An incisional hernia is a protrusion (bulging) of the abdominal lining or a portion of abdominal organ(s) through an area of weakness through the scar of a surgery performed in the abdominal area from the breastbone to the groin. The term ventral hernia is used for hernias that occur in the abdomen, commonly in the midline. When present around the navel it is called a paraumbilical hernia and when it is present above the navel it is called an epigastric hernia.
An incisional / ventral hernia is usually diagnosed by the doctor by performing a physical examination. If you have a large, complex incisional / ventral hernia the surgeon may order a CT scan to study the area of weakness in the abdominal wall and the contents of the hernia so as to allow him to plan the surgery. You will have to undergo certain laboratory tests, x-ray of the chest and ECG as a part of workup before surgery when this is suggested by your doctor.
Incisional and ventral hernias, particularly those with a narrow neck (area of weakness through which the intestines come out) have a high chance of getting incarcerated. The intestines or other tissues that are pinched by the neck may lose their blood supply and die.
There are no medicines that can treat an incisional or a ventral hernia. A belt or a corset worn to apply pressure to the site of the hernia is not a good idea because it does nothing to repair the hernia. It just minimizes symptoms by preventing significant herniation. As a result, the hernia continues to get larger. In addition, there will be scar tissue formed that provides no strength to the area. Both of these factors, enlargement of the hernia and scarring, make the surgical repair of the hernia more difficult and later recurrence more likely. By and large most incisional and ventral hernias require surgery,
which is the only definitive treatment.
This technique of hernia repair is performed under general anaesthesia. Your surgeon will make a small (1cm) cut on one side of the abdomen away from the bulge of the hernia and introduce a cannula (a tube-like instrument) inside the abdomen. He will insert a laparoscope (a telescope) attached to a miniature video camera through the cannula that gives him and the operating team a magnified view of your internal organs on a video monitor. He will then place two additional cannulas through tiny (5mm) cuts to accommodate special long instruments. The surgeon will pull the intestines or other tissues protruding into the hernia back into the abdominal cavity and expose the weak area in the abdominal wall from inside.
This area is covered with a special large mesh that is fixed to the abdominal wall. Following the repair, the surgeon will close the small incisions with stitches.
This is a recent technique in which removal of the adrenal gland (usually small tumors) is achieved through one small incision rather then four or five cuts. Dr Bhandarkar specializes in single incision laparoscopic surgery and offers this operation to certain suitable patients.
You will be kept fasting for up to six hours after surgery . You may be given a saline drip for a few hours. In the first few hours after recovery you patients may experience some nausea, but this soon passes away.
This depends very much on the nature of the job you do and the type of operation you have had. With the open repair you may be advised take it easy for up to six weeks and you will not be allowed to lift heavy objects for up to three months. If you have a laparoscopic repair you can return to light desk job work within 10 – 15 days after surgery and almost all activities will be permitted after about three weeks after surgery. Lifting of heavy weights (> 10 kg), however, should be delayed till around 8 weeks after surgery.
- No tubes placed to drain fluid from the wound after surgery
- Shorter hospital stay
- Shorter recovery time
- Faster return to normal diet
- Faster return to work or normal activity
- Less restriction in terms of activity as compared to after an open repair
- Better cosmetic healing
Publications and abstracts
- Bhandarkar DS, Date RS, Tamhane RG. Irreducible tubo-ovarian inguinal hernia. J Indian Med Assoc 1993; 91: 186.
- Bhandarkar DS. Randomized clinical trial of laparoscopic versus open inguinal hernia repair (Letter). Br J Surg 1999; 86: 1226-27.
- Bhandarkar DS, Katara AN, Shah RS, Udwadia TE. Transabdominal preperitoneal repair of a port-site incisional hernia. J Laparoendosc Adv Surg Tech 2005; 15:60-2.
- Bhandarkar DS, Shankar M, Udwadia TE. Laparoscopic surgery for inguinal hernia – current status and controversies. J Minim Access Surg 2006; 2:178-86.
- Mittal G, Bhandarkar DS, Katara AN, Udwadia TE. Temporary obturator nerve paresis following spray of local anaesthetic during laparoscopic extraperitoneal hernia repair (Letter). Surg Laparosc Endosc Percutan Tech. 2010;20:357