Published: 2018-07-24

Study of laparoscopic repair of abdominal incisional hernia

Nilesh P. Mangam, Ritesh M. Bodade, Asmita S. Dhurve, Sumeet Awasarmol, Deepa P. Jahagirdar, Raj N. Gajbhiye


Background: An incisional hernia is defined as any abdominal wall gap with or without bulge in the area of postoperative scar perceptible or palpable by clinical examination or imaging. It occurs in about 3 to 20 percent of patients undergoing laparotomy. Open hernia repair methods have an increased incidence of wound infections and wound-related complications. These problems have been overcome by laparoscopy. The placement of a large mesh by laparoscopy allows for an even distribution of forces along the surface area of the mesh, which account for the strength of the repair and the decreased recurrence rates associated with it. The merits of the laparoscopic approach are decreased rates of recurrence, reduced risks of wound complications. The aims and objective of this study were to evaluate etiological factors of incisional hernia, various techniques of laparoscopic repair of incisional hernia, and to investigate the influence of laparoscopic approach on hospital stay, complications associated with the procedure and recurrence rates.

Methods: In this hospital based prospective study, total 40 cases of incisional hernia were studied which were operated laparoscopically and followed up over period of two years.

Results: Incisional hernia occurrence was common in females (80%) with commonly observed risk factor was postoperative wound related complications (28 cases) and obesity (22 cases). Infraumbilical midline incision (67.5%) and supraumbilical midline incision (27.5%) was most commonly responsible for incisional hernia occurrence. LSCS was most commonly responsible for incisional hernia occurrence (45%) followed by laparotomy for various indications (27.5%). Intraperitoneal onlay mesh repair of single defect without anatomical repair was most common modality of laparoscopic repair (70%). Early postoperative pain (20%) and prolonged ileus (17.5%) was the most common complication observed. Average hospital stay was 4.22 days.

Conclusions: Postoperative wound related complications are important risk factor for incisional hernia. Laparoscopic repair of incisional hernia is better choice in view of reduced wound related complications, post-operative pain and hospitals stay.


Incisional hernia, Intraperitoneal onlay mesh repair, Laparoscopic repair, Lower segment caesarean section, Midline incision

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Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, et al. Classification and surgical treatment of incisional hernia. Langenbeck's Arch Surg. 2001 Feb 1;386(1):65-73.

Read RC, Yoder G. Recent trends in management of incisional herniation. Arch Surg. 1989;124:485-8.

Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG. Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg. 2015;7:293-305.

Al Chalabi H, Larkin J, Mehigan B, McCormick P. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65-74.

Le Blank K, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluroethylene preliminary findings. Surg Laparosc Endosc. 1993;3:39-41.

Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545-54.

Rives J, Pire JC, Flament JB, Palot JP, Body C. Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie. 1985;111:215-25.

‎RK Mishra. Laparoscopic Repair of ventral hernia In: Textbook of Practical Laparoscopic Surgery. 2nd Edition. Jaypee; 2013;17:233-234.

McCaffery M, Beebe A. Pain: clinical manual for nursing practice. V. V. Mosby Company, Baltimore; 1993.

Shukla VK, Gupta A, Singh H, Pandey M, Gautam A. Cardiff repair of incisional hernia: a university hospital experience. Eur J Surg. 1998;164:271-4.

Bose SM, Lal R, Kalra M, Wig JD, Khanna SK. Ventral hernia: A review of 175 cases. Indian J Surg. 1999;61(3):180-4.

Vant RM, De Vos Van Steenwijk PJ, Bonjer HJ, Steyerberg EW. Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am J Sur. 2004;70(4):281-6.

Blomstedt B, Welin-Berger T. Incisional hernias: a comparison between midline, oblique and transrectal incisions. Acta Chir Scand. 1972;138:275-8.

Carlson MA, Ludwig KA, Condon RE. Ventral hernia and other complications of 1,000 midline incisions. South Med J. 1995;88:450-3.

Parekh JN, Shah DB, Thakore AB. Incisional hernia - A study of 76 cases. Indian J Surg. 1988;50:49-53.

Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J. 1982;284:931-3.

Goel TC, Dubey PC. Abdominal incisional hernia - Anatomical technique of repair. Indian J Surg. 1981;43:324-7.

Hope PG, Carter SS, Kilby JO. The da Silva method of incisional hernia repair. Br J Surg. 1985;72:569-70.

Read RC, Yoder G. Recent trends in management of incisional herniation. Arch Surg. 1989;124:485-8.

Koehler R, Voeller G. Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature. J Soc Laparoendoscop Surg. 1999;3:293-304.

Merskey HE. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-226.

Henriford BT, Park A, Ramshaw BJ. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg.2000:190:645-50.

Costanza MJ, Heniford BT, Arca MJ, Mayes JT, Gagner M. Laparoscopic repair of recurrent ventral hernias. Am Surg. 1998;64:1121-5.

Wassenaar EB, Raymakers JT, Rakic S. Removal of transabdominal sutures for chronic pain after laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech. 2007;17(6):514-6.