Abdominal Wall Hernia (Umbilical/Epigastric/Incisional)

Abdominal wall hernia surgery

Abdominal wall hernias include umbilical , epigastric and incisional hernias. These hernias have different names based on their anatomical location. Hernias through weaknesses in the abdominal wall caused by previous surgery are called incisional hernias. Often Incisional hernias can be quite large.

 

The principles of repairing these hernias are the same.


Surgical repair is recommended for hernias that cause pain and other symptoms, and for irreducible hernias (structures cannot be returned to their normal locations) that are incarcerated or strangulated in an emergency setting. In some cases asymptomatic patients elect to have hernias repaired even when the risk associated are low.

 

Surgery to repair a hernia usually involves returning the contents of the hernia to their “normal” position and closing or reinforcing the defect in the abdominal wall through which the hernia occurs. Reinforcing the defect is usually achieved with the use of mesh.

 

Hernia surgery for abdominal wall hernias can often be performed as a day case. More extensive hernia repairs may require admission post operatively.


Types of Hernia Repair Surgery

The operation may be performed as an

  • Open Surgery
  • Keyhole or laparoscopic Surgery
  • Robotic surgery


There are reasons why one technique may be recommended over another. This can include;

  • Previous surgery
  • Whether this is a recurrent hernia
  • Single or multiple concurrent hernias for repair
  • Current medications and co-existing medical problems
  • Patient preference


There are multiple different techniques for laparoscopic abdominal wall hernia repair. The most commonly used surgical techniques for hernia repair are:

  • Transabdominal Preperitoneal (TAPP) Repair
  • Totally Extraperitoneal (TEP) Repair


Open Hernia Surgery

About Open Hernia Surgery

Open surgery for hernia repair can be performed under general or local anaesthesia. Your surgeon makes an incision of which it’s length is dependent on the size of the hernia. Whilst care is taken to make this as small as possible, it must be adequate to view and access the surgical site safely.

 

Your surgeon returns the part of the intestine, fatty tissue or any other structures that protrude through back into normal position. The defect within the weakened muscle layer is defined and closed by suturing (stitching) the healthy muscle wall together. Smaller hernias can be treated this way without the use of mesh.

 

With larger defect hernias there is robust evidence to suggest that in addition to closing the defect, using mesh decreases the risk of recurrence

 

A synthetic mesh is often placed and sewn over the weakened area to provide additional support and strength. There are different techniques for open hernia repair relating to which layer of the abdominal wall the mesh is placed. The mesh works as a scaffold to allow the body to deposit new connective tissue, reinforcing the repair

 

Whilst synthetic mesh is considered gold standard for reinforcing repairs, there are some absorbable meshes used.

 

Mesh is like any other medical device in that there are risks and benefits associated with its usage.

 

Once the hernia has been repaired, the wounds are closed using hidden absorbable sutures. Patients having very large hernias repaired may have a small drain placed temporarily under the wound to allow fluid to drain away while healing occurs.


Post-operative Care

Following surgery, you

  • Can usually go home the day of the procedure
  • Should avoid driving while taking pain killers as they induce drowsiness
  • Can resume daily activities early but avoid strenuous activities such as heavy lifting for up to 6 weeks
  • Use an ice pack on the wound to reduce pain and swelling

 

Risks and Complications

Like most surgical procedures, hernia repair is associated with the following risks and complications:

  • Reaction to anaesthesia
  • Infection
  • Bleeding at the operation site
  • Nerve damage and numbness of the skin
  • Damage to surrounding tissue

 

Although the recurrence of hernias is seen in less than 5% of patients after surgery, you would need to follow preventive measures.

 

Laparoscopic Hernia Surgery

About laparoscopic Hernia Surgery

 

Benefits of laparoscopic abdominal wall hernia surgery can include less post-operative discomfort, return to normal duties slightly quicker and less risk of wound infection.

 

Surgery is performed via smaller incisions than traditional open surgery.

 

In some situations such as with smaller or very large hernias, open surgery may in fact be recommended

 

Recurrence rates are similar to other techniques.

 

About laparoscopic Abdominal Wall Hernia Surgery


Laparoscopic hernia surgery is a surgical procedure in which a laparoscope is inserted into the abdomen through a small incision. The laparoscope is a small fibre-optic viewing instrument attached with a tiny lens, light source, and video camera.

 

The most commonly used laparoscopic surgical techniques for abdominal wall hernias relate to the positioning of the mesh used to re-inforce the repair. These include:

  • transabdominal preperitoneal (TAPP) repair
  • IPOM ( intra-peritoneal onlay mesh


TAPP Repair

Transabdominal Preperitoneal (TAPP) Repair surgery is is performed under general anaesthesia.

 

Your surgeon makes a small incision on the side of the abdomen. A 1cm diameter port is inserted into the abdominal cavity and filled with carbon dioxide gas. This allows your surgeon to view the internal organs clearly.

 

A camera is inserted through the port. Further, 2 more incisions on the abdomen are made to introduce the surgical instruments. The peritoneum (a membrane that lines the abdominal cavity) is cut and the contents of the hernia reduced (returned to their normal position).

 

A synthetic mesh is placed over the peritoneal opening to reinforce the defect and then peritoneum is closed. The skin wounds are then closed using absorbable sutures and waterproof dressings applied.

 

The advantage of the TAPP procedure is that it can be performed on patients who have undergone previous open hernia surgery and the mesh is not placed within the actual abdominal cavity

 

IPOM Repair

Similar to the TAPP repair , IPOM is performed laparoscopically with a camera via a port and two further small incisions to introduce surgical instruments.

 

The hernia contents protruding through the defect are returned into the abdominal cavity. Usually the defect is then sutured closed from the “inside” and synthetic mesh again applied. This time without incising the inner membrane lining of the abdominal wall (peritoneum)

 

Mesh used when performed an IPOM has a protective coating on one side to enable it to be used on the inside of the abdominal cavity. It is fixed in place with the aid of absorbable tacks.

 

Advantages of IPOM repair include decreased operative time under anaesthetic and decreased risk of surgical site infection.

 

Complications With laparoscopic Hernia Surgery

Specific complications of laparoscopic hernia surgery may include

  • local discomfort and stiffness,
  • infection,
  • damage to nerves and blood vessels,
  • Bruising, blood clots,
  • wound irritation and
  • urinary retention.
  • Rarely bowel or bladder injury

 

Post-operative Guidelines

  • Pain medication will be provided and should be taken as directed.
  • Remove the dressings after 5 days. There is no sutures that require removal. These are hidden and absorbable.
  • Swelling at the site of a hernia may occur due to serum accumulation in the cavity left by reducing the hernial sac.
  • Bruising can appears on the abdomen, which disappears over 1-2 weeks.
  • You are able to drive when you can safely operate the vehicle (i.e. come to an emergency stop without pain or hesitation), and when no longer taking stronger painkillers. Usually within a week
  • A follow-up visit is scheduled 2-6 weeks after surgery to monitor your progress.
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