Incisional Hernia: Mesh Repair

What is Incisional Hernia?

Hernia is a condition in which a hole is formed due to weakness in muscle causing the tissues to protrude through the hole. This creates a bulge under the skin and can be extremely painful or tender to touch. Hernias have several types. Incisional hernia is one of those when a weak muscle of the abdomen allows its tissues to protrude through the muscle. An incisional hernia is caused by incisions made in an earlier abdominal surgery.

Usually, an incisional hernia appears to be small enough to only let the lining of the abdominal cavity protrude; however in rarely severe cases, portions of organs may move through the muscle hole.

Are you at risk?

Incisional hernia occurs in patients who have gone through some abdominal surgery in which, incisions are made. Obese people and pregnant women are most prone to incisional hernia. A person with a history of several abdominal surgeries is also at risk. It is however interesting to note that if hernia develops in the abdomen and the patient has not had a surgery, it is not an incisional hernia. A further diagnosis is what may be required in such a case.

If a patient, who has recently gone through an abdominal surgery, becomes pregnant or takes part in activities that cause abdominal pressure, he is likely to be at risk for an incisional hernia. When an incision is fresh post surgery and is still healing, it is the weakest and most prone to catch hernia. In general, incisional hernias are likely to develop 3-6 months post surgery. However, they can enlarge months or even years after surgery.

Incisional Hernia Surgery - Mesh Repair

An incisional hernia surgery is carried out using general anaesthesia on an in-patient basis. A laparoscopic approach in which, small incisions are made, unlike the traditional, open-incision method. A general surgeon or a colon-rectal specialist can perform the laparoscopic incisional hernia surgery.

The surgery begins with anaesthesia. Once the anaesthesia is given, a small incision is made on either side of the hernia. Through this incision, a laparoscope is inserted while the other incision is used for surgical instruments. The portion of abdominal lining that pushes into the muscle hole is then isolated. This protruded tissue is called the 'hernia sac'. This portion is then put back into its right place in its appropriate position. The surgeon then begins to repair the muscle damage that causes hernia.

If this muscle damage (hole) is small, it can be sutured closed with stitches. These sutures are such that they remain in the place permanently thus preventing a recurrence.

If the muscle damage is large, the sutures are not adequate and this is where a mesh graft, a surgical implant, can be used to cover the hole. The mesh repair method for incisional hernia is permanent. Once the mesh is put in place of the hole and the muscle has been sutured, the surgeon removes the laparoscope, thereby closing the incision. This incision is closed permanently when the patient returns for a follow-up visit. The sutures are removed and a special form of adhesive is used to hold the incision closed once the sutures are removed. Small, sticky bandages, also known as steri-strips may be used too.

The mesh repair method is the standard treatment of incisional hernias but it may not be the best if a patient has a history of rejecting surgical implants as this may prevent the use of mesh. An in-depth diagnosis, along with a study of patient's medical history, is important to check whether the mesh repair method can be used.

Generally, within two to four weeks, incisional hernia patients can return back to their normal activity. However, certain precautions like not lifting heavy objects and not getting up from a seated position, should be taken. Protecting the incisions is of the utmost importance.