other incisions for inserting the surgical tools.
- Guided by the images from the laparoscope the surgeon gently pushes the protruding tissue or intestine back in place.
- The surgeon then checks for other weak spots, as an inguinal hernia might occur on one side or both sides.
- In the case of incarcerated or strangulated hernia, the surgeon may remove the hernia sac and repair the area with stitches.
- The surgeon fixes a mesh in the weak area to prevent the hernia from recurring.
- The surgeon strengthens the weak spot in the abdominal muscle wall with stitches
- The incisions are then closed with sutures.
- The patient is brought out of anesthesia, administered pain medication, and monitored in the recovery room until vital functions are stable.
- The procedure usually takes one to two hours to complete
How long does it take to recover from incisional hernia surgery?
Usually, patients can go home on the same day or a day after the laparoscopic inguinal hernia repair. They resume normal activities within two weeks. In some cases, it may be slightly longer depending on the extent of the procedure and how long it took the doctor to repair the abdominal wall. Patients will be advised to avoid heavy lifting, coughing, straining, and other strenuous activities.
What are the results of incisional hernia repair?
The outcome of incisional hernia repair is generally good, particularly with the laparoscopic method. The American College of Surgeons reports that recurrence rates after the first repair of an incisional hernia range from 25–52%. Recurrence is more frequent when conventional surgical wound closure with standard sutures (stitches) is used. Recurrence after open procedures has been shown to be less likely when the mesh is used, although complications, especially infection, have been shown to increase because of the larger abdominal incisions. Laparoscopy with mesh has shown rates of recurrence as low as 3.4%, with fewer complications as well.