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Incisional hernia repair

Definition

Incisional hernia repair is a surgical procedure performed to correct an incisional hernia. An incisional hernia, also called a ventral hernia, is a burl or protrusion that occurs virtually or straight forth a prior abdominal surgical incision. The surgical repair procedure is also known as incisional or ventral herniorrhaphy.

Purpose

Incisional hernia repair is performed to correct a weakened expanse that has adult in the scarred muscle tissue around a prior abdominal surgical incision, occurring every bit a consequence of tension (pulling in opposite directions) created when the incision was closed with sutures, or by whatsoever other condition that increases abdominal pressure or interferes with proper healing.

Demographics

Considering incisional hernias can occur at the site of any type of abdominal surgery previously performed on a broad range of individuals, at that place is no outstanding profile of an individual near likely to have an incisional hernia. Men, women, and children of all ages and ethnic backgrounds may develop an incisional hernia afterwards abdominal surgery. Incisional hernia occurs more commonly among adults than among children.

Description

An incisional hernia tin can develop in the scar tissue around whatsoever surgery performed in the abdominal expanse, from the breastbone down to the groin. Depending upon the location of the hernia, internal organs may press through the weakened abdominal wall. The rate of incisional hernia occurrence can be equally high as 13%

An incisional hernia occurs at the site of a previous incision (A). Intestinal contents break through the abdominal wall and bubble up under the skin. In a laparoscopic repair, the surgeon uses laparoscopic forceps to pull the material, omentum, from the hernia site (B). A mesh pad is inserted into the site to line the hernia site (C and D), and is tacked into place (E). (Illustration by GGS Inc.)

An incisional hernia occurs at the site of a previous incision (A). Intestinal contents break through the intestinal wall and bubble up under the skin. In a laparoscopic repair, the surgeon uses laparoscopic forceps to pull the material, omentum, from the hernia site (B). A mesh pad is inserted into the site to line the hernia site (C and D), and is tacked into place (East). (

Analogy past GGS Inc.

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with some abdominal surgeries. These hernias may occur later big surgeries such as intestinal or vascular (eye, arteries, and veins) surgery, or later smaller surgeries such as an appendectomy or a laparoscopy , which typically requires a small-scale incision at the navel. Incisional hernias themselves can exist very small or large and complex, involving growth along the scar tissue of a large incision. They may develop months later on the surgery or years afterwards, normally because of inadequate healing or excessive pressure on an abdominal wall scar. The factors that increment the hazard of incisional hernia are weather condition that increase strain on the intestinal wall, such every bit obesity, avant-garde historic period, malnutrition, poor metabolism (digestion and assimilation of essential nutrients), pregnancy, dialysis, excess fluid memory, and either infection or hematoma (haemorrhage under the pare) after a prior surgery.

Tension created when sutures are used to close a surgical wound may also exist responsible for developing an incisional hernia. Tension is known to influence poor healing conditions because of related swelling and wound separation. Tension and abdominal pressure are greater in people who are overweight, creating greater risk of developing incisional hernias post-obit any abdominal surgery, including surgery for a prior inguinal (groin) hernia. People who have been treated with steroids or chemotherapy are also at greater chance for developing incisional hernias considering of the affect these drugs have on the healing process.

The first symptom a person may have with an incisional hernia is hurting, with or without a bulge in the abdomen at or well-nigh the site of the original surgery. Incisional hernias tin increase in size and gradually produce more than noticeable symptoms. Incisional hernias may or may not require surgical treatment.

The effectiveness of surgical repair of an incisional hernia depends in part on reducing or eliminating tension at the surgical wound. The tension-gratis method used by many medical centers and preferred past surgeons who specialize in hernia repair involves the permanent placement of surgical (prosthetic) steel or polypropylene mesh patches well beyond the edges of the weakened area of the abdominal wall. The mesh is sewn to the surface area, bridging the hole or weakened surface area beneath information technology. Every bit the area heals, the mesh becomes firmly integrated into the inner abdominal wall membrane (peritoneum) that protects the organs of the abdomen. This method creates lilliputian or no tension and has a lower charge per unit of hernia recurrence, as well equally a faster recovery with less pain. Incisional hernias recur more than frequently when staples are used rather than sutures to secure mesh to the abdominal wall. Autogenous tissue (pare from the patient'southward ain trunk) has also been used for this blazon of repair.

