Midline Incisional Hernia Repair

Incisional hernias are defined as defects or weaknesses that develop at the site where the abdominal wall has been opened in a prior operation. This can be from a laparoscopy incision, or more commonly from an open surgical procedure. Incisional hernias are fairly common, with hundreds of thousands performed in the United States each year. Hernias develop when the forces on the abdominal wall closure over time are stronger than the sutures and abdominal wall healing. There are increased forces on the abdominal wall in heavier patients, so hernias occur more in this group. Poor healing can occur due to heavy abdominal wall scarring from prior surgery, due to medicines or conditions of the patient including steroid use, or most commonly due to infection.

Hernias are holes or defects in the abdominal wall that allow the intestines or tissues to protrude under the skin. If the bowel were to become caught in the tight hole, it could strangulate or die, and this is a surgical emergency. Alternatively, the bowel can become blocked within the tight confines of the hernia, causing a bowel obstruction with pain and vomiting. Hernias can also be painful. Finally, large hernias prevent the patient from developing the normal increases of abdominal pressure that are necessary for coordinated movement and activities. Poor function of the torso muscles increases the strain on the back, and therefore can contribute to back pain.

Over the last decade, advances in techniques and mesh have allowed the majority of hernias to be reparable with low recurrence and complication rates. Dr. Dumanian has published a 0-5% hernia recurrence rate at two years for a standard midline incisional hernia for large numbers of patients.