Introduction

Hernias are a prevalent health condition that impacts millions of individuals globally. This medical condition happens when an internal organ or tissue protrudes through a vulnerable area in the muscle or tissue wall that encircles it. Hernias usually occur in the abdomen or the groin. They are often caused by ageing, strain, injury, or genetics. Hernias are formed by the lining of the abdomen cavity in the form of a sac, bulging out through an abnormal opening. In the past, open hernia surgery was the standard surgical option for treating hernias. However, with advancements in surgical technology, laparoscopic hernia repair has become increasingly popular. This blog will discuss the differences between open and laparoscopic hernia repair to help you decide the best surgical option.

Open versus Laparoscopic Hernia Repair:
Open hernia repair, or open surgical repair, involves a large incision (cut) in the skin and muscle to access and repair the hernia. During the procedure, the hernia sac is carefully pushed back into the abdomen, and the weakened or damaged area of the muscle or tissue wall is repaired or reinforced. After the repair, the incision is closed with stitches or surgical staples. Open hernia repair is done under local anesthesia.
 
Laparoscopic hernia repair, or minimally invasive, is a newer surgical procedure or option involving making a few small incisions in the abdomen instead of one large incision to repair or remove the hernia sac. A laparoscope is a thin tube with a camera and light attached that is inserted through one of the incisions. Using a laparoscope, the surgeon can view the inside of the abdomen. Additional incisions are made to insert the surgical instruments. The hernia sac is removed or pushed back into the abdomen depending on the need. The weakened or damaged area of the muscle or tissue wall is repaired or reinforced through one of the incisions. The incisions are closed with sutures. Laparoscopic hernia repair is done under general anesthesia

Advantages of Open Hernia Repair

• Suitable for all types of hernias: Open hernia repair can treat all hernias, including inguinal, umbilical, incisional, and femoral hernias.
• Straightforward procedure: The procedure is straightforward and can be performed quickly.
• No specialised equipment needed: Open hernia repair does not require any specialised equipment, making it accessible to more patients.
• Local anesthesia: Since open hernia repair is performed under local anesthesia, it is suitable for patients experiencing complications associated with general anesthesia risks.

Advantages of Laparoscopic Hernia Repair

• Shorter recovery time: The recovery time for laparoscopic hernia repair is typically shorter than open hernia repair, as the small incisions take less time to heal. You can return to everyday life and activities sooner.
• Less discomfort: Laparoscopic hernia repair causes less discomfort than open hernia repair, as the incisions are smaller and require less healing time.
• Reduced scarring: The small incisions result in minimal scarring, which can be less unsightly for better cosmetic results and less discomfort. It also removes excess tissue and tightens the skin where the hernia is.

Disadvantages of Open Hernia Repair
Despite its effectiveness, there are several disadvantages associated with this procedure.

• Longer recovery time: Open hernia repair requires a longer recovery time than laparoscopic hernia repair due to the larger incision and the need for the body to heal.
• More pain and discomfort: Patients typically experience more pain and discomfort following open hernia repair due to the larger incision and the need for a more extended recovery period.
• Scarring: The large incision can result in significant scarring, which can be unsightly and cause discomfort. Open hernia repair leaves a noticeable scar due to the large incision.
• Risk of complications: Complications such as infection, bleeding, and blood clots are potential risks with any surgery.
• Reduced mobility: Open hernia repair may reduce mobility and physical activity during recovery, potentially impacting daily activities and work.

Disadvantages of Laparoscopic Hernia Repair
Despite its many benefits, Laparoscopic hernia repair also has several disadvantages.

• Longer operating time: Laparoscopic surgery typically takes longer than traditional open surgery due to the need for precise and delicate movements of the instruments.
• Specialised equipment needed: Laparoscopic hernia repair requires specialised equipment, which may not be available at all medical facilities.
• Technical difficulties: Laparoscopic surgery can be technically challenging, with the surgeon getting restricted movement to perform the surgery through tiny incisions.
• Risk of complications: Although rare, there is a risk of complications during laparoscopic surgery, such as injury to surrounding organs, infection, bleeding, and blood clots.
• Limited use: Laparoscopic surgery is unsuitable for all types of hernias and may be ineffective for repairing larger or more complex injuries.
• Conversion to open surgery: In some cases, the surgeon may need to convert laparoscopic surgery into an open surgery, which involves a larger incision, due to complications during the procedure or difficulty in visualising the damaged area.

