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:
Intake of steroid medications
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
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:
Due to the risk of incarceration or strangulation, laparoscopic repair of incisional hernias are performed with a no-tension, mesh repair. The number of trocars used is relative to the location of the 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 smooth layer facing inside. An absorbable or non-absorbable tacker acts as a fixation device. Strong transfascial 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.
Dr. Deepak Varma performs both open and laparoscopic repair of incisional hernias.