Shiv Paswan

By Anil Kumar and Shiv Shankar Paswan

Incisional hernia is one of the most common postoperative complications after abdominal surgery. Several studies have shown that incisional hernias have different etiologies which are related to the patient, the surgical technique, the suture material and experience of the surgeon. Most patients present with abdominal swelling with some level of discomfort, and in emergency the presentation is usually as bowel obstruction or strangulation which requires urgent exploration. The recurrence rate is almost the same for open as well as for laparoscopic approach. The hernia can be repaired either only by closing the defect with nonabsorbable suture or by applying mesh. The recurrence is very minimal with mesh application as compared to repair done only by suture. The mesh can be placed as onlay, inlay and in sublay positions. The intraperitoneal onlay mesh placement (IPOM) is the widely used laparoscopic method for the incisional hernia repair. The incisional hernia with larger defect usually more than 15 cm requires component separation to reconstruct the abdominal wall by releasing the external oblique or transverse abdominal muscle. The outcome of incisional hernia repair is dependent on the associated comorbid conditions like chronic cough, constipation, stricture of the urethra, benign prostate hyperplasia, ascites and obesity.

Part of the book: Techniques and Innovation in Hernia Surgery