What is Incisional Hernia Repair?
An incisional hernia repair is a surgical procedure performed for the treatment of a medical condition called an incisional hernia.
A hernia is a bulge that develops when the internal organs of the abdominal cavity are pushed out through a weakened spot in the abdominal wall. An incisional hernia is a 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 the 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 even years after the surgery.
During an incisional hernia repair, your surgeon pushes the hernia back into the abdominal cavity and the weakened abdominal wall area is sewn closed or strengthened with a synthetic mesh. This is performed either through an open surgery or a minimally invasive laparoscopic surgery.
Indications for Incisional Hernia Repair
Your physician may recommend incisional hernia repair when your hernia is abnormally enlarged or causing severe pain and discomfort that is preventing you from functioning normally. Sometimes, an incisional hernia may become trapped (incarcerated hernia) and pose a risk for strangulation, where the blood supply to the herniated part is cut off, causing tissue death (necrosis). An incarcerated hernia can also obstruct your bowel thereby causing abdominal distension. A strangulated hernia is a medical emergency requiring immediate surgery to avert damage to the intestines and other tissues. Symptoms of an incarcerated/strangulated incisional hernia include:
- Tender, painful, swollen, or discoloured bulge
- Severe abdominal pain
- Unable to pass stools or gas
Preparation for Incisional Hernia Repair
In general, preoperative preparation for incisional hernia repair will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from medications such as blood thinners or anti-inflammatories for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should shower with an antibacterial soap the night or morning prior to the operation.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery has been explained.
Procedure for Incisional Hernia Repair
Your surgeon may perform either an open or a laparoscopic surgery to repair an incisional hernia. The surgery is performed under the influence of general or local anaesthesia.
Open Incisional Hernia Repair
In an open surgery, your surgeon will make a single incision of 5 to 10 cm long at the site of the bulge. Your surgeon then pushes the part of the intestine that is protruding back into its normal position inside your abdomen. The weakened spot of the abdominal wall will then be stitched with sutures. In cases of large hernias, your surgeon may place a mesh patch for strengthening the weak abdominal wall area. The skin will be sutured with dissolvable stitches and a dressing will be applied to the wounded area.
Laparoscopic Incisional Hernia Repair
Your surgeon will make two to three small incisions around the site of hernia on the abdomen. A laparoscope (a fibre-optic tube with a light source and camera attached to it) and other special instruments are inserted through the incisions. Air or carbon dioxide is injected into the abdomen to inflate the abdominal cavity, enabling your surgeon to better visualise the internal organs. The video camera attached to the laparoscope will send magnified images to a monitor, which will guide your surgeon throughout the surgery. Your surgeon will push the bulge back into the abdominal cavity and the abdominal wall will either be stitched or a mesh will be placed to support the weak part of your abdominal wall. Once the repair is complete, the scope and other tools are withdrawn, and the small abdominal incisions are closed with stitches or surgical tape.
Advantages of a laparoscopic procedure over the open surgical method include shorter hospital stays, smaller incisions, less post-operative pain, and a faster recovery.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after incisional hernia repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will monitor your vital signs as your recover from the effects of anaesthesia.
- Most patients are able to go home the same day or the next day if it is a laparoscopic procedure or after two to three days if it is an open surgery.
- You may notice some pain, swelling, and discomfort in the groin or upper thigh area. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities, lifting heavy weights, and driving at least for the first few weeks. A gradual increase in activities over a period of time is recommended.
- Typically, you will be able to return to work and resume your daily activities in a week or two after surgery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Incisional Hernia Repair
Incisional hernia repair surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection at the incision site or mesh
- Postoperative pain
- Blood or fluid accumulation
- Anaesthetic reactions
- Recurrence of hernia
- Blood clots
- Injury to surrounding soft-tissue structures or organs