An incisional hernia is a weakness in a person’s abdominal wall resulting from a breakdown of a healed incision from a previous operation. Incisional hernias occur because a healed incision can weaken over time in some people. In those patients in whom the collagen framework of the healing tissue is weak, the continued pressure from within the abdomen causes the hernia to form. The weakness results in a bulge in the area of the incision and not uncommonly segments of bowel get trapped within the hernia. The abdomen becomes unsightly and the affected person experiences pain and occasionally incarceration of the bowel resulting in obstruction, sometimes strangulation and gangrene of the bowel. The only way to cure a hernia permanently is to repair it surgically.
In the past, this would be repaired by pulling the edges of the hernia together, but that kind of repair results in a recurrence rate of 20-30%. It is now standard therapy to repair hernias using a mesh. The mesh provides a strong framework for the repair of the weakness. There are two kinds of meshes. The first kind is called a synthetic mesh, usually made out of a very strong inert plastic called polypropylene. Another commonly used synthetic mesh is made out of expanded Teflon or Gore-Tex. Sometimes both are bonded together to form a composite mesh. The other kind of mesh is called a biologic mesh because it is made from either human skin or pig skin. The skin is treated and processed, removing all cells from the skin, leaving only the strong collagen behind. Some of these are then processed further to strengthen the collagen matrix.
In many instances, incisional hernias can be repaired laparoscopically using small, tiny incisions instead of a long incision. The main advantage of a laparoscopic repair of a hernia is diminished pain from the surgery and a quicker recovery.