“Incisional Hernia recurrence rates vary between 10 – 50% and are reduced by more than half with the use of a mesh. The experience with laparoscopic repairs employing mesh has been favorable with recurrence rates as low as 1 to 10%”.
Incisional hernias occur as a result of excessive tension and/or inadequate healing of a previous incision, which is often associated with surgical site infection.
SIGNS AND SYMPTOMS
It is done by a physical examination. Just in difficult cases, imaging studies such as ultrasound or CT Scan, may have a role.
For this type of hernia(s) the laparoscopic technique is the preferred option since the advantages of this approach are great, as seen below.
Primary repair (approximation of patient’s own tissues) of incisional hernias can be done when the defect is small in diameter, less than 1 inch (<2.5 cm) and there is viable (strong) surrounding tissue. Since larger defects, > 1 inch (>2.5cm) have a high recurrence rate if closed primarily (using just sutures to approximate tissues) the use of a prosthetic mesh is mandatory. Recurrence rates vary between 10 – 50% and are reduced by more than half with the use of a mesh. The experience with laparoscopic repairs employing mesh has been favorable with recurrence rates as low as 1-10%.
A great variety of meshes are available; the ideal mesh has yet to be defined and finally the one used is decided by Dr. Rosales, depending on what is best for your case.
Regarding the best technique, it is highly desirable to have the mesh placed beneath the fascia (the strongest abdominal wall layer), with a wide overlap of mesh and fascia, the forces of the abdominal cavity act to hold the mesh in place. This can be accomplished using the laparoscopic approach for incisional hernia repair, which relies on this principle; that is why it is Dr. Rosales’ preference in the majority of cases.
Image of the ventral/incisional defect “seen” with the camera from the inside of the abdomen and being covered with the mesh.
VENTRAL HERNIA SURGERY COMPLICATIONS
The incidence of postoperative complications and recurrence are less in hernias repaired laparoscopically; based on comparative trials, laparoscopic incisional hernia repair results in fewer complications, lower infection rate and decreased hernia recurrence. However, to achieve these results, it has to be done by a surgeon with experience in advanced laparoscopic procedures. It should, moreover, be remembered that many of these complications are transient and can be addressed easily.
ADVANTAGES OF LAPAROSCOPIC INCISIONAL HERNIA REPAIR
Laparoscopic Ventral Hernia Repair with Mesh
REPARACIÓN DE HERNIA INCISIONAL ABIERTA
SURGICAL TECHNIQUE (SIMPLIFIED)
Under general anesthesia, a 10 mm incision is made in the lateral area of the abdomen at the height of the umbilicus/navel, CO2 is introduced to the cavity, then 2 more incisions are made in the abdomen (both of 5mm) to introduce the rest of the instruments, the hernia sac and its contents are brought back to the abdominal cavity, the whole area is dissected and the mesh is introduced through one of the incisions and placed covering the totality of the defect(s) with an overlap of at least 4 cm, then it is fixed with staples, incisions are closed with suture and the procedure is completed.
**The material Dr. Rosales uses depends on the case and his preference based on his experience.
Incisions for Laparoscopic Incisional Hernia Repair
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