Incisional Hernia

Diseased or injured organs inside the abdomen sometimes require surgery for repair or removal. Although more and more intra-abdominal conditions can now be addressed using laparoscopic techniques (using a camera and instruments introduced through small tubes), many still require a traditional incision. At the completion of the operation, this incision is then closed with suture material, to hold the tissues closely together, until they can grow together and heal. If a separation develops between these cut tissues, they will not grow together, and an abdominal wall defect occurs.

incisionalRightClinically, they present as a bulge or protrusion at or near the area of a surgical incision. Virtually any prior abdominal operation can develop such an issue at the scar area (provided adequate healing does not occur due to infection), including large abdominal procedures such as intestinal or vascular surgery, and small incisions, such as (appendix removal or abdominal exploratory surgery). While these hernias can occur at any incision, they tend to occur more commonly along a straight line from the xiphoid process of the sternum straight down to the pubis, and are more complex in these regions. The defect cannot heal itself, and may stretch and increase in size over time. Although uncommon, abdominal contents can even become entrapped (incarcerated) in the  bulge, and potentially have their blood supply choked off (strangulation). Fortunately, this latter event is very rare. All abdominal surgeons, no matter how skillful, will occasionally (and fortunately, rarely) have a patients develop such a problem.

Hernias in this area have a high rate of recurrence if repaired via a simple suture technique under tension and are almost always repaired using some form of patch material to bridge and reinforce the defect. In many cases, these repairs can be performed using minimally invasive outpatient laparoscopic techniques—the operation is performed using surgical microscopes and specialized instruments. The surgical mesh is placed into the abdomen underneath the abdominal muscles through small incisions to the side of the herniation. In this manner, the weakened tissue is never re-incised to perform the repair, and one can minimize the potential for wound complications such as infections. In addition, performance of the operation through smaller incisions can make the operation less painful and speed recovery. Occasionally the characteristics of the problem dictate a more traditional incisional approach. These decisions are best made by an experienced specialist who is able to tailor the repair plan for each individual’s unique presentation.

Patient Testimonials:

…I just wanted to let you know how happy I am with the results of my recent hernia surgery. There was very little pain and only some minor discomfort as the result of the laparoscopic procedure that you employed… I appreciate the fact that you took time out from your Thanksgiving Day festivities with your family to call and check to see how I was doing…
Thomas J.