Open Incisional hernia repair
The open operation is the mainstay of incisional hernia repair. It gives good access and is generally safe. The small intestine is often caught in large, long standing hernia and the open operation may allow a safer dissection and bowel resection if needed
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Open repair can allow mesh to be placed on the deep side of the abdominal wall and sutured in place. This is not easily done. The 'muscle' defect can be suture closed over the mesh if the tension allows. The open operation has the advantage of allowing complete excision of the redundant hernia sac and stretched skin if needed.
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Open repair under a general anaesthetic is needed for large long standing hernia and especially if there have been previous operations.
Botox and hernia repair
Injection of Botox (botulinum toxin) into each side of the abdominal wall 2 - 3 weeks before surgery relaxes the abdominal muscles and may allow the central hernia defect to be closed. This is done under local aesthetic under ultrasound and may mean that the more complex 'Component Separation' procedure is not needed.
Component Separation repair of incisional hernia
This refers to a rather complex way of repairing larger, long standing incisional hernia. The operation requires relaxing incisions to be made in the lateral abdominal muscle and tendon junctions, to relax the abdominal wall and allow the tissue to be sutured together. A component repair may use a sheet of mesh to provide strength.
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It was first described as an open operation in the 1970's but now can be done by keyhole surgery.
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This is a complex operation that you are unlikely to need and will be discussed with you.
A large incision for a liver operation. It is easy to see how this might develope an incisional hernia.
This will be discussed with you if needed