Postoperative Hernias

This type of hernia, also called incisional hernia or postoperative hernia, is the hernia formed in the incisions of previous laparotomy, that is, abdominal surgeries. For this reason, they are seen wherever the incision is made, they are not limited to a certain anatomical region such as the muscle or the navel. The incisions of the most frequently performed surgeries are most frequently encountered by the surgeon in the form of incisional hernia. This may be a midline incision due to a stomach or bowel surgery or a horizontal incision in the lower abdomen due to a cesarean section. Hernias, called port hernias, may develop at the instrument insertion sites after closed, that is, laparoscopic surgeries.

Port hernias

In the USA, 100,000 incisional hernia surgeries are performed annually. Since this type of hernia tends to grow over time, better results are obtained if they are operated during the initial diagnosis period. Because the uncontrolled growth of the hernia may cause the abdominal wall muscles to be pulled to the sides, making the repair very difficult or even impossible over time.

The repair of recurrent inguinal and umbilical hernias, that is, a recurrent hernia, is more difficult than primary hernias that will be operated on. Because surgery has been performed before, tissues and even anatomical structures have partially lost their properties during wound healing. Apart from the repair, the risk of developing complications and recurrence after surgery is also increased. Here, incision hernias are considered a kind of recurrent hernia for the first time. Because there is a region that has been entered into the profit before. Wound healing process has been experienced and scar tissue has formed.

The surgical and technical options we have written for inguinal and umbilical hernias are also valid for incisional hernias. Simple primary tissue-suture repairs are very unreliable and result in a high rate of recurrence. Because there is a disorder and/or imbalance in the synthesis of collagen, which is considered as the building block, on the floor of incisional hernias. Moreover, incisional hernias are faced with a greater shear force from the direct reflection of intra-abdominal pressure compared to inguinal hernias.

Patch use has become the standard method for incisional hernia repairs today. Patch repairs can be performed openly or laparoscopically. In open repairs, the patch can be placed on the fascia (onlay), between the abdominal muscle and the muscle posterior sheath (retrorectus sublay), between the abdominal muscle and the peritoneum (preperitoneal), or directly into the abdomen (inlay). If intra-abdominal is preferred, the patch selection should be dual mesh. The situation is similar in laparoscopic repair. There was no significant difference between open and laparoscopic patch repairs in terms of recurrence. However, there are publications that suggest that seroma and wound infection may be more frequent, since more extensive dissection of the subcutaneous tissues is required in open repairs.

In cases where there are very large openings in the abdominal wall and most of the intra-abdominal organs are protruding, the open approach may become necessary for laparoscopic repair.