Incisional Hernia Repair
Incisional hernia repair
Definition
Incisional hernia repair is a surgical procedure performed to correct an
incisional hernia. An incisional hernia, also called a ventral hernia, is
a bulge or protrusion that occurs near or directly along a prior abdominal
surgical incision. The surgical repair procedure is also known as
incisional or ventral herniorrhaphy.
Incisional hernia repair is performed to correct a weakened area that has
developed in the scarred muscle tissue around a prior abdominal surgical
incision, occurring as a result of tension (pulling in opposite
directions) created when the incision was closed with sutures, or by any
other condition that increases abdominal pressure or interferes with
proper healing.
Demographics
Because incisional hernias can occur at the site of any type of abdominal
surgery previously performed on a wide range of individuals, there is no
outstanding profile of an individual most likely to have an incisional
hernia. Men, women, and children of all ages and ethnic backgrounds may
develop an incisional hernia after abdominal surgery. Incisional hernia
occurs more commonly among adults than among children.
Description
An incisional hernia can develop in the scar tissue around any surgery
performed in the abdominal area, from the breastbone down to the groin.
Depending upon the location of the hernia, internal organs may press
through the weakened abdominal wall. The rate of incisional hernia
occurrence can be as high as 13%
An incisional hernia occurs at the site of a previous incision (A).
Intestinal contents break through the abdominal wall and bubble up
under the skin. In a laparoscopic repair, the surgeon uses
laparoscopic forceps to pull the material, omentum, from the hernia
site (B). A mesh pad is inserted into the site to line the hernia
site (C and D), and is tacked into place (E).
Illustration by GGS Inc.
with some abdominal surgeries. These hernias may occur after large
surgeries such as intestinal or vascular (heart, arteries, and veins)
surgery, or after smaller surgeries such as an
, which typically requires a small incision at the navel. Incisional
hernias themselves can be very small or large and complex, involving
growth along the scar tissue of a large incision. They may develop months
after the surgery or years after, usually because of inadequate healing or
excessive pressure on an abdominal wall scar. The factors that increase
the risk of incisional hernia are conditions that increase strain on the
abdominal wall, such as obesity, advanced age, malnutrition, poor
metabolism (digestion and assimilation of essential nutrients), pregnancy,
dialysis, excess fluid retention, and either infection or hematoma
(bleeding under the skin) after a prior surgery.
Tension created when sutures are used to close a surgical wound may also
be responsible for developing an incisional hernia. Tension is known to
influence poor healing conditions because of related swelling and wound
separation. Tension and abdominal pressure are greater in people who are
overweight, creating greater risk of developing incisional hernias
following any abdominal surgery, including surgery for a prior inguinal
(groin) hernia. People who have been treated with steroids or chemotherapy
are also at greater risk for developing incisional hernias because of the
affect these drugs have on the healing process.
The first symptom a person may have with an incisional hernia is pain,
with or without a bulge in the abdomen at or near the site of the original
surgery. Incisional hernias can increase in size and gradually produce
more noticeable symptoms. Incisional hernias may or may not require
surgical treatment.
The effectiveness of surgical repair of an incisional hernia depends in
part on reducing or eliminating tension at the surgical wound. The
tension-free method used by many medical centers and preferred by surgeons
who specialize in hernia repair involves the permanent placement
of surgical (prosthetic) steel or polypropylene mesh patches well beyond
the edges of the weakened area of the abdominal wall. The mesh is sewn to
the area, bridging the hole or weakened area beneath it. As the area
heals, the mesh becomes firmly integrated into the inner abdominal wall
membrane (peritoneum) that protects the organs of the abdomen. This method
creates little or no tension and has a lower rate of hernia recurrence, as
well as a faster recovery with less pain. Incisional hernias recur more
frequently when staples are used rather than sutures to secure mesh to the
abdominal wall. Autogenous tissue (skin from the patient's own
body) has also been used for this type of repair.
