INCISIONAL HERNIASVentral Hernias
INCISIONAL Hernias, also often referred to as Ventral Hernias, may occur in the area of any prior surgical incision. These hernias can vary in size from very small and uncomplicated, to very large and complex. Incisional hernias develop in up to 11% of abdominal surgical wounds. Incisional hernias most commonly develop as the result of:
- Disruption along or adjacent to the area of abdominal wall incision closure
- Tension, placed on the tissue as a result of suturing wound edges inadequately or under tension
- Other inhibitors to adequate healing (infection, poor nutrition, long smoking history, obesity, or metabolic diseases such as diabetes)
Incisional ( or Ventral) hernias present as a bulge, or protrusion, at or near the area of the prior surgical incision scar. Although most commonly occurring along mid-line incisions (those incisions centrally located between the breast bone and pubis), virtually any prior abdominal operation can subsequently develop an Incisional Hernia. These include those from large abdominal procedures (intestinal surgery, vascular surgery) to small incisions (Appendectomy, or even Laparoscopy). Again, incisional hernias can occur at any incision, but tend to be larger and more complex along prior mid-line incisions. Mid-line Incisional Hernias also have a higher rate of recurrence if repaired using a simple tissue-to-tissue or suture-only technique under tension (up to 44%). It is advised therefore, that these hernias be repaired initially using the far more effective TENSION FREE repair method using mesh so as to significantly reduce the risk of future re-occurrence of the hernia.
Incisional hernia re-occurrence, following older, conventional, suture-only type repairs can develop in up to 44% when tissues are placed under too much tension, or when mesh is inappropriately used (e.g., use of on-lay mesh only, use of inadequate or too-small sized mesh, and even the inappropriate use of bio-degradable meshes). Importantly, these "recurrent" incisional hernias are far more difficult to effectively repair. Surgical experience and expertise is imperative when addressing primary and recurrent Incisional Hernias
These hernias may develop soon after the original surgery, or at any time thereafter. Most however become evident within 2 years or less of the initial surgery, Incisional Hernias gradually increase in size once they develop and become progressively more symptomatic. A bulge may not be evident at the hernia site initially and pain may be the only early symptom. These hernias develop in many cases as a result of too much tension placed when closing the abdominal incision, as stated above. Tension creates poor healing, swelling, wound separation and eventual Incisional Hernia formation.
Effective repair must include a TENSION FREE approach in order to avoid the risk of recurring subsequent hernias by eliminating tissue tension. This fact is not well understood by many surgeons who repair these hernias utilizing a simple tissue-to-tissue, suture only technique. Examination by a trained Hernia Specialist may be necessary to detect these hernias early on in their development, as well as to repair them properly to avoid recurrence and complications later on.
At The NORTH PENN HERNIA INSTITUTE , our Surgical Staff is able to repair many of these hernias effectively using our TENSION FREE METHOD. Here, mesh is placed broadly, under the defect in the muscle layer of the abdominal wall. The mesh extends well beyond the under edges of the hole or defect, and is not merely sewn to the hernia edges. Organs within the abdomen are protected from injury from the mesh by a naturally occurring membrane called "peritoneum", which is neither cut nor entered in this repair under most circumstances. Adhesions to intestine are thereby avoided. This approach assures an EFFECTIVE repair without tension and without the need for tight and painful tension suture placement. The result is a more effective repair with a lower recurrence rate and a more rapid and less uncomfortable recovery. This method is also applicable to most, but not all previously-repaired Recurrent Incisional Hernias.
Patients with Recurrent Incisional Hernias, previously repaired using mesh may not be acceptible candidates for repair using this method. While we are most happy to see such patients in consultation, it is advised that a preliminary telephone consultation with one of our surgeons be scheduled before long-distance travel to the North Penn Henria Institute to determine suitability for surgery.
In smaller and uncomplicated incisional hernias, discharge on the same day as surgery is anticipated.
While surical repair of Ventral/Incisional Hernias can often be performed as a "One Day" procedure, using local anesthesia and sedation, in many cases Large and more Complex Incisional Hernia repairs may require General Anesthesia, as well as a potential overnight hospital stay. Unless preliminary discussion with our surgeons suggests otherwise, full examination and evaluation prior to arranging surgery is necessary to appropriately outline the operative approach in these large and complex cases. Importantly, this technique is quite effective and well tolerated even in these circumstances.
Return to Normal Activity in Days
Surgery performed at
in Lansdale, Pennsylvania
LARGE or COMPLEX
"INCISIONAL" and "VENTRAL" HERNIAS
Very large and/or complex Incisional Hernias often require General Anesthesia as well as a potential hospital admission. Patients with large, recurrent or complex Incisional Hernias are requested to call
North Penn Hernia Instituteto discuss your particular INCISIONAL HERNIA with our surgeons prior to your consultation or surgery.
INCISIONAL HERNIA REPAIRS-
The patient should be at or near Ideal Body Weight or with a Body Mass Index (BMI) not over 28 and generally healthy medically to be considered a good candidate for this safe and effective INCISIONAL HERNIA repair procedure.
RECURRENT INCISIONAL HERNIAS, previously repaired elsewhere using mesh, especially in those individuals exceeding Ideal Body Weight may not be candidates for repair with this method. Patients with concurrent abdominal wall infections, drainage or open wounds may not be candidates for this technique. Preliminary examination is required for evaluation and determination. Consultation and comprehensive examination beforehand is therefore necessary in all patients with a Recurrent Incisional Hernia previously repaired using mesh.
Please feel free to call our office to speak to one of our surgeons about your INCISIONAL HERNIA to find out if you are a candidate for this advanced, effective method of Incisional Hernia repair. (215-368-1122)
These weight requirements are NOT mandatory for Inguinal (primary or recurrent), Umbilical, or Femoral hernia repair techniques.