Laparoscopic and Open Incisional Hernia Repair

info sheet

The information here is a guide and reflects only the views of Dr Slater, Prof. Fawcett and Dr Hodgkinson.

WHAT IS INCISIONAL HERNIA?

Incisional hernia occurs when there is a hole or defect in the deep layers of an old surgical scar. The muscle layers separate over time and a piece of bowel or fat from inside the abdominal cavity pushes out through this hole.
Hernias come in all sizes – small to massive. They do not get better by themselves. Over time they tend to get larger and become more difficult to repair.

WHAT CAUSES INCISIONAL HERNIAS?

There are many factors that contribute to hernias.

WHAT PROBLEMS CAN INCISIONAL HERNIAS CAUSE?

Incisional hernias do not get better without treatment. Hernias cause discomfort as they get bigger. The larger they are, the more difficult they are to repair.
The feared complication of incisional hernia is when a piece of bowel becomes trapped, loses its blood supply and dies. This is a surgical emergency and can be life threatening. Symptoms of this include sudden, extreme pain in the hernia, inability to push the hernia back in, vomiting or redness over the hernia. Should this occur, you should immediately go to the Emergency Department.

HOW ARE INCISIONAL HERNIAS TREATED?

Incisional hernias can be extremely difficult to repair because the tissue we are working with is stretched and has little strength.
Surgery involves reducing the contents of the hernia back into the abdominal cavity and placing a nylon material called MESH in the defect. This replaces the tissue that has been lost. The mesh becomes incorporated into the body and adds extra strength.

Incisional hernias can be repaired in two ways.

Laparoscopic surgery tends to have a lower rate of wound infections, serum leaks and mesh infection than open surgery. Laparoscopic surgery probably has a higher risk of bowel injury.
Both techniques have their pros and cons and are acceptable. Your surgeon will decide the best technique for you.

ARE THERE ANY ALTERNATIVES TO HAVING INCISIONAL HERNIA SURGERY?

There are no treatment alternatives other than surgical repair of incisional hernias. Some people wear a support garment called a TRUSS. This is an elastic band that can attempt to keep the hernia in place. These do nothing to help repair incisional hernias.

WHAT WILL MY ABDOMEN LOOK LIKE AFTER INCISIONAL HERNIA SURGERY?

No surgeon can ever return to abdomen to looking the way it did when you were born. Your abdominal wall will always be weaker and scarred. You will never have a so called “wash-board” abdomen. 
The initial appearance is different for the two techniques:

Open surgery

Your old incision will be opened and the skin lifted up so the mesh can be placed over the defect. The wound is then closed with staples or invisible stitches. The wound may bulge for some weeks as fluid collects under it. Over time, this will smooth out.

Laparoscopic surgery

The best way to describe the appearance after this approach is that you will look like an “upholstered cushion”. There is a special instrument used to put stitches into these hernias. The result is many tiny puncture wounds in the abdominal wall.
A volume of fluid will collect, where the hernia once was. It may seem for a while that the hernia has come back. There may also be a lot of bruising. Over time, this fluid collection will disappear and smooth out. The contour of the “upholstery” will also smooth out over time.

WHAT ARE THE COMPLICATIONS OF SURGERY FOR INCISIONAL HERNIAS?

There are different risks depending on whether the operation is done open or laparoscopically.
Risks Specific to Open Incisional Hernia Repair

Risks Specific to Laparoscopic Incisional Hernia Repair

General Risks

WHAT TO  EXPECT IMMEDIATELY AFTER SURGERY

Pain Relief

Every effort will be made to minimize the discomfort. Your surgeon and nurses will be monitoring your level of pain control frequently. One of the advantages of the keyhole technique is less pain. Open hernia repair is done via a major incision and hence, is usually more painful. It is very common to have pain in the right shoulder after keyhole surgery. This is due to the effect of the gas pumped into your abdominal cavity during the surgery. The pain typically disappears one day after surgery. On the first day after surgery, there may be a moderate amount of discomfort at the site of the operation. You will have a few choices for pain relief.

There are two major types of pain relievers after keyhole surgery:

Panadol

NSAIDs (Indocid, Brufen, Mobic)

Morphine, Fentanyl (narcotics)

Drain tubes

Sometimes you will wake up after surgery with a soft plastic drain tube in your abdomen. Your surgeon will advise when this needs to be removed.

Eating

If the surgery is laparoscopic, you will resume eating shortly after surgery. If you have an open operation, eating will commence more slowly. It is very common to feel slightly nauseated for 12 hours following surgery.

Urinating/Bowel Movements

If your hernia is very large, you will have a catheter placed in your bladder under anaesthesia.
After any surgery, a patient may have trouble passing urine. This is uncommon and temporary. Occasionally a catheter needs to be inserted to help you pass urine.  
There may be some disturbance to your bowels in the week after surgery. Discuss this with your doctor if this occurs.
Activity

It is very important to begin light activity shortly after surgery. This is to prevent pneumonia, clots in the legs and loss of general condition. You can expect to have to wear stockings on your legs whilst in hospital to prevent clots and have an injection of heparin twice a day under the skin for the same reason. Increase your activity as you feel able.
Your Incision

Length of Stay in Hospital

Length of stay is variable depending on the size of the hernia. Small laparoscopic hernias can go home the following day. Patients with larger open hernia repairs may need a week in hospital.

Other Important Information

You can expect to see your surgeon every week day. On weekends or in times when your surgeon is operating elsewhere, you will see one of the practice partners. All are very experienced in this type of surgery and commonly assist each other in the operating theatre.
We will make every effort to keep you informed of your progress. We are always honest and open with you and your family. Feel free to ask questions.

AFTER DISCHARGE

WHAT CAN I EAT AFTER I HAVE HERNIA SURGERY?

It is best to eat a low fat health diet after any surgery. If there is a lot of dissection of the bowel involved, then you will be started off on clear fluids.

How you may feel

It is quite common to feel very tired and to want to have daytime naps for the first two weeks after surgery. Listen to your body and rest when you need to.

This is transient and can be expected to resolve in 2-4 weeks.

Activity

Costs to be incurred from this surgery