Two surgical approaches are used to care for incisional hernias: either a laporoscopic incisional herniorrhaphy, which uses small-scale incisions and a tube-similar instrument with a photographic camera attached to its tip; or a conventional open repair procedure, which accesses the hernia through a larger abdominal incision. Open procedures are necessary if the intestines have get trapped in the hernia (incarceration) or the trapped intestine has become twisted and its blood supply cut off (strangulation). Extremely obese patients may also require an open procedure because deeper layers of fatty tissue will accept to be removed from the abdominal wall. Mesh may exist used with both types of surgical admission.

Minimally invasive laporoscopic surgery has been shown to have advantages over conventional open procedures, including:

reduced hospital stays
reduced postoperative hurting
reduced wound complications
reduced recovery fourth dimension

Surgical procedure

In both open and laparoscopic procedures, the patient lies on the operating table, either apartment on the back or on the side, depending on the location of the hernia. General anesthesia is usually given, though some patients may have local or regional anesthesia, depending on the location of the hernia and complexity of the repair. A catheter may be inserted into the bladder to remove urine and decompress the bladder. If the hernia is near the tummy, a gastric (nose or mouth to tummy) tube may be inserted to decompress the tum.

In an open procedure, an incision is made just large enough to remove fatty and scar tissue from the abdominal wall most the hernia. The outside edges of the weakened hernial expanse are defined and backlog tissue removed from inside the area. Mesh is and then applied so that it overlaps the weakened area by several inches (centimeters) in all directions. Non-absorbable sutures (the kind that must be removed by the doctor) are placed into the full thickness of the intestinal wall. The sutures are tied down and knotted.

In the less-invasive laparoscopic process, two or iii small incisions will be made to access the hernia site—the laparoscope is inserted in i incision and surgical instruments in the others to remove tissue and identify the mesh in the same mode as in an open procedure. Significantly less abdominal wall tissue is removed in laparoscopic repair. The surgeon views the entire procedure on a video monitor to guide the placement and suturing of mesh.

Diagnosis/Preparation

Diagnosis

Reviewing the patient's symptoms and medical history are the offset steps in diagnosing an incisional hernia. All prior surgeries volition exist discussed. The doctor will ask how much pain the patient is experiencing, when it was get-go noticed, and how information technology has progressed. The md will palpate (touch) the area, looking for any abnormal bulging or mass, and may inquire the patient to cough or strain in lodge to come across and feel the hernia more easily. To confirm the presence of the hernia, an ultrasound examination or other scan such equally computed tomography (CT) may exist performed. Scans will allow the doctor to visualize the hernia and to brand sure that the bulge is non another type of intestinal mass such as a tumor or enlarged lymph gland. The physician will be able to determine the size of the defect and whether or not surgery is an advisable way to treat information technology. A referral to a surgeon will exist made if the dr. believes that medical treatment will not finer correct the incisional hernia.

Training

Many months before the surgery, the patient'southward doctor may propose weight loss to assist reduce the risks of surgery and to improve the surgical results. Command of diabetes and smoking cessation are also recommended for a amend surgical result. Shut to the time of the scheduled surgery, the patient will accept standard preoperative claret and urine tests, an electrocardiogram, and a chest ten ray to make sure that heart and lungs and major organ systems are functioning well. A week or so before surgery, medications may be discontinued, especially aspirin or anticoagulant (blood-thinning) drugs. Starting the night before surgery, patients must not eat or drink annihilation. One time in the hospital, a tube may be placed into a vein in the arm (intravenous line) to deliver fluid and medication during surgery. The patient will be given a preoperative injection of antibiotics earlier the procedure. A sedative may exist given to relax the patient.

Aftercare

Immediately after surgery, the patient will be observed in a recovery area for several hours, for monitoring of body temperature, pulse, blood pressure, and heart part, besides as ascertainment of the surgical wound for undue haemorrhage or swelling. Patients will usually be discharged on the twenty-four hours of the surgery; only more complex hernias such every bit those with incarcerated or strangulated intestines will require overnight hospitalization. Some patients may have prolonged suture-site pain, which may be treated with pain medication or anti-inflammatory drugs. Antibiotics may be prescribed to help prevent postoperative infection.

In one case the patient is dwelling house, the hernia repair site must exist kept clean, and whatsoever sign of swelling or redness reported to the surgeon. Patients should as well report a fever or any abdominal pain. Outer sutures may have to be removed by the surgeon in a follow-up visit about a week after surgery. Activities may be limited to not-strenuous movement for upwardly to 2 weeks, depending on the type of surgery performed. To allow proper healing of muscle tissue, hernia repair patients should avoid heavy lifting for at to the lowest degree six to eight weeks after surgery, or longer as advised.

