Demystifying Incisional Hernia Repair: From the Operating Table to Recovery

Author: Wang Baoshan, attending physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Shin Youngmo, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Incisional hernia, as a common type of abdominal wall hernia, is often closely related to poor incision healing after abdominal surgery. With the advancement of medical technology, incisional hernia repair has become an important means of treating such diseases.

Today, we will take an in-depth look at the entire process of incisional hernia repair - from delicate surgical operations to the application of patches, to postoperative effects and precautions, to give you a comprehensive understanding of this "behind-the-scenes hero" who protects your health.

The core of incisional hernia repair is to return the hernia contents to the abdominal cavity through delicate surgical operations and use patches to reinforce the abdominal wall defect to prevent the recurrence of hernia. The surgical process can be divided into two categories: open surgery and laparoscopic surgery, depending on the method used.

In open surgery, after successful anesthesia, the doctor will first free up enough space to place the patch according to the size and location of the hernia defect. There are many choices of patches, including square, rectangular, oval and round, and their size needs to be adjusted according to the actual situation of the hernia defect. In ONLAY surgery, the patch is placed in front of the muscle aponeurosis, that is, between the anterior sheath of the rectus abdominis and the skin, and fixed by suture or medical glue. In SUBLAY surgery, the patch is placed in the preperitoneal space and fixed by the "sandwich effect" of the peritoneum and muscle tissue. Regardless of the method used, the edge of the patch must exceed the edge of the hernia defect by 3-5 cm to ensure adequate coverage and fixation.

Figure 1 Original copyright image, no permission to reprint

Laparoscopic surgery has the advantages of less trauma and faster recovery. Under the laparoscope, the doctor can directly observe the defect on the abdominal wall and insert the patch into the abdominal cavity through a tiny incision. After the patch is unfolded in the abdominal cavity and adjusted to the appropriate position, a nail gun is used to firmly nail the patch to the muscle tissue of the abdominal wall. This surgical method not only reduces the patient's pain, but also shortens the hospital stay and improves the safety of the operation.

Of course, although incisional hernia repair is a mature technique, it still has certain surgical risks and potential complications.

First of all, since the operation needs to be performed under general anesthesia, it has certain requirements on the patient's cardiopulmonary function. In addition, unexpected situations such as abdominal adhesions and intestinal perforation may be encountered during the operation, which require doctors to conduct sufficient evaluation and preparation before the operation.

Postoperative risks mainly include infection, bleeding, intestinal adhesions and intestinal obstruction. Among them, patch infection is one of the more serious complications. Once infection occurs, the patch may need to be removed and anti-infection treatment may be performed. However, it is worth noting that the incidence of patch infection is relatively low and can be controlled through conservative treatment in most cases. For patients who really need to remove the patch, the doctor will develop a personalized treatment plan based on the patient's specific situation and reconsider the possibility of patch repair after the infection is controlled.

Incisional hernia repair is effective. By using a patch for reinforcement and repair, the recurrence rate of hernia can be significantly reduced. The recurrence rate of traditional suture surgery can reach 5%-20%, but after using a patch repair, the overall recurrence rate is reduced to less than 1%, and even to less than 0.5% in some specialized hospitals. This achievement is due to the advancement of patch materials and the continuous improvement of surgical techniques.

Postoperative patients need to pay attention to the following points to promote recovery: first, they should control their weight to avoid obesity leading to increased abdominal pressure; second, they should wear an abdominal belt in the early postoperative period to protect the wound and promote the healing of the patch and the abdominal wall tissue; at the same time, they should avoid strenuous exercise and behaviors that increase abdominal pressure, such as lifting heavy objects, severe coughing, etc.; in addition, they also need to actively treat constipation, prostate hyperplasia and other diseases that may cause increased abdominal pressure.

Figure 2 Original copyright image, no permission to reprint

In terms of follow-up, patients should return to the hospital regularly to check the recovery of the wound and hernia according to the doctor's advice. If symptoms such as nausea, vomiting, abdominal distension, incomplete intestinal obstruction, or swelling or pain at the incision site occur, seek medical attention in time.