Complex Incisional Hernias: Is outpatient laparoscopic repair the best option?

An incisional hernia is the term used to describe a hernia that forms at the location of a prior surgery.  This means that when the muscle was opened for a prior surgery, and then sewn back together, the muscle didn’t heal 100%.  A small tear in the muscle formed where the prior surgery took place. This could be from a simple gallbladder surgery or c-section, to a more complex surgery like cancer or intestine surgery. Regardless, these types of hernias are not uncommon. However, they can be some of the more challenging cases that we see. In the past most surgeons, including myself, would recommend the newest, latest, greatest, minimally invasive, laparoscopic incisional hernia repair. Patients would be treated as an outpatient and would recover for several days in the comfort of their own home.  This seemed like the best option for both the patient and the surgeon. Then we realized that by just patching the inside of the muscle where the hole is, we don’t actually close the muscle back to it’s original intended position. Most of the time for small hernias this didn’t make a difference. However, for larger hernias measure several inches in size, patients would still notice a bulge under the skin because the mesh would ‘bow’ out around the still present tear in the muscle.

Over time, I’ve developed a dislike for the residual ‘bulge’ that some patients may not even notice but that I do. Some patients (not all!) with larger hernias I try to steer towards a more comprehensive surgery with closure of the muscle, component separation, and placement of a mesh.   You can see more descriptions of other cases on our ‘Unique Cases‘ page.