Incisional Hernia

Visit our YouTube channel   2010 AUDIT   Mr Charles Leinkram

Incisional hernias occur at the site of a previous abdominal operation. The common types of abdominal operations which lead to incisional hernias are those for bowel surgery or gynaecological surgery. Others occur following stomach or gallbladder surgery and even at the entry site used for “key-hole” surgery, (i.e, the “port”).

It has been reported that after major abdominal operations, incisional hernias occur in up to 30% of cases. The reasons for this are that a long incision is made and the tissues are sutured together over an extensive area. Following major surgery there is often abdominal distension with gas or fluid, weakening of the tissues from infection or from excessive straining, e.g. vomiting or constipation. In addition, systemic factors such as poor nutrition, Diabetes or smoking also affect wound healing.

All of these factors may lead to a break down of the abdominal wound. This may occur very soon after surgery or even years later.

Mr Leinkram has developed a wide experience in repairing incisional hernias…

In his opinion, virtually all incisional hernias are anatomically different, and that their repair must therefore be tailored to suit the individual patient. We can illustrate this by showing some examples of incisional hernias that Mr Leinkram has repaired. However, before doing so, several general points need to be made:-

  1.  We prefer to use the “open” method of repair, that is to make an incision on the abdomen.
  2. The hernia sac is opened and its contents are completely freed.
  3. The hernia sac is then excised.
  4. All adhesions to the abdominal wall are completely cleared.
  5. A large sheet of non-adherent mesh is securely stitched to the abdominal wall musculature using multiple transmuscular sutures.
  6. The abdominal wall muscles are then closed over the mesh.
  7. If there is a significant amount of associated skin laxity, this can also be excised, thus improving the cosmetic appearance, (see Case 4).
Mr Leinkram prefers the “open” method of incisional hernia repair over the alternative “key-hole” method because:-
  • The hernia sac is excised completely.
  • The mesh is securely sutured to the anterior abdominal wall musculature rather than being stapled or glued as is often done in the “key-hole” method. The mesh is therefore less likely to slip or become detached using the “open” technique.
  • The muscle layer of the anterior abdominal wall can almost always be closed, thereby avoiding the creation of a “dead space”. A “dead space” can result in the accumulation of a significant amount of subcutaneous fluid post-operatively, giving rise the presence of a large swelling in the abdomen which can take weeks to resolve.
  • The open method in effect constitutes a 2-layered closure of the hernia defect (an inner layer of the double-sided sheet of mesh, and a second layer of the closed muscle itself). In the key-hole method, only the placement of the inner layer is performed.
  •  The incisional hernia repair operation can also incorporate a “tummy-tuck” if required.

Clinical Images

The case studies below contain clinical images. Click on the arrows to view the images.

Case 1.
Incisional hernia in a patient who had previously undergone vascular surgery for aorto-iliac disease.

operative-photos1

Figure 1

Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 2. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 3. Melbourne Hernia Clinic.

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Figure 4

Incisional Hernia. Figure 4. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 5. Melbourne Hernia Clinic.

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Incisional Hernia.Figure 6. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 7. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 8. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

Figure 9

Case 2.
Incisional hernia in a patient who had previously undergone surgery for removal of a rectal cancer.

operative-photos1

Figure 1

Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 2. Melbourne Hernia Clinic.

Figure 3

Incisional Hernia. Figure 3. Melbourne Hernia Clinic.

Figure 4

Incisional Hernia. Figure 4. Melbourne Hernia Clinic.

Figure 5

Incisional Hernia. Figure 5. Melbourne Hernia Clinic.

Figure 6

Incisional Hernia. Figure 6. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 7. Melbourne Hernia Clinic.

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Incisional Hernia. Figure 8. Melbourne Hernia Clinic.

Case 3.
Incisional hernia in a patient who had previously undergone a cholecystectomy (removal of the gallbladder)

operative-photos1

Figure 1

Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

 

Figure 2

Incisional Hernia. Figure 2. Melbourne Hernia Clinic.

Figure 3

Incisional Hernia. Figure 3. Melbourne Hernia Clinic.

Figure 4

Incisional Hernia. Figure 4. Melbourne Hernia Clinic.

Figure 5

Incisional Hernia. Figure 5. Melbourne Hernia Clinic.

Figure 6

Incisional Hernia. Figure 6. Melbourne Hernia Clinic.

Figure 7

Incisional Hernia. Figure 7. Melbourne Hernia Clinic.

Figure 8

Incisional Hernia. Figure 8. Melbourne Hernia Clinic.

Case 4.
Incisional hernia adjacent to the umbilicus in a patient who had previously undergone key-hole surgery for removal of the gallbladder. An abdominoplasty (“tummy-tuck”) was also performed.

incisional hernia operative photo

Figure 1

Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

Figure 2

Incisional Hernia. Figure 2. Melbourne Hernia Clinic.

Figure 3

Incisional Hernia. Figure 3. Melbourne Hernia Clinic.

Figure 4

Incisional Hernia. Figure 4. Melbourne Hernia Clinic.

Figure 5

Incisional Hernia. Figure 5. Melbourne Hernia Clinic.

Figure 6

Incisional Hernia. Figure 6. Melbourne Hernia Clinic.

Figure 7

Incisional Hernia. Figure 7. Melbourne Hernia Clinic.

Case 5.
Recurrent incisional hernia in a patient who had previously undergone an attempted repair of this same problem. Prior to this, he had undergone multiple abdominal operations for complications following a key-hole umbilical hernia repair.

operative-photos1

Figure 1

Incisional Hernia. Figure 1. Melbourne Hernia Clinic.

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Figure 1

Figure 2

Incisional Hernia. Figure 2. Melbourne Hernia Clinic.

Figure 3

Incisional Hernia. Figure 3. Melbourne Hernia Clinic.

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Figure 3

Figure 4

Incisional Hernia. Figure 4. Melbourne Hernia Clinic.

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Figure 5

Incisional Hernia. Figure 5. Melbourne Hernia Clinic.

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Figure 5

Figure 6

Incisional Hernia. Figure 6. Melbourne Hernia Clinic.

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Figure 7

Incisional Hernia. Figure 7. Melbourne Hernia Clinic.

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Figure 8

Incisional Hernia.Figure 8. Melbourne Hernia Clinic.

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