Two surgical approaches are used to treat incisional hernias: either a
laporoscopic incisional herniorrhaphy, which uses small incisions and a
tube-like instrument with a camera or a conventional
open repair procedure, which accesses the hernia through a larger
abdominal incision. Open procedures are necessary if the intestines have
become trapped in the hernia (incarceration) or the trapped intestine has
become twisted and its blood supply cut off (strangulation). Extremely
obese patients may also require an open procedure because deeper layers of
fatty tissue will have to be removed from the abdominal wall. Mesh may be
used with both types of surgical access.
Minimally invasive laporoscopic surgery has been shown to have advantages
over conventional open procedures, including:
reduced hospital stays
reduced postoperative pain
reduced wound complications
reduced recovery time
Surgical procedure
In both open and laparoscopic procedures, the patient lies on the
operating table, either flat on the back or on the side, depending on the
location of the hernia. General anesthesia is usually given, though some
patients may have local or regional anesthesia, depending on the location
of the hernia and complexity of the repair. A catheter may be inserted
into the bladder to remove urine and decompress the bladder. If the hernia
is near the stomach, a gastric (nose or mouth to stomach) tube may be
inserted to decompress the stomach.
In an open procedure, an incision is made just large enough to remove fat
and scar tissue from the abdominal wall near the hernia. The outside edges
of the weakened hernial area are defined and excess tissue removed from
within the area. Mesh is then applied so that it overlaps the weakened
area by several inches (centimeters) in all directions. Non-absorbable
sutures (the kind that must be removed by the doctor) are placed into the
full thickness of the abdominal wall. The sutures are tied down and
In the less-invasive laparoscopic procedure, two or three small incisions
will be made to access the hernia site—the laparoscope is inserted
in one incision and
in the others to remove tissue and place the mesh in the same fashion as
in an open procedure. Significantly less abdominal wall tissue is removed
in laparoscopic repair. The surgeon views the entire procedure on a video
monitor to guide the placement and suturing of mesh.
Diagnosis/Preparation
Reviewing the patient's symptoms and medical history are the first
steps in diagnosing an incisional hernia. All prior surgeries will be
discussed. The doctor will ask how much pain the patient is experiencing,
when it was first noticed, and how it has progressed. The doctor will
palpate (touch) the area, looking for any abnormal bulging or mass, and
may ask the patient to cough or strain in order to see and feel the hernia
more easily. To confirm the presence of the hernia, an ultrasound
examination or other scan such as computed tomography (CT) may be
performed. Scans will allow the doctor to visualize the hernia and to make
sure that the bulge is not another type of abdominal mass such as a tumor
or enlarged lymph gland. The doctor will be able to determine the size of
the defect and whether or not surgery is an appropriate way to treat it. A
referral to a surgeon will be made if the doctor believes that medical
treatment will not effectively correct the incisional hernia.
Preparation
Many months before the surgery, the patient's doctor may advise
weight loss to help reduce the risks of surgery and to improve the
surgical results. Control of diabetes and smoking cessation are also
recommended
for a better surgical result. Close to the time of the scheduled surgery,
the patient will have standard preoperative blood and urine tests, an
electrocardiogram, and a
to make sure that heart and lungs and major organ systems are functioning
well. A week or so before surgery, medications may be discontinued,
especially
or anticoagulant (blood-thinning) drugs. Starting the night before
surgery, patients must not eat or drink anything. Once in the hospital, a
tube may be placed into a vein in the arm (intravenous line) to deliver
fluid and medication during surgery. The patient will be given a
preoperative injection of
before the procedure. A sedative may be given to relax the patient.
Immediately after surgery, the patient will be observed in a recovery area
for several hours, for monitoring of body temperature, pulse, blood
pressure, and heart function, as well as observation of the surgical wound
for undue bleeding or swelling. Patients will usually be discharged on the
only more complex hernias such as those with
incarcerated or strangulated intestines will require overnight
hospitalization. Some patients may have prolonged suture-site pain, which
may be treated with pain medication or anti-inflammatory drugs.
Antibiotics may be prescribed to help prevent postoperative infection.
Once the patient is home, the hernia repair site must be kept clean, and
any sign of swelling or redness reported to the surgeon. Patients should
also report a fever or any abdominal pain. Outer sutures may have to be
removed by the surgeon in a follow-up visit about a week after surgery.
