An incisional hernia is a protrusion of tissue that forms at the site of a healing surgical scar. This is a type of ventral hernia and accounts for 15-20% of all abdominal hernias, occurring when improper healing from previous surgery further weakens abdominal muscles. The hernia appears as a bulge under the skin and can be painful or tender to the touch. The characteristic “bulge” of an incisional hernia can be identified when you are standing upright or are performing physical activity, such as heavy lifting. Incisional hernias do not heal on their own and require surgical treatment to repair.
Dr. Ford will look and feel for a bulge in your incision. He may ask you to lie down with your legs bent. He may also ask you to cough while standing up. You may need a CT scan to show the hernia.
Causes of an Incisional Hernia
People who had abdominal surgery are at risk for developing incisional hernias. They are especially susceptible three to six months following the procedure when the tissues are healing from the incision. Incisional Hernias are more likely after emergency surgery or surgery that requires a large incision. If the edges of the wound aren’t properly aligned after surgery, the incision may not heal well, increasing the likelihood of a hernia. The sewing technique used to close the incision can also play a part.
Strenuous activity, substantial weight gain, or pregnancy can cause excessive stress on the healing abdominal tissue and should be avoided during this healing window.
Several things can prevent the surgical incision from healing properly, including:
- Putting too much pressure on your abdomen
- Becoming pregnant before the cut fully heals
- Getting back into physical activities too soon after surgery
Several risk factors can increase the chances of a hernia developing after surgery, including:
- Wound infection
- Existing health conditions, such as renal failure, diabetes, or lung disease
- Obesity
- Smoking
- Certain medications, including immunosuppressant drugs or steroids
Symptoms of an Incisional Hernia
The most noticeable symptom of an incisional hernia is a bulge near the incision site. It’s often most visible when you strain your muscles, such as when you stand up, lift something, or cough.
Besides a visible bulge, incisional hernias might also cause:
- Nausea and vomiting
- Fever
- Burning or aching near the hernia
- Abdominal pain and discomfort, particularly around the hernia
- Faster heartbeat than usual
- Constipation
- Diarrhea
- Thin, narrow stool
While you’re most likely to develop a hernia between three and six months after your surgery, hernias can occur before or after this time frame. Hernias are often categorized as reducible or irreducible:
- Reducible HerniasReducible hernias can be pushed back in. They may also shrink when you lie down.
- Irreducible HerniasIrreducible hernias happen when part of your intestine pushes into the hernia, making it hard to push the hernia back in. Irreducible hernias can lead to bowel obstruction, which can then lead to a strangulated hernia. This requires immediate treatment.
Dr. David W. Ford employs the 2 main types of surgery for hernias: Open Herniorrhaphy or Robotically-Assisted Laparoscopic Herniorrhaphy, both with or without a mesh (Hernioplasty). Although laparoscopic surgery, either robotically-assisted or not, is the preferred method, it does carry a higher probability of reoccurrence and often open surgery is suggested if scar tissue resectioning is involved.
Robotically-Assisted Incisional Herniorrhaphy or Hernioplasty
with The Da Vinci® Robotic Surgical System
Surgical robotics for minimally invasive surgery
As a Board-Certified General Surgeon, Dr. David W. Ford operates with a minimally invasive robotic system to repair ventral and inguinal hernias. Both minimally invasive approaches only requires a few small incisions that doctors use to insert surgical equipment and a camera for viewing.
Robotically-assisted Incisional Hernia surgery utilizes an advanced robotic platform that is not autonomous but is controlled by the surgeon who is seated in the operating room and operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and a camera. The da Vinci Surgical System allows surgeons to perform minimally invasive hernia repairs with clinically supported precision and accuracy. Robotically assisted surgery uses a laparoscope (a thin lighted tube with a camera on the tip) that is inserted through one of several small incisions, made away from where the hernia has occurred. The images gathered from the laparoscope’s camera are magnified, high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the operation. If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow the doctor to view the inside of the body.
