How can an incisional hernia be cured? How did the surgery close the “hole” in the abdominal wall? An incisional hernia occurs because the muscle in the incision has not fully grown after the previous surgery, and there is even a “hole”. When the pressure in the abdominal cavity rises, the organs in the stomach can burst out from here. Therefore, to cure an incisional hernia, it is necessary to find a way to close the “hole” in the abdominal wall. The old surgical method was to sew the “hole” directly with a thread, but nowadays the surgical method is to use a patch to repair the hole. For example, a “hole” in the abdominal wall is like a hole in a garment. If the hole is small, the hole can be sewn shut with a needle and thread; if the hole is large, a piece of fabric can be used to patch the hole, which is equivalent to using a patch to repair it. Domestic and international guidelines recommend that small incisional hernias can be repaired with direct sutures, while medium and large incisional hernias should always be repaired with patches. This is because when the “hole” in the abdominal wall is large, direct suturing will force the muscles around the “hole” to be pulled and sewn together, which will easily “open” the sutures again. The same reason for patching clothes is to use a piece of cloth to make a patch, so that the clothes will be flatter and much stronger. How big is the incisional hernia that needs to be patched? Domestic and international guidelines state that the choice of surgery is based on the size of the abdominal wall defect, that is, the size of the “hole” in the abdominal wall. Previously, incisional hernias were classified as small, medium, large and giant according to the maximum diameter of the “hole”, with small incisional hernia being less than 3 cm in maximum diameter, medium incisional hernia being 3-5 cm, large incisional hernia being 5-10 cm and giant incisional hernia being greater than 10 cm. In 2014, the grading standard was changed, and the new standard stipulates that small incisional hernia is less than 4 cm, medium incisional hernia is 4-8 cm, large incisional hernia is 8-12 cm, and large incisional hernia is more than 12 cm. In addition, another indicator is added to assess the size of the hernia, which is the ratio of the bulging pouch to the size of the stomach (abdominal volume). If the bulge reaches more than 15% of the abdominal volume, it is also called a giant incisional hernia. In general, small incisional hernias, i.e., those with a maximum diameter of less than 4 centimeters, can be repaired by direct suturing, whereas for incisional hernias with a maximum diameter of 4 centimeters or more, patches are used, the difference being the size and placement of the patches. What is the difference between direct suturing and patching? Incisional hernia emphasizes individualized treatment. The surgeon will choose the most suitable surgical procedure for the patient to obtain the best treatment result according to his condition, the size and location of the hernia, as well as his age, gender and obesity level. Of course, there are some complications that may occur whether the hernia is sutured directly with thread or with a patch. Among them, the patient’s biggest concern is recurrence. With direct sutures, the incisional hernia recurrence rate is around 30%; if the incisional hernia recurs after suturing, and direct suturing is chosen again, the probability of recurrence can be as high as 50%, 70% or even 100%. If patch repair is used, the recurrence rate of incisional hernia can be reduced from about 30% to 1%, or even 0.5%, or less. If a patch is used, how is the patch secured in the body? Will there be any adverse reactions if the patch stays in the body? The patch is always a foreign substance to the body, will there be any adverse reactions? How can I fix it in my body? This is a concern for many patients. Currently, the patches used to repair incisional hernias are basically not completely absorbed, which means that the patch must remain in the body. The material used for these patches has been in use for about 60 to 70 years and is very safe in the human body, “getting along” with the surrounding tissues and not adhering to the organs in the abdominal cavity, so there is no need to worry about adverse reactions. How the patch is fixed in the body has to do with where it is placed, and the exact placement of the patch is determined by the doctor according to the patient’s condition. The abdominal cavity is like a room, and the abdominal wall is the wall around it. The first is to place the repair material outside the walls, together with the surrounding bricks; that is, to place the patch outside the muscular layer of the abdominal wall and sew the patch together with the tough tissue around the “hole”, such as tendons. The second type of repair is inside the house, where the hole in the inner surface of the wall is covered with the repair material and the “patch” is then firmly nailed to the wall with a nail. In other words, the patch is placed inside the abdominal cavity, fixed directly to the peritoneum and abdominal wall, and then stapled to the abdominal wall in a circle around the patch with a medical staple gun, as if with a stapler, and it is patched. Are both of these repair options done openly? Is it possible to do minimally invasive laparoscopic surgery? Whether the repair is done with direct sutures or with a patch, it can be done openly or using laparoscopy. In general, if the repair is done with direct sutures, open surgery is often used because it is easier to tear the surrounding muscles into one piece. If the repair is done using a patch, then either open surgery or laparoscopic surgery can be used. What are the advantages and disadvantages of open and laparoscopic incisional hernia surgery? In addition to being able to repair an incisional hernia, open surgery can also do skin contouring. The excess skin and other tissues can be removed for a more aesthetic appearance after surgery. Also, the incision is larger, making it easier to place a patch and to separate the internal organs that are stuck together. However, open surgery only allows visualization around the incision, whereas laparoscopic surgery allows visualization of various locations inside the abdominal cavity, allowing detection of small, multiple or hidden hernias. In addition, compared with open surgery, laparoscopy is operated in the whole abdominal cavity, which has more space and can fully flatten the patch and provide better repair results. Some people say that laparoscopic surgery is not possible if the hernia is a giant incision. What should I do? Whether a giant incisional hernia can only be operated on varies from person to person. In the past few years, a “hybrid” approach between laparoscopic and open surgery has been proposed, which can combine the advantages of both procedures. In patients with large incisional hernias, the bulge is large and the skin is loose, so if laparoscopic surgery is used alone, even if the hole is patched from the inside of the stomach, the loose skin on the outside will not return. Therefore, a combination of open surgery is needed to remove the excess skin and subcutaneous tissue and to separate some of the more severely adherent organs. At the same time, a giant incisional hernia requires a relatively large patch, which is too large to be easily delivered laparoscopically to the abdominal cavity. In this case, an open incision can be made to place the patch, and then the laparoscope can be used to fix the patch. As mentioned earlier, the laparoscope can better flatten the patch and see if there is a hernia elsewhere in the abdominal cavity. Therefore, for large incisional hernias, a “hybrid” approach is suitable, which fully combines the advantages of both. What other cases are suitable for “hybrid” surgery? For complex and difficult incisional hernias and incisional hernias in special locations, “hybrid” surgery may be more effective, allowing the patient to obtain the best treatment results and reducing the incidence of postoperative complications. What are considered complex or special incisional hernias? Locations such as below the rib cage, above the pubic bone, and in the lateral lumbar region are difficult to fix patches because the incisional hernia is surrounded by bones and vital organs. In addition, many patients have a stoma on their stomach for defecation or urination because of their disease, and these areas are also prone to hernia, and such stoma hernia and para-stoma hernia also belong to the category of recurrent difficult hernia. For these special cases, the surgeon will choose a “hybrid” surgical approach according to the patient’s condition, mainly to reduce postoperative complications and ensure better surgical results.