Activities may be limited to non-strenuous movement for up to two weeks,
depending on the type of surgery performed. To allow proper healing of
muscle tissue, hernia repair patients should avoid heavy lifting for at
least six to eight weeks after surgery, or longer as advised.
Long-term complications seldom occur after incisional hernia repair.
Short-term risks are greater with obese patients or those who have had
multiple earlier operations or the prior placement of mesh patches. The
risk of complications has been shown to be about 13%. The risk of
recurrence and repeat surgery is as high as 52%, particularly with open
procedures or those using staples rather than sutures for wound closure.
Some of the factors that cause incisional hernias to occur in the first
place, such as obesity and nutritional disorders, will persist in certain
patients and encourage the development of a second incisional hernia and
repeat surgery. Each subsequent time, the surgery will become more
difficult and the risk of complications greater. Postoperative infection
is higher with open procedures than with laparoscopic procedures.
Postoperative complications may include:
fluid buildup at the site of mesh placement, sometimes requiring
aspiration (draining off)
postoperative bleeding, though seldom enough to require repeat surgery
prolonged suture pain, treated with pain medication or anti-inflammatory
intestinal injury
nerve injury
fever, usually related to surgical wound infection
intra-abdominal (within the abdominal wall) abscess
urinary retention
respiratory distress
Normal results
Good outcomes are expected with incisional hernia repair, particularly
with the laparoscopic method. Patients will usually go home the day of
surgery and can expect a one- to two-week recovery period at home, and
then a return to normal activities. The American College of Surgeons
reports that recurrence rates after the first repair of an incisional
hernia range from 25–52%. Recurrence is more frequent when
conventional surgical
wound closure with standard sutures (stitches) is used. Recurrence after
open procedures has been shown to be less likely when mesh is used,
although complications, especially infection, have been shown to increase
because of the larger abdominal incisions. Laparoscopy with mesh has shown
rates of recurrence as low as 3.4%, with fewer complications as well.
Morbidity and mortality rates
Deaths are not reported resulting directly from the performance of
herniorrhaphy for incisional hernia.
Alternatives
The alternatives to first-time and recurrent incisional hernia repair
begin with preventive measures such as:
L maintaining suitable weight for age and height.
Strengthening abdominal muscles through regular moderate
such as walking, tai chi, yoga, or stretching exercises and gentle
Reducing abdominal pressure by avoiding constipation and the buildup of
excess body fluids, achieved by adopting a high-fiber, low-salt diet.
Learning to lift heavy objects in a safe, low-strain way using arm and
leg muscles.
Controlling diabetes and poor metabolism with regular medical care and
dietary changes as recommended.
Eating a healthy, balanced diet of whole foods, high in essential
nutrients, including whole grains, fruits and vegetables, limited meat
and dairy, and eliminating prepared and refined foods.
Maddern, Guy J.
Hernia Repair: Open vs. Laparoscopic Approaches.
London: Churchill Livingstone, 1997.
organizations
American College of Surgeons (ACS), Office of Public Information. 633
North Saint Clair Street, Chicago, IL . (312) 202-5000.
The National Digestive Diseases Information Clearinghouse (NIDDK). 2
Information Way, Bethesda, MD .
"Focus on Men's Health: Hernia." January 2003.
MedicineNet
Incisional and Ventral Hernias (Patient Information).
Central Montgomery Medical Center, Outpatient Surgery Department. 2100 N.
Broad Street, Lansdale, PA 19446. (215) 368-1122.
L. Lee Culvert
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Incisional hernia repair is performed in a hospital
or a one-day surgical center by a general surgeon who may specialize in
hernia repair procedures.
QUESTIONS TO ASK THE DOCTOR
What procedure will be performed to correct my hernia?
What is your experience with this procedure? How often do you perform
this procedure?
Why must I have the surgery?
What are my options if I do not have the surgery?
How can I expect to feel after surgery?
What are the risks involved in having this surgery?
How quickly will I recover? When can I return to school or work?
What are my chances of having this type of hernia again?
What can I do to avoid getting this type of hernia again?
