Incisional hernias in adults are best repaired using a prosthesis or ‘mesh’. This prosthesis may be placed through open surgery or through keyhole surgery. The size and location of incisional hernias vary greatly and a variety of factors will determine which surgical method is the most appropriate.

Types of treatment

Laparoscopic repair of incisional hernia

For most incisional hernias where we think that we will be able to close the abdominal opening, we opt for a laparoscopic hernia repair at the Maria Middelares Hernia Centre in Ghent. In the case of a large incisional hernia where the abdominal opening cannot be closed though keyhole surgery or due to another reason, open surgery using the classical method may be preferred. Your surgeon will discuss this with you during the pre-operative consultation.

If an incisional hernia repair is performed through keyhole surgery, a large prosthesis can be placed. It is important that the prosthesis is fastened to the abdominal wall with staples. These staples will secure the prosthesis to the abdominal muscles. This may be quite painful in the initial post-operative period, especially when sneezing or coughing as this causes the muscles to contract. Good pain relief therefore is important in the first days after a laparoscopic repair of an incisional hernia. For a laparoscopic incisional hernia repair, a prosthesis is used that is soft on one side to prevent fusion with the bowel.

Robot-assisted laparoscopic incisional hernia repair

In September 2016, the Maria Middelares Hernia Centre in Ghent was the first European centre to offer robot-assisted laparoscopic hernia repair. This was started after extensive training in the States, where 5% of all incisional hernia repair procedures in adults are robot-assisted. The procedure is essentially the same as the traditional laparoscopy, but the instruments and the camera are operated by the surgeon from a console. At the Maria Middelares Hernia Centre in Ghent, we use the latest generation of the Intuitive DaVinci Xi robot. Dr Muysoms now trains European surgeons in this latest innovation in abdominal wall surgery. Together with other surgeons performing robot-assisted incisional hernia repair, several innovative techniques were developed at the Maria Middelares Hernia Centre in Ghent, where the prosthesis is not placed in the abdomen but between the various muscle layers. This new technique, termed TARUP (trans abdominal retromuscular umbilical prosthesis), retains the advantages of keyhole surgery but avoids placing the prosthesis so that it comes into contact with the bowels and avoids the painful fastening using staples.

For large incisional hernias, a robot-assisted technique was developed termed roboTAR (robot-assisted transversus abdominus release), which avoids having to reopen the entire wound. Not all patients qualify for roboTAR, but if they are, this has the important benefit of avoiding incisions.

Open surgery for incisional hernia repair

If an incisional hernia is not eligible for laparoscopic repair due to its size or location, open surgery is performed. This involves placing a large prosthesis between the different muscle layers using the Rives-Stoppa technique or through a TAR procedure (transversus abdominus release).

What are the complications of an incisional hernia repair?

Incisional hernia surgery generally is a safe procedure and serious complications are rare. Possible complications are listed below. The list is not exhaustive but contains the most frequent complications:

  • Bruises, wound infection and wounds opening up.
  • Bleeding of the abdominal wall or navel; this sometimes requires another operation.
  • Infection of the prosthesis.
  • Accidental injury of the bowel or other abdominal organ.
  • Change from keyhole surgery to an open procedure.
  • Complications that are not directly caused by the surgery: pneumonia, bladder infection, heart rhythm disorders, etcetera.
  • Complications associated with general or epidural anaesthesia.
  • Over the long term, the surgical site will remain painful for some patients.

Side effects

Some side effects occur very frequently but are no reason for concern:

  • Fluid accumulation

    After the operation, a swelling often remains for a few weeks where the umbilical hernia was located. This is fluid accumulation (also termed seroma) that usually is not painful but often causes patients concern. This swelling is a normal side effect of the operation. It will slowly disappear of its own accord. If, in exceptional cases, the fluid accumulation causes pain, the surgeon may decide to drain it.
  • Bruise

    Another common side effect is bruising around the wound. This is no cause for concern either, and it will spontaneously disappear in the weeks following the operation. In case of doubt or concern, feel free to contact your GP or our department.

Can an incisional hernia recur?

A mesh placement reduces the risk of a recurrent incisional hernia but it cannot be entirely ruled out. This is because the mesh we use may shrink a little, causing the weakened area in the abdominal wall around the incision to expand. This means that about 20% of patients will develop a new hernia in the area around the incision. These are often small and do not require a second procedure.
However, if a new incisional hernia becomes bigger and/or is painful, a new repair is required, with a bigger prosthesis. About 3 in 20 patients (15%) will need to undergo a second procedure in the ten years after the incisional hernia repair.

Aftercare

Smaller incisional hernia repairs can be performed in the day clinic for most patients. However, for larger incisional hernia repairs hospitalisation, including overnighting, will be needed. The duration of the hospital stay strongly depends on the size of the hernia and/or whether the repair can be performed with keyhole surgery. It is important that you are active and move around a lot as soon as possible after the operation. We do recommend you avoid lifting heavy loads and strenuous sport activities for three weeks after the procedure. After the check-up with the surgeon, three weeks after the operation, you will be able to resume all activities again including lifting and sports.

You will also be given a bellyband that you may wear in the first weeks for support

When you are discharged from the hospital, we will ask you to visit your GP ten days after the procedure to have your wound checked and your sutures removed. In case of problems, you or your GP can of course always contact our department.

How much does an incisional hernia repair cost?

The Maria Middelares Hernia Centre in Ghent charges the official RIZIV prices. The invoice will be sent to you by post after a period of approximately three months. In addition to the surgeon's and anaesthesiologist's fee, this will display the general charges for hospital admission and the use of materials such as the mesh.

As is the case in almost any hospital, there is an additional charge for the use of a single room. At the Maria Middelares General Hospital in Ghent, this additional charge is a maximum of 150% of the official price. No additional charges are added to the fee if a multiple-occupancy room is chosen.

Latest publication date: 05/02/2021