A hernia is a medical condition in which tissue or organs protrude due to damage to the continuity of the wall meant to hold them in place. This condition occurs after surgery, following poor closure, tissue rupture or scar closure threads.
Incisional hernia (POVH) occurs in 10-15% of cases of abdominal surgery. It is more common in patients with a particular medical background (e.g. immunosuppression, smoking or malnutrition) obesity, cough or following the characteristics of surgery and subsequent recovery.
When is it important to repair a hernia in the surgical scar?
The decision to perform the hernia repair surgery relies, among other things, on the severity of the hernia and its accompanying symptoms.
In most cases the hernia will appear shortly after the abdominal surgery, but can also appear years after the surgery. The hernia will manifest as a bulge in the abdominal wall in the area of the surgical scar, which is an aesthetic problem. In other cases the hernia can cause a feeling of abdominal discomfort. Exertion or coughing whilst having a large hernia can cause a bowel obstruction.
The course of the surgery
The purpose of surgery to repair a hernia through the surgical scar is to repair the abdominal wall in the damaged area, and therefore the hernia will usually be fixed with a mesh. The mesh strengthens the abdominal wall and significantly reduces the chance of future recurrence of the hernia.
The repair itself can be performed with an open approach or with a laparoscopic approach. The choice between the two approaches relies mainly on the size of the hernia, as well as on the medical profile of the patient.
There is no difference between the two approaches in the risk of recurrence of the hernia, however the advantage of the laparoscopic approach is a lower rate of infection, less pain and a good cosmetic result.
The surgery is performed under general or regional anesthesia.
Preparation before surgery
The diagnosis of a hernia in the surgical scar is made on the basis of a physical examination only. However, in some cases you may be asked to perform an imaging such as a CT, to demonstrate with certainty the contents of the hernia and its location.
A preoperative evaluation should be performed by an anesthesiologist. If the patient has any background illnesses or is taking regular medications, they will be further assessed before surgery and guided on additional tests that may be necessary to complete.
Postoperative recovery
The patient may be discharged on the day of surgery or the next day depending on the size of the surgery.
It is recommended to avoid strenuous exercise in the 4-6 weeks after surgery, but it is possible to return to work within a week or two of surgery.
Possible complications after hernia repair surgery.
Recovery is short, but the patient may suffer from pain and discomfort for about a week after surgery. The risk of complications such as bleeding or infection is less than 5%. The chance of recurrence of the hernia is minimal, especially if it is done with a reinforcing mesh.
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