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It was a lovely spring day on Thursday, May 7th for the Opera Society’s Spring Luncheon and Installation of Officers for . As guests gathered in the Lounge of the Bistro Mezzaluna, Ann Rentoumis graciously entertained us on the piano as we sipped our champagne. After socializing for a while we headed upstairs to the Lighthouse room for the membership meeting and luncheon.
As the guests’ lunch menu preferences were being taken, a brief business meeting was conducted. Karen Mathieson, welcomed guests and acknowledged our special guests, Susan Danis, General Director and CEO, Florida Grand Opera, and Justin Moss, FGO’s Director of Broward Operations & Outreach. Our two new members in attendance, Dr. Jacqueline Hayward and Mr. Jeffrey Blum were introduced and presented with a welcoming rose. President Eric Koskoff then presented gifts of acknowledgement to the Opera Society
Justin Moss conducted the swearing in ceremony to install the new Officers and presented the ladies with a lovely rose and for the gentlemen, a tasty chocolate rose. The new slate of Officers for
President:
Dr. Claire Crawford
V.P. Ways & Means:
Karen Mathieson
V.P. Membership:
Eric Koskoff
V.P. Public Relations:
Betty Young
Corresponding Secretary:
Dr. Linda Balent
Recording Secretary:
Ruth Molina (not in attendance)
Treasurer:
Gary Loft: (not in attendance)
We were then honored to have Susan Danis, General Director & CEO present an overview of Florida Grand Opera’s
Bistro Mezzaluna served a lovely lunch consisting of a choice of three entrees: wedge salad with grilled chicken, grilled salmon, or Rigatoni Bolognese. Desert was key lime pie. It was a delightful event everyone enjoyed. Special thanks to Isobel Sturgeon for the lovely table decorations, to our gifted pianist Ann Rentoumis, and to our photographer Betty Young for the wonderful pictures.
Karen Mathieson
An evening of Singing and Socializing at Renzo’s of Boca Raton made our Member Mixer a Great Success!
On April 14th, Opera Society members and friends were joined by a number of new faces at this charming and delightful restaurant recently featured on Miichele Bernstein’s “Check Please!”
Renzo’s proprietor,
Beatrice Sciortino, was a wonderful hostess and treated us to her special Italian appetizers.
Peter, the piano player, entertained the group with a selections from Broadway, classical and popular music. However, everyone will agree that the show-stopper was the superb singing of the chef, Giuseppi. He regaled us with well-chosen Opera favorites as well as some great Italian standards. The gang even chimed in and joined in a sing-along!
The evening gave everyone a chance to relax, unwind, and make some new friends with many common interests. It also gave some subscribers living in Boca an opportunity to find out more about Opera Society activities and events. This
important outreach to Palm Beach County area by The Opera Society will definitely be repeated.
A special thank you goes to Ted Belloise for arranging the wonderful evening.
Enjoy the photos taken by our Vice-President for Publicity, Betty Young!
Almost 130 people attended the very elegant and enjoyable event “Arias at Sea” aboard Holland America’s ms Westerdam at Port Everglades on Saturday, March 21st. Guests were treated to the beautiful performances of eleven of Florida Grand Opera’s Young Artists while sipping champagne and mimosas in the beautiful ship’s show room. Justin Moss, in his inimitable style, provided the introductions for each of the singers and their selections.
Following the performances, a superb luncheon was served by the ship’s staff. The food and service were absolutely first class. A brief business meeting was held for the election of officers.
The elected candidates were congratulated by all. Next came the raffle drawing.
The raffle prizes, two Florida Grand Opera subscriptions for next season and a cruise certificate from Holland America Lines for up to seven days for two people aboard any Holland America ship to Alaska, the Caribbean, Mexico or Canada/New England delighted the winners!
Comments from all the guests were uniformly enthusiastic and The Opera Society looks forward to repeating this wonderful event next year.
This event was very successful in raising funds for Florida Grand Opera thanks to the generosity of Holland America Lines with their much appreciated community outreach, support and the donation of th to Coldwell Banker Cares Foundation for their generous donation towards the event and to the dedication and hard work of many of The Opera Society’s board members.
