Incisional hernia
Encyclopedia
An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen
are frequent for abdominal exploratory surgery
, ventral incisional hernias are termed ventral hernias. If it is not caused by an incision, then it is a epigastric hernia
. These can be among the most frustrating and difficult hernias to treat.
1 - haematoma: it decrease wound healing
2 - seroma: it decrease wound healing also
3 - infection: also decrease wound healing
4 - poor technique
or may be caused by increased intra abdominal pressure which caused by:
1 - chronic cough like COPD
2 - constitutions
3 - urinary obstruction, like BPH
4 - pregnancy
5 - Ascites
does not occur due to infection), from large abdominal procedures (intestinal surgery, vascular surgery
), to small incisions (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. Hernias in this area have a high rate of recurrence if repaired via a simple suture technique under tension. For this reason, it is especially advised that these be repaired via a tension free repair method using mesh
(a type of synthetic material).
Laparoscopic incisional hernia repair is a new method of surgery for this condition. The operation is performed using surgical telescopes and specialized instruments. The surgical mesh is placed into the abdomen underneath the abdominal muscles through small incisions to the side of the hernia. In this manner, the weakened tissue of the original hernia 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 recovery quicker. Laparoscopic repair has been demonstrated to be safe and a more resilient repair than open incisional hernia repair.
Linea alba
The linea alba is a fibrous structure that runs down the midline of the abdomen in humans and other vertebrates. The name means white line and the linea alba is indeed white, being composed mostly of collagen connective tissue....
are frequent for abdominal exploratory surgery
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
, ventral incisional hernias are termed ventral hernias. If it is not caused by an incision, then it is a epigastric hernia
Epigastric hernia
An epigastric hernia is a type of hernia which may develop in the epigastrium . Epigastric hernias usually appear in adults....
. These can be among the most frustrating and difficult hernias to treat.
Etiology
Incicional hernia usually caused by weakness of the surgical wounds which is caused by:1 - haematoma: it decrease wound healing
2 - seroma: it decrease wound healing also
3 - infection: also decrease wound healing
4 - poor technique
or may be caused by increased intra abdominal pressure which caused by:
1 - chronic cough like COPD
2 - constitutions
3 - urinary obstruction, like BPH
4 - pregnancy
5 - Ascites
Signs and symptoms
Clinically, incisional hernias present as a bulge or protrusion at or near the area of a surgical incision. Virtually any prior abdominal operation can develop an incisional hernia at the scar area (provided adequate healingHealing
Physiological healing is the restoration of damaged living tissue, organs and biological system to normal function. It is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area....
does not occur due to infection), from large abdominal procedures (intestinal surgery, vascular surgery
Vascular surgery
Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery...
), to small incisions (appendix removal, or abdominal exploratory surgery
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
). 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
Pubis
Pubis may refer to:* Pubis * Mons pubis, a padding of fat that protects the pubis bone...
, and are more complex in these regions. Hernias in this area have a high rate of recurrence if repaired via a simple suture technique under tension. For this reason, it is especially advised that these be repaired via a tension free repair method using mesh
Mesh
Mesh consists of semi-permeable barrier made of connected strands of metal, fiber, or other flexible/ductile material. Mesh is similar to web or net in that it has many attached or woven strands.-Types of mesh:...
(a type of synthetic material).
Treatment
Traditional "open" repair of incisional hernias can be quite difficult and complicated operations. The weakened tissue of the abdominal wall is re-incised and a repair is reinforced using a prosthetic mesh. Complications frequently occur because of the large size of the incision required to perform this surgery. These are primarily wound complications such as infection of the incision. Unfortunately, a mesh infection after this type of hernia repair most frequently requires a complete removal of the mesh and ultimately results in surgical failure. In addition, large incisions required for open repair are commonly associated with significant postoperative pain.Laparoscopic incisional hernia repair is a new method of surgery for this condition. The operation is performed using surgical telescopes and specialized instruments. The surgical mesh is placed into the abdomen underneath the abdominal muscles through small incisions to the side of the hernia. In this manner, the weakened tissue of the original hernia 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 recovery quicker. Laparoscopic repair has been demonstrated to be safe and a more resilient repair than open incisional hernia repair.