Laparoscopic surgery for incisional hernia: How this advanced technique can provide the best-possible results
An incisional hernia occurs when tissue or part of an organ protrudes through a weakened area in the abdominal wall at the site of a previous surgical incision. These hernias can cause pain, discomfort, or visible bulging and may lead to complications if left untreated. Advances in laparoscopic surgery have transformed how incisional hernias are repaired, offering patients quicker recovery, reduced pain, and excellent long-term outcomes.
What is an incisional hernia?
Incisional hernias are a type of ventral hernia that appear at the site of a healed surgical wound, often months or even years after abdominal surgery. They develop when the abdominal muscles have not fully healed, allowing internal tissues to push through the weakened area.
Risk factors include:
- Previous open abdominal surgery
- Obesity
- Poor wound healing
- Infections at the surgical site
- Heavy lifting during recovery
Most incisional hernias will require surgery, particularly if symptoms are present. However, some small ones may be monitored.
How is laparoscopic surgery used to treat incisional hernias?
Laparoscopic hernia repair is a minimally invasive technique where the surgeon makes small incisions in the abdomen and uses a camera (laparoscope) to guide the procedure. Special instruments are inserted through the incisions to place a mesh over the hernia and reinforce the weakened area of the abdominal wall.
This approach avoids reopening the previous surgical scar, reducing the risk of wound complications.
What are the advantages of laparoscopic surgery compared to open repair?
Laparoscopic surgery is now considered the preferred approach for many incisional hernias due to its numerous benefits. These include:
- Smaller incisions and less visible scarring
- Reduced post-operative pain
- Lower risk of wound infection
- Shorter hospital stay and quicker return to normal activities
- Better visualisation of the abdominal wall, allowing for more precise mesh placement
- Lower risk of hernia recurrence when performed by experienced surgeons
What are the latest developments in laparoscopic hernia surgery?
Recent innovations in laparoscopic incisional hernia repair include:
- Robotic-assisted surgery: Offers improved control and precision, particularly in complex or recurrent hernias.
- Enhanced mesh materials: Lightweight, biocompatible meshes now integrate better with surrounding tissue and reduce post-operative discomfort.
- Component separation techniques: Used in combination with laparoscopy for large or complex hernias, allowing for tension-free closure.
- Improved fixation methods: Such as absorbable tacks or glue, which reduce pain and inflammation.
- Mesh placement: Some surgeons, including myself, place the mesh in the inter muscular plane by the e-TEP (extended totally extra-peritoneal) technique. This results in better outcomes compared to the traditional IPOM (intra-peritoneal) technique of placing the mesh inside the abdomen. eTEP requires a greater level of skill and expertise but results in fewer recurrences.
These advances contribute to better outcomes and a lower risk of long-term complications.
Is laparoscopic repair suitable for all incisional hernias?
While many patients are good candidates, laparoscopic surgery may not be suitable in cases of very large or strangulated hernias, extensive scar tissue, or certain medical conditions. A full assessment by a consultant surgeon is necessary to determine the most appropriate approach.