For the Incisional Hernia Repair, the inner lining of the abdomen is cut to allow Dr. David W. Ford to see the weakness in the abdominal wall. The surgery can also cut into the peritoneum (the sac created around the old scar tissue) or it can repair and push fatty tissue, muscle and intestines back in without cutting the peritoneal sac. Reconstruction of the abdominal wall, removal of extraneous fat, tissues or scar tissue occurs at this time. Surgical mesh material is usually inserted to strengthen the weakened area and reconstruct the abdominal wall, although sometimes a suture-only repair is needed, especially in child-bearing women. After the procedure is completed, the small incisions in the abdomen are closed with a stitch or two or with surgical tape and a drain may be inserted at the incision site if needed. Dr. David W. Ford’s use of the state-of-the-art da Vinci Surgical System in his robotically assisted hernia repair surgeries has allowed him to set a very high standard of expertise that can combine this method with traditional Open Surgery if required.
Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in hernia repair surgery. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.
This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the repair can be done with more precision, and complex hernias can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications. This is the preferred approach for medium to large hernias and many inguinal hernias as it combines the best of open and laparoscopic surgeries. Also, Dr. Ford is more likely to be able to sandwich the mesh between layers of the abdominal wall to keep the mesh from coming into contact with the intestines.
Other benefits of robotic hernia surgery include:
- Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
- Dr. Ford can easily use stitches to sew tissue and meshes into the inside of the abdomen.
- The patient is left with smaller scars rather than one large incisional scar.
- The possibility of much less pain, faster recovery, and quicker return to normal diet and activities after surgery are observed, compared to all other types of hernia repair surgery.
Should robotically-assisted surgical laparoscopic surgery be recommended as part of treatment for your hernia repair, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.
How The Da Vinci® Robotic Surgical System works
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
Surgeon Console
Patient Cart
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
Vision Cart
The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.
Open Incisional Herniorrhaphy
In open incisional hernia repair, also called herniorrhaphy, the patient is given general anesthesia as a sedative, and this is often augmented with epidural anesthesia to improve recovery time and pain control. Then Dr. David W. Ford makes an incision on the abdomen, releases scar tissue, moves the hernia contents (often bowel or fat) back into the abdomen, and reinforces the muscle wall with stitches.
Usually, the area of muscle weakness is reinforced with a synthetic or biologic mesh to provide additional support to reduce the likelihood of recurrence (Hernioplasty), however, the Open Incisional Hernia Repair can be done with or without the mesh insertion. A drain at the incision site may also be needed.
This surgical method generally takes about 3 hours, and one can expect to stay at the hospital for observation for 2-5 days.
Non-Surgical Options:
- Conservative, watch & wait management is helpful for patients with minimal or no symptoms.
- The hernia itself should not limit your ability to engage in your usual daily activities.
Surgical Options:
Hernia repair involves an operation, with overall one of two main approaches:
- Mesh repair – the use of mesh to enhance the repair & provide further reinforcement
- Non-mesh repair – closing the abdominal defect with stitches, creating some tension
Safety of Surgical Mesh:
- There is a large volume of data on the outcome of various hernia operations and different types of mesh, and the use of mesh to repair the majority of hernias has been the preferred method in the US, UK, and worldwide for over 30 years.
- When surgeons themselves have hernias that require surgery, they opt for mesh repairs.
- Patient safety is a critical component, and therefore, different meshes used in surgery are tightly regulated in both the US and UK.
What is the “Gold Standard”?
- Using mesh has become the gold standard in hernia repairs – and has a lower recurrence rate.
- Many patients with hernias have tissue weakness and often do not hold stitches well, which may explain why non-mesh repairs have a higher failure/recurrence rate than with mesh.
- For the vast majority of patients, mesh poses little if any additional risk.
Risks of Mesh:
- Mesh is a foreign material, like synthetic implants, such as dentures, crowns, heart valves, etc.
- It is possible for mesh to become infected, but this is rare.
- Some patients develop chronic pain after surgery. There is no strong relationship with the use of mesh and chronic pain. Furthermore, non-mesh repairs can result in similar pain outcomes.
