A general surgery procedure that repairs a hernia formed by weakening at the healed incision line of a previous abdominal surgery, most often using mesh.
Indication
- A visible or palpable bulge over an old surgical incision
- A bulge and pain that become more apparent with increased intra-abdominal pressure (coughing, straining, standing up)
- Pain or discomfort restricting daily activities
- Risk of incarceration or strangulation
- A recurrent or progressively enlarging incisional hernia
- Large hernias creating significant deformity in the abdominal wall
Preparation
- No food or drink for 8 hours before the procedure
- Blood thinners are adjusted with physician approval
- Routine blood tests, ECG; abdominal CT may be planned for large hernias
- Obesity, diabetes, smoking, and conditions raising intra-abdominal pressure are optimized as much as possible
- Anesthesia consultation is performed; abdominal wall and skin condition are evaluated
How it's performed
- General anesthesia is administered; vital signs are continuously monitored
- In the open approach, the skin and subcutaneous tissues are passed through over the old incision and the hernia sac is mobilized
- The hernia contents are returned to the abdominal cavity; adhesions are released when needed
- The defect in the abdominal wall is reinforced with a synthetic mesh; in some cases, additional techniques such as components separation are used
- In laparoscopic / robotic methods, mesh is placed through small incisions using a camera and instruments
- Skin layers are closed; a drain and abdominal compression garment are used when needed
Post-procedure
- Hospital stay is generally 1-3 days; longer for large hernias
- Pain control, early mobilization, and breathing exercises are recommended
- Heavy lifting, straining, and activities raising intra-abdominal pressure are restricted for 6-8 weeks
- An abdominal binder may be recommended for a defined period
- Scheduled outpatient follow-up visits for wound care and suture review
Risks
- Wound infection, seroma, or hematoma
- Mesh-related infection or adhesions (rare)
- Skin necrosis or wound dehiscence (especially in very large hernias)
- Bowel injury (especially when adhesions are extensive, rare)
- Recurrence of the hernia; anesthesia and thromboembolism risks
FAQ
Why did a hernia develop again at my old surgical site?
Healing along the old incision line can result in weakening. Infection, obesity, diabetes, smoking, chronic cough, and excessive straining increase the risk of hernia development.
Is mesh always required?
Mesh is preferred in most incisional hernias because it significantly lowers the risk of recurrence. In selected cases with very small defects, repair without mesh may be considered.
How long does recovery take?
Depending on the size of the incision and overall health, return to daily activities may take 2-4 weeks, while return to heavy work can take 6-8 weeks.
What can I do to reduce the risk of another hernia?
The most important steps are weight control, smoking cessation, treating constipation and chronic cough, and avoiding excessive straining and heavy lifting.
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