Conclusion

In conclusion, both open and laparoscopic hernia repair have advantages and disadvantages. Open hernia repair is a straightforward procedure that can be performed quickly and is suitable for all types of hernias. However, it has a longer recovery time, more discomfort, and can result in significant scarring. Laparoscopic hernia repair has a shorter recovery time, less discomfort, and reduced scarring. However, it requires specialised equipment and may not be suitable for all types of hernias. The best surgical option for you depends on your circumstances, pain threshold, and doctor’s recommendation. Discussing your options with your doctor and making an informed decision that is best for you is important.

FAQs : 
 
Q. How is open hernia repair different from laparoscopic hernia repair?
Open hernia repair involves a large incision in the skin and muscle to access and repair the hernia. In contrast, laparoscopic hernia repair involves several small incisions in the skin and using a laparoscope to repair the hernia.

Q. Which is better, open or laparoscopic hernia repair?
The best surgical option for you depends on your circumstances and the doctor’s recommendation. Both open and laparoscopic hernia repair have advantages and disadvantages, and your doctor will help you make an informed choice based on your specific needs.

Q. Is laparoscopic hernia repair less painful than open hernia repair?
Typically, laparoscopic hernia repair is less painful than open hernia repair as the incisions are smaller and take less time to heal. However, the level of discomfort and pain can vary from person to person.

Q. Is laparoscopic hernia repair a newer procedure compared to open hernia repair?
Yes, laparoscopic hernia repair is a newer surgical option than open hernia repair. It has only become popular with advancements in surgical technology.

Q. Is laparoscopic hernia repair more expensive than open hernia repair?
The cost of laparoscopic hernia repair may be higher than open hernia repair, as it requires specialised equipment. However, the cost can vary depending on location, insurance coverage, and other factors.

Q. Is the recovery time shorter after laparoscopic hernia repair than after open hernia repair?
Typically, the recovery time after laparoscopic hernia repair is shorter than open hernia repair, as the small incisions take less time to heal. However, the recovery time can vary from person to person.

References : 
https://www.drbramana.com/blog/open-hernia-surgery-laparoscopic-hernia-surgery/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC403835/
https://misjournal.net/article/view/4099
https://www.lifespan.org/centers-services/general-and-gastrointestinal-surgery/about-inguinal-hernias/open-surgery-versus

Introduction

An incisional hernia occurs when the muscles or tissues around a previous surgical incision site do not fully heal or may be due to some infection leaving a weakness in the abdominal wall. It occurs when the muscles or tissues in the area of the incision are weak or damaged, allowing a protrusion of abdominal contents through the weakened area and forming a bulge. Incisional hernias can be painful and cause discomfort or difficulty with physical activity. They can cause complications such as bowel obstruction if left untreated. In such a scenario, an incisional hernia repair is recommended. It is a surgical procedure used to treat a hernia that has developed at a previous abdominal incision site. This procedure aims to repair the weakened area of the abdominal wall and prevent the hernia from recurring.

Treatment of Incisional Hernia

Treatment for an incisional hernia typically involves surgery to repair the weakened abdominal wall area, called Incisional hernia repair. It is a surgical procedure to repair the weakness in the abdominal wall and return the protruding intestine or other abdominal contents to their normal position. The surgery is typically performed using general anesthesia. Depending on the individual case, it can be done through open or laparoscopic surgery. Open surgery involves a single large incision, while laparoscopic surgery uses several small incisions and specialised instruments. It is the size and location of the hernia and the patient’s overall health that determine the type of surgery. The surgical repair of an incisional hernia involves placing a strong, synthetic mesh over the weakened area of the abdominal wall. This mesh provides additional support and helps to hold the abdominal contents in place, reducing the risk of hernia recurrence. The mesh is usually secured to the surrounding tissue using sutures or special tacks.

