Tre­at­ment of in­ci­sio­nal her­ni­as

If gaps develop in the abdominal wall, the peritoneum or intestines can pass through. Incisional hernias occur most frequently after surgical access via the midline, but can in principle occur at any former access to the abdominal wall.

In addition to a disturbing swelling, incisional hernias can also cause varying degrees of pain. They also tend to become larger over time. This makes them more difficult to treat and can lead to functional limitations of the abdominal wall.

Incisional hernias should therefore always be treated surgically.

Several surgical procedures are available. These all involve the implantation of a non-dissolvable plastic mesh to reinforce the abdominal wall. This reduces the risk of the hernia recurring. Open and minimally invasive procedures are also available for treatment.

The exact choice of procedure is primarily determined by the morphology of the hernia. Whenever possible, a minimally invasive procedure is chosen, as this can reduce the rate of adverse events after the operation. Technical advances, all of which are available at the Hernia Centre Basel, are helping to achieve this goal in more and more cases. However, in the case of very large hernias or hernias in unfavourable locations, it may still be necessary to perform the procedure by reopening the old scar.

• Open treatment with mesh insertion behind the abdominal muscles
  The scar from the old incision is reopened. Any adhesions in the abdominal wall are loosened. The abdominal wall is then reconstructed. To do this, the connective tissue layer behind the abdominal muscles is first detached from the straight abdominal muscles. A synthetic mesh is inserted into this space to reinforce the abdominal wall. The abdominal wall is then closed over the mesh using a suture.
• Endoscopic treatment using the IPOM technique
  During endoscopic treatment, three small incisions are made on the side of the abdomen and these are used to enter the abdominal cavity. Any adhesions of the abdominal organs caused by the previous operation are loosened. From the abdominal cavity, the hernia gap is freed from the tissue inside and then closed with sutures if possible. A plastic mesh is then placed against the abdominal wall from the inside to reinforce the abdominal wall at the site of the hernia.
• Endoscopic treatment using the eTEP technique
  Similar to the operation using the IPOM technique, the operation is performed via small incisions. The difference here is that the abdominal cavity is not opened and the operation is performed within the abdominal wall. The mesh position is also outside the abdominal cavity. A decision must be made as to which of the two techniques should be used.
• Endoscopic robot-assisted treatment with mesh insertion
  With this new, minimally invasive technique, an approach is also made from the side of the abdominal wall. Any adhesions of the abdominal organs caused by the previous operation are loosened. With the aid of the surgical robot, it is now also possible to prepare the layers of the abdominal muscles very precisely using a minimally invasive technique, thus enabling the plastic mesh to be placed outside the abdominal wall. The posterior connective tissue layer of the abdominal wall is detached from the straight abdominal muscles. The hernia gap is freed from the tissue inside and then closed with sutures. A plastic mesh is then inserted into the newly created space behind the abdominal muscles to reinforce the abdominal wall and covered with the posterior layer of connective tissue. This means that the mesh has no contact with the organs of the abdominal cavity.