A hernia is a general term that refers to a protrusion of a body tissue through a wall of a cavity in which it is normally contained.
An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall.
When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs).
Incision from a previous surgical procedure in the abdominal area can leave the muscle tissues in the region weaker. Hernia caused by the protrusion of intestines through such incision-related weak spots is termed incisional hernia. The incidence of this is primarily seen in the elderly, obese or those who lack physical activity following an abdominal surgery. Incisional Hernia occurs after 5% – 20 % of all abdominal surgeries .
In the same way that an inner tube pushes through a damaged tire , the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a balloon – like sac . This can allow a loop of intestine or other abdominal contents to push into the sac .
The incision in your abdominal wall will always be an area of potential weakness . Hernias can develop at these sites due to , infection at that site following surgery ,obesity , chronic cough , heavy weight lifting , straining during bowel movements or urination . The incisional hernia can occur immediately following surgery or may not be apparent for years following surgery .
A hernia is usually recognised as a bulge under your skin . Occasionally it causes no discomfort at all , but you may feel the pain during lifting heavy objects , coughing , straining during bowel movements or urination or with prolonged standing or sitting .
In general, incisional hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required later . Under certain circumstances the hernia may be watched and followed closely . These situations are unique to those individuals who are at high operative risks (i.e. those with severe heart or lung disease, or bleeding problems). Of course, even in the high risk person, if the symptoms become severe or if strangulation occurs, then an operation must be performed.
Serious complications from a hernia can result from the trapping of contents in the hernia – a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to strangulation resulting in gangrene or death of the content, usually small bowel . Any continuous or severe pain ,abdominal distension ,vomiting , redness near the bulge are the indications of hernia being entrapped or strangulated . These are cause for concern and the surgeon should be immediately contacted .
This warrants Emergency Surgery .
There is no acceptable nonsurgical medical treatment for a hernia. The use of abdominal binder is occasionally prescribed but , often ineffective . A incisional hernia does not get better over time , nor will it go by itself .
There are two options for Incisional Hernia Repair .
1 .Open Repair : This traditional approach is done through an incision in the abdominal wall . It may go through part or all of the previous incision , skin , underlying fat layer and into the abdomen . The surgeon may choose to sew your tissues back together , but frequently , it requires the placement of mesh in or on the abdominal wall for a sound closure . This is performed under general , spinal or epidural anaesthesia . Due to the larger size of the incision, open hernia repair is generally painful with a relatively long recovery period.
2. Laparoscopic Repair : In this approach , a laparoscope ( a tiny telescope with a television camera attached ) is inserted through a cannula ( a small hollow tube ). The laparoscope and TV camera allow the surgeon to view the hernia from inside . Any multiple defects or weakness of the abdominal wall can be assessed with this approach . The mesh is fixed under the hernia defect covering at least five centimetres beyond the edge of the defect . It is held in place with special surgical tacks and sutures . This is termed as Intraperitoneal Onlay Mesh ( IPOM ) repair .This is performed under General anaesthesia .
- Less post operative pain.
- Less bleeding.
- Shortened hospital stay.
- Quicker return to normal activity.
- Faster return to regular diet.
- Less infection.
- No big scars adding cosmesis
Only after thorough examination can your surgeon determine whether a laparoscopic approach is right for you . The laparoscopic procedure may not be best for some patients who have had extensive previous abdominal surgery or underlying medical conditions making them unfit for general anaesthesia .
We perform Laparoscopic Incisional Hernia Repairs as a DAY CARE procedure. Patients are admitted the same day of their surgery. Following the procedure and recovery from anaesthesia, they are taken to hospital room where they spend the night. We encourage our patients to move as quickly as possible. Most patients stay in the hospital 1 or 2 days following surgery. Patients are then seen, by the surgeon, one week after discharge.
There is no dietary restriction. Patients are encouraged to engage in light activity while at home after surgery . It is generally not advisable to engage in any strenuous exercise or heavy lifting for few weeks , to allow the hernia repair to heal.