During open surgery, the surgeon will make an incision in the abdominal wall to access the hernia and identify the hernia and repair the weakened area. The hernia sac is then carefully dissected away from the surrounding tissues, and the hernia defect is repaired. The surgeon may use sutures, mesh, or both to close the defect and strengthen the abdominal wall.
 
Laparoscopic surgery is less invasive as compared to open surgery. It involves making several small incisions in the abdomen using specialised instruments, including a laparoscope, a thin and flexible tube with a light, and a camera at the end used to have a view of the inside of the abdomen. During laparoscopic incisional hernia repair, the surgeon makes several small incisions in the abdominal wall and inserts the laparoscope and other instruments through the incisions. The hernia is repaired using similar techniques as in open surgery, but the smaller incisions and use of laparoscopy result in less pain and a faster recovery.
 
Regardless of the approach used, strengthening the abdominal wall and preventing the hernia from recurring are the main goals of incisional hernia repair. Recovery from incisional hernia repair surgery can take several weeks and may involve pain management, wound care, and physical therapy to help restore strength and mobility.

Risks and Complications

Incisional hernia repair surgery is generally considered safe and effective, but as with any surgery, there are potential risks and complications. The success rate for incisional hernia repair is high, with most patients experiencing a significant improvement in their symptoms. As with any surgical procedure, there is a risk of complications, including infection, bleeding, mesh rejection, allergic reactions to anesthesia, and damage to nearby organs or tissues. Discussing the potential risks and benefits of incisional hernia repair with a healthcare provider is essential to determine the best treatment plan.

Recovery

Recovery from incisional hernia repair typically takes several weeks. Patients may need to limit physical activity and avoid heavy lifting for some time to allow the incision to heal. Pain and discomfort can be managed with over-the-counter or prescription pain medication.

Lifestyle changes and the way forward

In addition to surgery, lifestyle changes can help prevent the development of incisional hernias or reduce the risk of recurrence. It is important to maintain a healthy weight, quit smoking, and manage any underlying medical conditions to reduce the risk of developing an incisional hernia or experiencing complications after surgery:

• Maintaining a healthy weight: Excess weight can strain the abdominal muscles, increasing the risk of a hernia.
• Avoiding heavy lifting: Lifting heavy objects can strain the abdominal muscles and increase the risk of a hernia.
• Quitting smoking: Smoking can weaken the muscles in the abdominal wall and increase the risk of a hernia.

Conclusion

Recovery from incisional hernia repair surgery can take several weeks and may involve pain management, wound care, and physical therapy. Overall, incisional hernia repair is a safe and effective treatment option for individuals who have developed a hernia at the site of a previous abdominal incision. Suppose you are experiencing symptoms of an incisional hernia. In that case, you must talk to your doctor to determine the best treatment for your needs.

FAQs

Is incisional hernia repair major surgery?
Yes, incisional hernia repair is considered a major surgery requiring general anesthesia and usually involves making a large incision or a few smaller incisions, depending on the type of surgery in the abdominal wall to access and repair the hernia.
 
What causes an incisional hernia?
An incisional hernia can occur due to various factors, including improper healing after surgery, excessive strain on the abdominal muscles, and obesity.
 
How to know if one has an incisional hernia?
Symptoms of an incisional hernia may include a bulge or lump at the site of previous surgery, pain or discomfort in the abdominal area, and difficulty with physical activities.
 
Can an incisional hernia be prevented? 
The risk of developing an incisional hernia can be reduced by maintaining a healthy weight, avoiding activities that strain the abdominal muscles unnecessarily, and quitting smoking.
 
Is incisional hernia repair surgery risky?
As with any surgery, there are potential risks involved with incisional hernia repair. These may include infection, bleeding, and reactions to anesthesia. Your surgeon will discuss the risks and benefits of the procedure with you before the surgery.

