Incisional and Ventral Hernia Repair

Abstract

Ventral hernia is a common type of abdominal hernia. There are three types of ventral hernia: incisional hernia, spigelian hernia, and epigastric hernia. Traditionally, hernia repairs have been performed as open procedures. In the last decade, laparoscopic hernia repair has become popular. Laparoscopic surgery allows for a smaller incision, which results in less post-operative pain and less risk of incisional hernia. Decreases in the size and number of trocars should be considered if outcomes similar to those of traditional laparoscopic technique can be obtained. The indication for laparoscopic ventral hernia is a hernia with a minimum defect size of 3 cm. In cases of simultaneous contamination, the use of mesh is basically contraindicated. An inability to tolerate general anesthesia and uncontrolled coagulopathy are also contraindications. A small incision of 2–3 cm is made on the hernia bulge along the previous surgical scar. A silicone wound protector is used, and a silicone cap for use of several trocars is set. At least two trocars of 5-mm are needed to introduce the laparoscope and a tacker for mesh fixation. After complete detachment of all adhesions below the surgical scar, all incisional hernias must be evaluated, including small fascial defects. The mesh should be larger than the hernia defect with a margin of at least 3 cm in all directions. The silicone cap is opened, and the mesh is easily introduced through the wound protector and spread flat with the knitted side up. Lifting stitches are caught by a suture passer and fixed to the abdominal wall. With the use of fixation tacks, the edge of the mesh is circumferentially fixed to the abdominal wall.