Incisional hernias and large ventral hernias
Incisional hernias
Incisional hernias develop in scars of the abdomen following abdominal surgery (e. g. laparotomy, appendectomy, gall bladder removal). Incisional hernias are diagnosed and treated by ZweiChirurgen at our “Competence centre for hernia surgery” in Switzerland (Basel, Zurich, Liestal).
The scar tissue is not as stable as the natural abdominal wall and prone to develop a hernia defect. For example, one year after laparotomy almost 20% of patients develop an incisional hernia. Incisional hernias usually cause symptoms such as the dull pain and a clearly visible and palpable bulge. Due to the symptoms and quite fast progression of the hernia size an operation is mostly always necessary. The aim of the operation is a tension-free closure of the abdominal wall defect and the perfect restoration of the abdominal wall anatomy. In all cases the hernia should be closed using a suture with a reinforcing mesh. The used surgical techniques are depending on the size and localization of the incisional hernia. Our standard procedure is the MILOS technique (mini less open surgery), where the hernia is operated through a small incision (4-5cm) over the hernia. In larger hernias the surgical technique needs to be adapted. To plan the procedure perfectly, we usually perform a computer tomography (CT scan) before surgery.
Open approaches
- Retromuscular mesh reinforcement (Rives-Stoppa)
- Preperitoneal umbilical mesh placement (PUMP operation)
Minimally-invasive approaches
- Extraperitoneal mesh implantation using laparoscopy (TAPP, extended TEP)
- MILOS operation (Minimal or Less Open Surgery)
Hospital stay: 2—4 days
Large ventral hernias (>8cm hernia diameter)
In the case of very large hernias (larger 8cm in diameter) a tension-free closure of the abdominal wall is difficult and sometimes not possible without additional measures. An elegant option is to pre-treat the lateral abdominal muscles with botulinum toxin A (so-called Botox). The medication is injected into the lateral abdominal muscles 4 weeks before the operation (under ultrasound control). These muscle groups then relax at their maximum after 4 weeks, which usually allows the large hernia to be closed without tension. In a few cases, a so-called component separation is necessary, in which an additional dissection of the lateral abdominal wall muscles is required during the operation, to achieve a tension-free closure of the abdominal wall.
Surgical techniques
- Open retromuscular mesh insertion Rives-Stoppa
- Endoscopic, posterior or anterior component separation (ECS, TAR)