Incisional hernia
Incisional hernia can occur after any abdominal surgery where an incision is made in the abdominal wall. Incisional hernias have also been reported after abdominal wall injuries. These hernias develop due to the inability of the abdominal wall to heal properly. Despite advances in abdominal wall closure techniques, the rate of incisional hernia after laparotomy ranges from 15% to 20%. Reasons for the incision failing to heal properly include:
- patient-related factors
- factors associated with the condition
- technical factors
Incisional hernia risk factors
Patient-related factors that affect proper wound healing and affect the strength of new tissue to support the abdominal wall increase the incidence of incisional hernia. Such factors include:
- Systemic chronic diseases, such as kidney failure
- Obesity
- Smoking
- Malnutrition conditions
- Long-term use of drugs such as steroids and immunosuppressants
Factors associated with the disease, may include:
- the incision points
- time and
- the urgency of the operation
Complications and the underlying disease play an important role in the occurrence of an incisional hernia.
Other factors that are related to a higher incidence of incisional hernia are:
- Emergency surgeries
- Midline incisions
- Infections
- Acute abdominal surgeries
Wound infection, in particular, is a risk factor frequently associated with incisional hernia.
Technical factors relate to the surgical technique or suture materials used for closure.
Poor surgical technique can lead to acute wound dehiscence or delayed healing in the form of postoperative hernia. When the ends of the fascia are not approached properly from side to side using suture material with suitable strength and length, incisional hernia is more likely to occur.
Although research is ongoing into the ideal methods of closure to prevent incisional hernias and recent guidelines have been published, surgeons still frequently encounter incisional hernias.
What treatments are available for incisional hernia?
Treatment strategies for an incisional hernia include:
- surgical repair or
- conservative non-surgical treatment
Choosing the optimal treatment depends on a number of factors such as symptoms, hernia size, complications and patient preference. Small and asymptomatic hernias can be observed safely with a low risk of complications, unless contraindicated. Large or symptomatic hernias should be surgically repaired to prevent complications, relieve symptoms, and improve quality of life.
Usually in cases of post-operative hernia there is a significant loss of muscle wall, therefore the abdominal wall has degenerated to a great extent, as a result of which the daily life of the patient is drastically affected.
In these cases it is not enough to weld the hernial orifice with a mesh. Restoration of the normal anatomy of the muscle wall is needed. Carefully planned reconstructive surgery of the abdominal wall, combining various techniques of either laparoscopic or reconstructive surgery, is necessary to obtain an excellent result. Essential to this goal is for the surgeon to restore the degenerated part of the muscle wall. This is achieved by welding the fascia from the edges of the hernia. For this purpose we use specialized techniques such as component separation and Transversus Abdominis Release (TAR).
TAR method
The TAR method is a revolution in the field of hernia surgery, offering the lowest recurrence rates and the lowest morbidity rates in complex hernias. Dr. Chrysocheris has been thoroughly and extensively trained in this specific technique and has given many speeches at international conferences on hernia repair.
An incisional hernia operation is a complex procedure that can only be performed by fully qualified general surgeons. Dr. Pericles Chrysocheris is the most suitable surgeon for performing incisional hernia surgery, as he has carried out numerous hernia operations and during his postgraduate training at Harvard University he was included in the “Top Surgeons of America” guide.