What is the recovery time from incisional hernia repair surgery?
The recovery time after incisional hernia repair surgery will depend on the type of surgery performed and the individual patient. Generally, open surgery has a longer recovery time than laparoscopic surgery. Recovery from incisional hernia surgery typically takes several weeks, with most people able to return to normal activities after 4-6 weeks.
 

Will I have a scar after incisional hernia repair surgery?
Yes, you will have a scar after incisional hernia repair surgery. The size and location of the scar will depend on the type of surgery performed and the size of the hernia.
 
Can an incisional hernia return after surgery?
Most incisional hernias usually do not return after surgery. Still, about 5 percent of them come back in patients who have had a previous repair.
 
Is an incisional hernia serious?
Yes, an incisional hernia can be serious and potentially lead to complications if left untreated. It can cause pain, increase the risk of intestine obstruction, and lead to other problems if the hernia becomes incarcerated or strangulated.
 
What is the success rate of incisional hernia repair?
Incisional hernia repair success rate is generally high, with studies reporting success rates of 85-95%. However, the risk of hernia recurrence is higher for incisional hernias than other hernias. The success of the surgery depends on various factors, like the size and location of the hernia, the patient’s overall health, and the type of surgical repair performed.

References :
https://emedicine.medscape.com/article/1892407-overview
https://www.ncbi.nlm.nih.gov/books/NBK395550/

Hernia surgery is typically a very routine procedure to repair the hernia. In most cases, surgery becomes the only option to treat hernia since it does not get healed on its own. A surgeon performs incisions in the patient’s abdomen, removes the hernia sac or pushes it back into the abdomen, and closes the incision. The process is repeated on another side of the body if needed. The size of the incisions depends on the type of hernia surgery performed. In the case of open surgery, the cut is made at the location of the hernia into the body. In Laparoscopic Surgery, tiny holes are made to insert the surgical tools to perform the surgery. Robotic surgery is a newer technique of hernia surgery. It is similar to Laparoscopic Surgery except that in Robotic Surgery, the surgeon performs the surgical operations with the help of three dimensional images of the abdominal cavity, and robotic arms perform the procedure controlled by the surgeon from his console.

Robotic surgery offers surgeons a new way to approach these operations. There are several advantages of robotic surgery over traditional surgery. The first and foremost advantage is the precision, access to difficult locations inside the cavity, 3D view, motion control, AI-enabled decision making, comfort etc. and many more.

What are the new-age trends in Hernia Repair Surgery?

Robotic hernia repair is one of the surgical procedures using a robot to repair a hernia.

Advantages of having new-age techniques Hernia Surgery

Reduced infection: According to several studies, robot-assisted surgery can reduce the risk of infection by up to 80%, which is a common cause of surgical site infection-related death among patients undergoing traditional abdominal surgeries.

Reduced risk of injury: With traditional surgery, surgeons aren’t always sure if they injure a healthy organ. Robotic surgery, on the other hand, doesn’t have these risks.

Fewer surgeries: Another advantage of robotic surgery is the reduction in surgeries performed by surgeons. One study found that robotic hernia repair can cut the need for additional surgeries by as much as 86%.

Greater precision: Robotic Surgery can often achieve greater precision and accuracy than traditional surgery. This can result in less damage to a healthy organ and a shorter hospital stay.

Factors like the cost and availability of robotic systems currently limit their use in many countries. However, these costs may come down in the foreseeable future, allowing surgeons to perform more procedures with robotic technology. Also, robotic systems need to be properly maintained to function properly. This can be a challenge in some countries. The key advantage of robotic surgery is the precision and accuracy provided by the robot. This requires surgeons to use different techniques, which can take some time to master.

Steps followed by surgeons to perform robotic hernia repair

The laparoscope is the key to performing robotic hernia repair. The laparoscope is a thin tube with a camera at the end. A surgeon makes a small abdomen incision and inserts the laparoscope. Once the incision is made, the surgeon can view the abdomen and perform the surgery as if inside the patient’s body. To allow the surgeon to have a good view of the inside of the abdominal cavity, some space is created by inflating the abdomen using harmless gas. The tiny camera attached at the end of the laparoscope projects three-dimensional images of the three dimensional images on the screen. The robotic system used for robotic hernia repair includes a robotic arm and a surgical tool. The surgeon controls the robotic arm using a computer. After the incision is made, the surgeon can control the robotic arm to separate the hernia from the tissues around it. The surgeon gently removes the hernia sac or pushes it back into the abdomen. He then closes the incision.