Betty Young provided all the great photos.
Louise and Terry “O’Moore” were delightful hosts at their lovely home as part of The Opera Society’s Guess Who’s Coming to Dinner series. Cocktails and hors d’oeuvres were followed by a wonderful menu of traditional dishes including corned beef and cabbage, parsley potatoes, glazed carrots, red and white wines, key lime pie, Irish Mist and coffee.
To make the evening really special the guests were treated to the beautiful singing of Louise and Terry performing well-known Irish songs.
Thank you to Lesleen Bolt for the great pictures!
On Thursday, February 19, twenty nine ladies of The Opera Society gathered at Umberto’s of Long Island for a delicious Italian lunch. Part of the Guess Who’s Coming To Dinner series, this event is anticipated by many members. Each year we enjoy different cuisines in different venues.
This year we decorated the single long table with Sunflowers and enjoyed a sumptuous salad served family style and red wine also served family style. The guests had a choice of Mussels Marinara, Chicken Marsala or Stuffed Shells. Dessert was spumoni and a very large cup of coffee! Everyone had a wonderful time and enjoyed their authentically Italian meal. Join us next year in a new venue!! Enjoy the photos taken by our own Betty Young!!
On Dec. 20, 2014 at 7:30 PM, Larry and Ruth Molina hosted 65 members and friends of the Opera Society at a Holiday Party in their home in Plantation Acres.
It was gratifying to see not just the regular members, but friends of the Museum of Art and the Friends of the Uffizi Gallery and the Molina’s personal friends get together and enjoy an evening of drinks, dinner and music.
The evening began with champagne and appetizers indoor, and from there we moved out doors to the patio, which was festively decorated in honor of the season. The lovely pool area was large enough to accommodate the large group, and the weather was extremely cooperative.
Everyone was hungry and tackled the buffet feast, which included London broil, lasagna, penne a la vodka, asparagus oreganato, salad, and chicken francaise. Everyone repaired to the patio deck and had some wine and awaited the performance.
The FGO Young Artists, Will Hughes – bass-baritone, Rebecca Henriques – soprano and Marina Paulina Garcia – accompaniest, provided us with a program full of Holiday Songs, Cuban ballads, and excerpts from the Opera. Everyone joined in and tried their hand at singing holiday songs. It was wonderful!
Then on to dessert and more conversation and music, and we still manage to collect some greatly needed funds for the Opera. All in all, we have established a great December tradition that we hope will continue for years to come.
All the delightful photos are courtesy of our Vice-President for Publicity, Betty Young.
The Opera Society celebrated its first Lyrical Luncheon on November 20, 2014 at the Coral Ridge Yacht Club attended by almost 50 guests. Chair Barbara Parent welcomed the members and guests. Co-Presidents Ruth Molina and Eric Koskoff spoke about up-coming events including the January 29, 2015 Lyrical Luncheon, which will be held at the Coral Ridge Country Club and the March 21, 2015 Lyrical Luncheon, which will be held onboard the Holland America ms Westerdam cruise ship with a 45 minute performance by our Young Artists. Also planned for March 6-7 is the Sarasota Opera Trip. For more information contact Ruth Molina.
Other events coming up: December – April are the Guess Who’s Coming to Dinner series. Chairpersons Claire Crawford and Caroline Seabright had the sign up sheets available for the members.
New member, Barry Rabinowitz, was welcomed.
Justin Moss then gave his presentation “The Lower Voices You Can’t Do Without Them”. Young Artists Raehann Bryce-Davis, Mezzo Soprano, and Isaac Bray, Baritone, sang several beautiful arias to illustrate the variety of roles these voices sing from hero (or heroine) to villain (or villainess). The piano accompanist, Maria Paulina Garcia, performed beautifully. The guests thoroughly enjoyed the performance and luncheon!
Enjoy the delightful photos courtesy of Betty Young!
The Opera Society enjoyed a delightful Fall Membership Cocktail Party on Saturday, October 25th, graciously hosted by our esteemed patroness, Barbara Copanos, at her lovely home in Sea Ranch Lakes. We had a good turnout of our members and their guests attended this time-honored event.
