Incisional Hernia Repair (Open and Laparoscopic)

An incisional hernia is the bulge that develops from a previous abdominal surgical scar that causes weakness in the abdominal area. Incisional hernias can occur with a few types of abdominal surgeries. The scars left from surgeries of the heart and intestine, appendectomy (removal of appendix) and laparoscopy (minimally invasive surgery) are prone to incisional hernia. Poor healing of the surgical incisions or pressure on the scars may cause a bulge to develop months or years after the surgery.

Your doctor may suggest a hernia belt (truss) which compresses the bulge back into its proper place and reduces it. Surgery is not necessary for treating a small incisional hernia. However, a large painful hernia that is growing in size requires surgical repair. Surgery is indicated in the following conditions:

• Very large hernia which enlarges over time
• Bulge that does not reduce even when you lie down
• Painful hernia

Your doctor may recommend either open surgery or laparoscopic surgery based on the severity of the situation and what is most beneficial for you. Open surgery is considered the best approach for treating incisional hernias. In an open surgery, your surgeon will make a single cut at the site of the bulge, remove the fat and scar tissue and push the internal organs back inside the abdominal cavity. In a laparoscopic surgery, several small incisions will be made on the abdominal wall to insert a laparoscope (flexible tube with a lighted device and a camera attached to it) and other special instruments. The bulge will then be pushed back into your abdomen.

The hernia is then repaired by one of two methods. An incisional hernia that is smaller than 3 centimetres may be repaired with just suturing the cut. However, larger hernias require a tension-free repair with a mesh patch to support the abdominal wall. These procedures will be performed under general, local or regional anaesthesia.

Recurrent incisional hernia repair may be prevented by following a few measures:

• Regular exercise to strengthen the abdominal muscles
• Avoid constipation and fluid retention to reduce abdominal pressure
• Lift heavy objects safely without straining