FAQs

Can a hernia be repaired with robotic Surgery?

Robotic Surgery for Hernia Repair Robotic surgery is a new-age, state-of-the-art technique for repairing hernias where the surgeon is seated at a console and is aided by a robot for precision while the surgeon controls and handles the surgical instruments from the console. The room for error is massively reduced while the process offers three-dimensional images of the abdomen and ensures more minor scars and less pain.

What is the best way to repair a hernia?

With medical technology achieving significant leaps and bounds in terms of innovations with robotic and minimally invasive approaches, surgeons today can perform hernia repair surgery through tiny incisions resulting in quicker healing time, less infection, and more precision, unlike the large incisions associated with traditional Open Surgery.

Hernias do not heal on their own. Though they can remain asymptomatic for a long time and cause no trouble, they also have high possibilities of getting worse with time. Usually surgical repair is recommended for treating hernias but your doctor may prescribe OTC (Over-the-Counter) antacid medicines at times to reduce the risk of your hernia or may ask you to wear a supporting truss. The hernia has a high rate of recurrence, and surgeons often use surgical mesh to strengthen the repair and reduce the rate of recurrence. The use of surgical mesh may also improve patient outcomes through decreased operative time and minimized recovery time. Now let’s understand more about Hernia mesh.

What is hernia mesh?

A hernia mesh is a surgical device used to provide added backing to damaged or impaired tissue due to hernia till it gets healed. It is placed through the area around the hernia, attaching it with stitches, staples or glue. Mesh’s pores let tissue to grow into the device.

How a hernia mesh works?

A hernia surgical mesh functions as an elastic scaffold for hernia repair. It reinforces walls of muscles and prevents organs from protruding through them.

Types of Hernia mesh

Most of contemporarily existing hernia mesh devices are composed of synthetic materials or tissues of animals. Surgical mesh manufactured from synthetic materials is available in knitted or non-knitted variants. The synthetic hernia meshes are made of absorbable, non-absorbable or a combination of these materials. Animal-derived meshes are made of processed and disinfected intestine or skin of pigs or cows, which are absorbable, suited for application as an implanted device.

Is Hernia mesh safe?

Hernia repair using mesh is currently one of the most regularly accomplished surgeries in general surgery. The use of mesh is recognized to reduce recurrence rates of hernia. As per evidence, non-mesh repair of hernias are associated with a higher recurrence rate at 1 year when compared to mesh repair.

Currently, chronic pain following hernia surgery is the most concerning post-operative complication with recurrence rates decreasing than ever before by using surgical hernia mesh.

Hence, the focus in hernia surgery is now shifted in defining, assessing and identifying risk factors relating to chronic pain. Chronic pain hernia surgery is a vital problem for a considerable number of patients. Some identified risk factors for post-operative pain include younger age, female gender, hernia recurrence, operative complications, and elevated pain levels in the immediate post-operative period. However, recent evidence confirms the safety and effectiveness of mesh utilization in hernia surgery. The recent evidence demonstrates that hernia repair with mesh is not linked to an intolerable level of severe chronic pain. Complication rates are low for hernia repair surgery and in majority of cases, not related to the mesh itself. It is shown that pain scores normally improve post 1 year of hernia repair.

How long does Hernia mesh last?

Non-absorbable mesh stay in the body forever and is termed as an everlasting implant. It is used to provide long-lasting support to the repaired hernia. On the contrary, absorbable mesh gets degraded eventually, losing its strength over time depending on its composition. It is not meant to provide lasting support to the repair site. As the absorbable mesh material degrades, new tissue growth is meant to give power to the repair.

If you are unsure about the specific which mesh to go with, mesh manufacturer and brand used in your surgery and have questions about your hernia repair, contact your surgeon or the facility where your surgery was performed to obtain the information from your medical record.