An incisional hernia is a defect in the anterior abdominal wall arising after a previous procedure, i.e. secondary to an intervention involving the abdomen. As a result, it is located in the area of the previous incision scar. Almost one in five patients may develop this type of hernia with bulging after a procedure involving the abdomen.
Incisional hernias are therefore one of the most common complications of abdominal surgery. Up to 50,000 patients undergo surgery for their incisional hernia every year in Germany.
As with primary abdominal wall defects (e.g. umbilical hernia or epigastric hernia), parts of intestines or parts of organs from inside the abdominal cavity can enter the hernial sac that protrudes beyond the abdominal muscle wall.
The development of an incisional hernia appears to be a multi-factorial process involving numerous different components. A distinction is made between 2 groups of factors that can influence the development process. Whereas in the past it was primarily surgical technique-related factors that were regarded as the cause, recent studies have also uncovered patient-dependent, biological factors that can encourage the development of incisional hernias.
(from `Narbenhernie Pathogenese, Klinik und Therapie. Schumpelick V., Junge K. ,Klinge U., Conze J. Deutsches Ärzteblatt 2006)
As a result, a repair can be open or laparoscopic using keyhole surgery, with the mesh being used to reinforce the abdominal wall (= mesh augmentation) or to replace it (= mesh bridging). In open techniques, the mesh can be placed on the fascia (known as the onlay method), retromuscularly between the layers of the abdominal wall behind the muscles (known as the sublay method) or inside on the peritoneum (known as the open IPOM method). With laparoscopic procedures, a laparoscopy is first carried out and the hernial orifice is then covered from inside with a coated synthetic mesh.