Midline Hernias
Hernias that occur in the midline of the abdomen are second in frequency only to groin hernias. Previous sutured repairs have now been superseded by mesh repairs, as found in the groin, and this has led to significant reductions in recurrence rates. The technological advances for midline hernia meshes allow them to be safely placed within the abdomen directly onto the bowel. This provides the most mechanically strong repair for what are often complex areas of weakness. These new meshes have a ‘non stick surface’ on one side which makes placement on the bowel safe. These meshes are made of thin plastic although there is a move towards the use of biological material derived from animal tissue. The advantage of biological mesh is that it is more impervious to infection (particularly important in high risk cases) and eventually becomes incorporated into the patients own normal tissue.
Midline hernias vary from small ones found within and adjacent to the umbilicus and those more complex hernias that may arise as a result of poor healing of a wound after surgery (so called incisional hernias). All of these hernias are repaired using mesh, with the small ones done as day cases and sometimes under local anaesthesia. It is however the management of incisional hernias that is most complex either due to their size or involvement of the underlying intestine.
