Incisional Hernias
After surgery on the abdomen the incisions made can create sites of potential weakness which can then develop into so called ‘incisional hernias’. The incidence of hernia formation is associated with increasing age, obesity, emergency surgery, the type of incision and particularly post operative wound infection. Once a hernia forms its management can be complicated and involves not only repairing the defect but also dealing with the underlying bowel.
Repairing incisional hernias is always performed using mesh which maybe plastic or in selected cases made of material derived from animal tissue. Whilst plastic mesh is suitable for most patients, in the more complex /high risk cases the use of biological mesh is more appropriate. These biological meshes are far more resistant to infection and can even be used where there is MRSA or other infective agents present however biological mesh is far more expensive than conventional plastic varieties and therefore it is only used in carefully selected cases.
Management of complex incisional hernias is now becoming increasingly centralised in major centres with access to both plastic and general surgeons as well as state of the art intensive care and other support services. Such complex cases may require not only the use of biological mesh but also a team of surgeons who are able to reconstruct the entire abdominal wall often with soft tissue flaps akin to those in abdominoplasty.
Unfortunately if a plastic mesh becomes infected it usually requires its removal which can be extremely complex and may necessitate a number of operative procedures to correct but provisional reports from high volume centres performing such complex cases demonstrate that even in high risk patients excellent outcomes can be achieved.
Any patient with an incisional hernia should be referred to a Surgeon with an expertise in the management of such cases as the first repair provides the best opportunity for a definitive reconstruction.
