An incisional hernia is so-named because it tends to develop shortly after surgery – usually within three to six months – in the abdominal area.
The protrusion of intestinal material or other tissue is often felt as a bulge under the skin. After a positive diagnosis is made, a GI doctor may recommend laparoscopic repair as an alternative to open hernia surgery.
This is a type of minimally invasive surgery that may become an option if an incisional hernia is excessive large, painful, or cosmetically unappealing.
Before Laparoscopic Incisional Hernia Repair
Prior to determining if laparoscopic surgery is appropriate, patients are usually thoroughly examined to determine the extent of the protrusion. Once a bulge, swelling, or a visible protrusion is detected in the abdominal area, blood tests and certain images that may include a CT scan or X-ray are usually ordered. Before surgery, patients are normally advised to stop smoking. Certain medications may also need to be temporarily stopped, especially blood thinners and anti-inflammatory medications.
How the Procedure is Performed
Normally performed after general anesthesia is administered, laparoscopic incisional hernia repair is done with smaller incisions. These incisions are used to insert specialized surgical instruments to perform the necessary steps to correct the damage from the incisional hernia. One of the incisions is used for the insertion of a lighted scope with a camera attached (laparoscope).
What’s termed the “hernia sac” is located and isolated. This is the area where the abdominal lining is coming through the abdominal wall. The protruding tissue is then returned to its original position. The tear is then corrected. If the defect is small, it may be closed with sutures. If the tear is larger, a mesh graft may be used to cover the hole. With larger tears, the use of mesh reduces the odds of recurrence.
After the mesh is correctly placed, the laparoscope and other instruments are removed and the small incisions are closed with sutures. When the sutures are removed during a follow-up visit, small, sticky bandages (steri-strips) may be placed over the incisions. Sometimes, a special type of glue is used.
After Laparoscopic Incisional Hernia Repair
Minimally invasive operations like this are usually performed as outpatient procedures. It’s normal to have some tenderness and mild discomfort within the affected area after laparoscopic incisional hernia repair. Over-the-counter or prescription pain medications may be recommended to manage post-procedure discomfort. Most patients are able to return to their normal activities after about 2-4 weeks. During the initial healing period, it’s advised that patients avoid:
- Excessive straining in the abdominal area
- Forceful coughing or sneezing
- Hard bowel movements (stool softeners may be recommended to reduce this risk)
- Heavy lifting
While there are many appealing benefits associated with laparoscopic incisional hernia repair, it’s not always the best option in every situation. If tissue or organ protrusion is extensive, for instance, open hernia surgery (herniorrhaphy) may be the better option. Since incisional hernia repair is one of the most commonly performed general surgery operations, success rates are fairly high. And because incisional hernias are associated with abdominal surgery, they are not as likely to recur as some other types of hernias once repaired unless a patient has surgery for another abdominal condition in the future.