(Major Ventral Hernia)
An Incisional Hernia is a hernia that occurs through a previously made incision in the abdominal wall, ie the scar left from a previous surgical operation.
The incision will have been made in order to get to an internal organ such as the appendix, or a caesarian section. So an Incisional hernia is not the same as a Recurrent Hernia.
After that previous operation, the surgeon will have had to close the layers of the abdominal wall with stitches. Sometimes this closure simply comes apart, fails to heal properly in the first place or just comes apart with time.
How common are they?
Remarkably common, really. It is estimated that at least 12-15% of abdominal operations lead to an incisional hernia. Historically, and even today, the success rate for repairing them is quite poor with a high incidence of complications and failure. In some reports from other surgeons 50-60% of incisional repairs have failed within 2 years.
Are incisional hernias dangerous?
As with all hernias, if the hernia strangulates, i.e. the hernia contents (the intestine) get trapped and lose their blood supply, which is very dangerous.
Can or should I leave it?
If you do, it will almost certainly enlarge. It will just get bigger and probably become more and more unsightly and uncomfortable.
Do I have any non-surgical options?
Wear a corset or belt. Not ideal, can cause additional problems and it is difficult to find a good one. This was a favoured remedy in the last millennium as this old American advert shows
What is the best way of repairing it?
That is one of the really important questions. We have extensive experience in this area and today most hernia surgeons agree:
- Using mesh gives the best results
- Open or keyhole repairs are both good (when performed by expert specialists) and which to use depends on the hernia, the intended result, the patient, and the surgeon. The type of repair should be tailored to the individual case and by an expert.
- The layer of the abdominal wall in which the mesh is placed is a really important factor.
Is mesh always used?
It should be. Sutured repairs have a really high failure rate Biological meshes are unproven, and there are few long-term results available. So far in the majority of cases, when the mesh dissolves, the hernia returns.
Is the old cut reopened?
For open repairs, yes it is. If done well it’s an excellent operation. Some claim that the risk or incidence of infection is high. We think that this a reflection of poorly performed surgery.
How good is the keyhole repair?
It depends who does it. It does not bring the edges of the hole together, so if there is a really wide gap the result may be disappointing, with quite a big bulge remaining. However, in the hands of experts specialising in this method of hernia repair, the results can be good. With kehole repairs of this type there is always the risk of a bowel (or other internal organ) injury) as these organs can be quite tightly stuck to the hernia from the inside.