Co-President Eric Koskoff opened up the evening by thanking Barbara for her hospitality and over 20 years of significant support for Florida Grand Opera and The Opera Society and for providing the drinks and scrumptious hors d’oeuvres. Ruth Molina then reviewed the upcoming events, including the Lyrical Luncheon, which will be held on November 20th. Ruth introduced Claire Crawford and Caroline Seabright, chairs of the Popular “Guess Who’s Coming to Dinner” series. They presented the roster of lunches and dinners, that included some annual parties as well as new parties. Sign up soon to ensure a reservation!
Helena Caplan, VP of membership, presented a rose to new member, Barbara Franco, and welcomed her to the group. Brenda has joined our Board this year and we are excited about her energy and enthusiasm.
Susan T. Danis, Florida Grand Opera’s CEO & Director previewed the exciting upcoming Opera Season.
Enjoy the wonderful photos taken by our Public Relations Vice-President, Betty Young!
September 16, 2014
Over 40 members, new members, and guests launched the season and reconnected with friends at the Royal Pig Pub at 350 E. Las Olas. Over drinks and appetizers, we caught up with co-members who returned to Florida to enjoy the season. A lot of members stayed for a special prix-fixe dinner organized by the Royal Pig. The favorite drink was the dirty pig, a dirty martini garnished with a bacon-wrapped olive. What an unusual way to savor a vodka!
Our first membership event is on Saturday evening, October 25th, and we will be treated to a performance and cocktails at the lovely home of a prominent board member.
Then, we’ll be ready to enjoy a great season of Opera. Our first is Madama Butterfly, which opens on Thursday, December 4th. There will be a Reception at the Broward Center before the performance, so be sure to get tickets for both the performance and the Pre-Opera party. If you or your company is interested in helping to sponsor the reception, please contact Eric or Ruth at . Justin Moss will do a pre-Opera presentation to provide us with his unique perspective and little-known facts about this great Puccini classic. Even if you have already seen what is probably the world’s most famous opera, the staging and sets will still astound you, and the story and melodies literally never get old.
Come to our Lyrical Luncheon on November 20 and get private glimpse into the workings of an Opera Company, directly from the people who manage it.
And mark your calendars for our Holiday Party on Friday, December 18th so that we can celebrate the season together in style!
Check back for new listing of events and picture postings from all of our gatherings.
Photos from this event will be posted shortly.
On Thursday, May 8th, 2014 the Opera Society held the Installation of Officers Luncheon at the Bistro Mezzaluna in Fort Lauderdale. As guests gathered in the lounge, they were greeted to a champagne reception and the delightful sounds of Ann Rentoumis on the piano. After mingling and sharing stories of plans for the summer, guests went upstairs to the Lighthouse room for the Spring membership meeting and luncheon. As the guests’ lunch menu preferences were being taken, a brief business meeting was conducted.
Event chair, Karen Mathieson thanked the guests for attending the luncheon and introduced our President, Eric Koskoff. Eric thanked the membership, board and the chairs of the year’s events for a very successful year. He gave a brief, but positive report on the membership and financial statement. He then presented gifts of acknowledgement to the Opera Society
We were then honored to have Susan Danis, General Director & CEO of Florida Grand Opera install the new Officers for
and to present each of the ladies with a lovely rose and for the gentlemen, a tasty chocolate rose. The new slate of Officers for
Ruth Molina and Eric Koskoff
Co-Presidents
Elizabeth Hopwood
1st Vice President, Ways & Means
Karen Mathieson
2nd Vice President, Membership
Betty Young
3rd Vice President, Public Relations
Ted Belloise
Recording Secretary
Linda Balent
Corresponding Secretary
Gary Loft and Ann Clark
Co-Treasurers
Bistro Mezzaluna served a lovely lunch consisting of lobster bisque, choice of grilled salmon or chicken breast, rosemary roasted potatoes, mixed vegetables and key lime pie for dessert. Everyone had a wonderful time. Special thanks to Ann Rentoumis our pianist and to Betty Young our photographer. Enjoy her photos!
Karen Mathieson, Installation Luncheon Chair
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