Laparoscopic treatment of incisional hernia

  Abdominal incisional hernia is a hernia that occurs at the surgical incision after abdominal surgery and is clinically more common, accounting for the third most common type of extra-abdominal hernia, especially in the longitudinal abdominal incision area. If the incision is healed in one stage, the incidence of incisional hernia is usually less than 1%, but the incidence can be up to 10% if the incision is infected or if the postoperative period is characterized by severe coughing, high abdominal pressure, repeated diaphragmatic reversion, etc.; the incidence can even be up to 30% or more if the wound is dehiscent.  The main symptom of abdominal incisional hernia is the presence of a reducible mass at the abdominal wall incision.  The mass is usually more pronounced in the standing position or with exertion and shrinks or disappears at rest. After return of the mass, a deep abdominal wall defect may be palpable in the scar area. Larger incisional hernias have a pulling sensation in the abdomen. This is accompanied by loss of appetite, nausea, constipation, and vague abdominal pain. Most incisional hernias do not have an intact hernia sac, so the contents of the hernia can often adhere to the extraperitoneal abdominal wall tissue and become a difficult hernia, sometimes with partial intestinal obstruction. The diagnosis of incisional hernia is not difficult based on the patient’s surgical history and symptoms at the incision site. Patients who cannot tolerate surgery are recommended to be protected with an elastic lap band to prevent incisional hernia ingrowth and slow down the enlargement of the hernia ring.  There are two types of incisional hernia surgery: traditional direct tissue suture and artificial material repair (tension-free repair), the former of which is rarely used in developed regions. The foreign body sensation of the patient is obvious.  Another type of anti-adhesive patch can be placed in the abdominal cavity. The general method of surgery is to clean and separate the intra-abdominal tissues or organs adhering to the hernia ring part of the abdominal wall, reveal the hernia ring, and select an appropriate anti-adhesive patch to be fixed in the abdominal wall to strengthen the abdominal wall and organize the herniation of the abdominal contents. This patch is expensive, but it is a recommended surgical procedure because it is less invasive, has a faster recovery, and most importantly, has a much lower recurrence rate.  The development of laparoscopy has made laparoscopic hernia repair possible. It is an excellent option for patients with small to medium incisional hernia in the abdomen (hernia ring less than 10 cm). The procedure does not require an incision, especially for those patients who have experienced open surgery and have some fear of the open procedure. Only one 1 cm diameter and two 0.5 cm diameter punctures are made in the abdomen, and the lumpectomy and instruments are inserted to separate the adhesions, repair the defect and fix the patch under direct television lumpectomy. The patient’s recovery time after surgery is greatly reduced and he can be discharged 1-2 days after surgery if it goes well. It is recommended that eligible patients consult with a hernia specialist or minimally invasive surgery department at a regular hospital to choose such a procedure for treatment.