Incisional hernia repair surgery: All you need to know

Preparing for surgery to repair a hernia can, understandably, be daunting for patients and their loved ones. In this article, leading consultant laparoscopic general and colorectal surgeon Mr Dominic Coull, who specialises in hernia repair surgery outlines what patients can expect from the incisional hernia repair surgical procedure and why it is necessary.

What is an incisional hernia?

An incisional hernia is a protrusion of abdominal contents felt as a noticeable weakness in your abdominal wall at the site of a previous surgical incision.

Why is it necessary to operate and repair incisional hernia?

Surgical repair should result in a stronger abdominal wall with the hernia no longer present. This will allow the patient to return to normal activities including sport and exercise. An incisional hernia cannot repair itself, so surgery is the only cure available. Avoiding surgery to repair the hernia can result in the following:

• An increase in the size of the hernia
• Possible incarcerated hernia (trapped bowel)
• Possible strangulated hernia (trapped bowel that has lost blood supply), which requires emergency surgery

If a trapped bowel develops a hole or tears, this causes peritonitis which can be fatal.

What does an incisional hernia repair involve?

Incisional hernia repair can usually be performed by either laparoscopically (keyhole) or through open surgery.

Understanding which of the two possible techniques is right for you is important and you should have a thorough discussion in clinic with your surgeon about your individual case. Your fitness will also be assessed for a general anaesthetic and you may also need to see an anaesthetist before the surgery if you have any other health issues that need to be taken into account.

During surgery, an incision is made down to the hernia sac which is then excised and the hernia defect is closed by sutures (stitches). Alternatively, a surgical mesh may be inserted into the hernia sac which will obliterate it. The skin will be closed with an absorbable suture just below the surface so it will not be visible and will not require removal.

Are there any risks to incisional hernia repair?

As with all types of surgery, there is a small chance of general complications, such as bleeding or blood clotting.

Specific to incisional hernia repair, in rare cases patients may develop numbness, nerve pain or swelling around the wound which usually resolves itself without the need for further intervention within a few weeks.

An injury to the bowel or a need to remove the umbilicus are rare complications of this type of hernia surgery, the latter being more likely to occur in patients with a Body Mass Index in the obese range. It is important to note that recurrence of the hernia can occur in a small percentage of patients which will require another operation.

What is the recovery process like after open incisional hernia repair?

Patients usually undergo incisional hernia repair as an in-patient procedure, meaning staying in the hospital for between one and four nights after surgery.

A physiotherapist will advise how to maintain movement throughout your recovery, which could begin as soon as the day following your surgery. Most patients take four to six weeks off work to fully recover and strenuous exercise and heavy lifting should be avoided until around six weeks after surgery.

If you require reparative surgery for an incisional hernia and wish to discuss your case further, you can book a consultation with Mr Coull by visiting his Top Doctors profile.