How long does it take to recover after an incisional hernia repair?
Unlike most other hernia repairs, it is a more major undertaking and requires an average hospital stay of 5 days. Length of stay will vary depending on the size and the complexity of the incisional hernia. You may not be able to return to work for about two weeks or longer if the incisional hernia is large. Your ability to drive a car is governed by being able to put your right foot on the brake pedal to perform an emergency stop without inhibition (automatic transmissions) or both feet on the clutch and brake pedals (manual transmissions). Avoidance of heavy lifting or straining for three months is recommended to allow the tissues to reach their maximal tensile strength and therefore reduce the risk of recurrence.
Incisional hernias occur through old wounds as a result of poor surgical technique, wound infection, too early return to strenuous work or exercise. Other contributory factors include poor nutritional status, weak tissues, obesity and the presence of major systemic illness such as cancer, It has been reported that abdominal incisional hernias may occur in up to 15% operations in the longer term. The wounds most affected are those in the midline through the linea alba where it is sometimes difficult to get the fibrous tissue to heal well. However, incisional hernias do occur through other common operation sites such as after an appendicectomy in the right lower quadrant of the abdomen and through open cholecystectomy wounds in the right upper quadrant. Even following laparoscopic (keyhole) surgery, hernias can occur through the port sites, particularly if these areas have not been closed correctly.
What are the signs and symptoms?
The most common presenting feature is that of a lump or swelling in the old abdominal wound. Pain, discomfort and incarceration may also be present. Where the muscles and tissues have an overall weak status there may be a generalised bulge in association with the hernia. Repairs of incisional hernias need to take of this phenomenon.
Do incisional hernias need surgery?
Yes. The natural history of these types of hernia suggests that once the weakness is established, the hernia continues to enlarge and puts the patient at risk of incarceration and strangulation.
What are the surgical / treatment options?
If hernia is small, then repair with non-absorbable sutures is indicated. However, a tension free open mesh repair is the optimal method of repair advocated by the HKHC with the lowest incidence of recurrence. The mesh is placed in the preperitoneal plane if possible to avoid the mesh sticking to the intestines. While there is a laparoscopic method of repairing this defect which is less invasive, there have been no randomised studies published thus far to demonstrate this a better way of repairing this type of hernia.