Risks

Long-term complications seldom occur afterwards incisional hernia repair. Short-term risks are greater with obese patients or those who have had multiple before operations or the prior placement of mesh patches. The gamble of complications has been shown to exist well-nigh 13%. The hazard of recurrence and repeat surgery is as loftier equally 52%, particularly with open procedures or those using staples rather than sutures for wound closure. Some of the factors that cause incisional hernias to occur in the first place, such as obesity and nutritional disorders, will persist in certain patients and encourage the development of a second incisional hernia and repeat surgery. Each subsequent time, the surgery will become more difficult and the risk of complications greater. Postoperative infection is higher with open procedures than with laparoscopic procedures.

Postoperative complications may include:

fluid buildup at the site of mesh placement, sometimes requiring aspiration (draining off)
postoperative bleeding, though seldom enough to require echo surgery
prolonged suture pain, treated with pain medication or anti-inflammatory drugs
abdominal injury
nervus injury
fever, usually related to surgical wound infection
intra-abdominal (inside the abdominal wall) abscess
urinary retention
respiratory distress

Normal results

Good outcomes are expected with incisional hernia repair, particularly with the laparoscopic method. Patients will usually become home the day of surgery and can await a one- to two-week recovery period at abode, and and so a return to normal activities. The American College of Surgeons reports that recurrence rates after the get-go repair of an incisional hernia range from 25–52%. Recurrence is more than frequent when conventional surgical wound closure with standard sutures (stitches) is used. Recurrence after open procedures has been shown to be less likely when mesh is used, although complications, especially infection, take been shown to increase because of the larger abdominal incisions. Laparoscopy with mesh has shown rates of recurrence as low every bit iii.4%, with fewer complications as well.

Morbidity and mortality rates

Deaths are not reported resulting directly from the functioning of herniorrhaphy for incisional hernia.

Alternatives

The alternatives to first-time and recurrent incisional hernia repair brainstorm with preventive measures such as:

Losing weight; maintaining suitable weight for age and peak.
Strengthening abdominal muscles through regular moderate exercise such equally walking, tai chi, yoga, or stretching exercises and gentle aerobics.
Reducing abdominal pressure level by avoiding constipation and the buildup of excess body fluids, achieved by adopting a high-fiber, low-salt nutrition.
Learning to lift heavy objects in a rubber, low-strain way using arm and leg muscles.
Decision-making diabetes and poor metabolism with regular medical care and dietary changes as recommended.
Eating a salubrious, balanced diet of whole foods, high in essential nutrients, including whole grains, fruits and vegetables, express meat and dairy, and eliminating prepared and refined foods.

Resource

books

Maddern, Guy J. Hernia Repair: Open vs. Laparoscopic Approaches. London: Churchill Livingstone, 1997.

organizations

American College of Surgeons (ACS), Office of Public Information. 633 North Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. http://www.facs.org .

The National Digestive Diseases Data Clearinghouse (NIDDK). ii Information Way, Bethesda, Dr. 20892-3570. http://www.niddk.nih.gov/health/digest/nddic.htm .

other

"Focus on Men'southward Wellness: Hernia." January 2003. MedicineNet Domicile. http://www.medicinenet.com .

Incisional and Ventral Hernias (Patient Information). Central Montgomery Medical Center, Outpatient Surgery Department. 2100 Northward. Broad Street, Lansdale, PA 19446. (215) 368-1122.

50. Lee Culvert

WHO PERFORMS THE Process AND WHERE IS It PERFORMED?

Incisional hernia repair is performed in a hospital operating room or a one-day surgical eye past a full general surgeon who may specialize in hernia repair procedures.

QUESTIONS TO ASK THE Medico

What procedure will be performed to correct my hernia?
What is your experience with this procedure? How often practice you lot perform this process?
Why must I take the surgery?
What are my options if I do not accept the surgery?
How can I expect to experience later surgery?
What are the risks involved in having this surgery?
How quickly volition I recover? When can I return to schoolhouse or work?
What are my chances of having this type of hernia again?
What tin can I do to avoid getting this type of hernia again?

Source: https://www.surgeryencyclopedia.com/Fi-La/Incisional-Hernia-Repair.html

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