Hernia is a protrusion of a piece of tissue or a loop of bowel, through a weak spot or opening in the abdominal wall. An incisional hernia is a type of hernia that bulges out of a weak spot, which occurred from a previous surgery in the abdomen. The hernia occurs through the previous incision scar. An Incisional Hernia Repair or Incisional Herniorrhaphy is a surgical procedure performed to repair incisional hernia.
What are the reasons behind an incisional hernia repair surgical procedure?
An incisional hernia repair procedure is done, to reduce the patient's risk of a future surgical emergency. If a repair is not performed, the hernia may reduce or become irreducible, obstructed, or strangulated.
How an incisional hernia repair surgical procedure is performed?
- A reducible hernia occurs, when a hernia can be pushed back into the abdomen, either spontaneously or with manipulation. This is the most common type of incisional hernia and it is usually a painless condition
- An irreducible hernia occurs, when a hernia becomes stuck. This can cause pain and a feeling of illness
- An obstructed hernia occurs, when a part of the intestine enters the hernia sac and gets blocked, causing an intestinal obstruction
- A strangulated hernia occurs, when a hernia blocks blood supply to a part of the bowel. If the herniated bowel has its blood supply diminished, because of pressure from other nearby organs or structures, the affected tissue can die and be invaded by bacteria. This is a life-threatening surgical emergency condition
There are two kinds of Incisional Hernia Repair: Open repair and laparoscopic repair.
- An incision is made in the region of the previous incision scar (either through or around the scar)
- The incisional hernia sac is identified and separated from the tissues around it
- The sac is opened and its contents are examined for viability
- The scar tissue attaching the bowel to the inside of the abdominal cavity are divided
- The defect is then obliterated, either by approximation of the adjacent tissue, or by placement of a prosthetic mesh
- In cases of compromised bowels, mesh placement is contraindicated, due to an increased risk of mesh infection
Preparations needed before an incisional hernia repair surgical procedure
- Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area that is farther away from the previous scar
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
- Other cannulas are inserted, which allow the surgeon to delicately divide the scar tissues that attach the bowel to one another, and also to the abdominal wall
- Once the bowel is separated from the abdominal wall, the surgeon identifies the defect and covers it with a piece of prosthetic mesh
- A laparoscopic repair is not performed in cases of strangulated hernia, where the bowel viability is compromised
Diagnostic tests required before an incisional hernia repair surgical procedure
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
Risks and complications during incisional hernia repair surgical procedure
- The diagnosis is largely a clinical one, generally done by physical examination of the abdomen/groin region
- However, in some patients (especially obese patients), imaging in the form of ultrasonography, CT or MRI scans may aid in the diagnosis of an incisional hernia
The possible risks or complications that may arise during the incisional hernia repair surgery are:
Risks and complications after incisional hernia repair surgical procedure
Post incisional hernia repair procedure, the following complications may arise:
Post-operative care needed after an incisional hernia repair surgical procedure
At home, the following post-operative care is recommended, after an incisional hernia repair procedure:
- Avoid strenuous physical activities for a certain period of time, before slowly getting back to your regular daily routine
- Keep incision wounds clean and dry
- Complete the prescribed course of medications
- Avoid taking any pain-killers, unless they are prescribed by your physician
- Take stool softeners to prevent constipation, under advice by the physician
- Take antibiotic medication to help combat or prevent infection, under advice by the physician