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What is the treatment for recurrent incisional hernia?

Q: I have swellings in the left lower abdomen and just above the navel. I underwent abdominal hysterectomy 20 years back and developed stomach pain due to adhesions in 2000 & laporotomy was done (limited resection of sigmoid). Then I developed incisional hernia and hernioplasty was done with prolene mesh. Then again I developed ventral hernia; hernioplasty was done using prolene mesh along medial side of prevous scar. Now the local doctor has advised for an abdominoplasty using prolene mesh. I would like your advice on the course of treatment I should follow. Which specialists, preferably in India, should I consult?

A:From your description, you seem to have a recurrent incisional hernia. If so, you require a mesh repair. Incisional hernia has the highest recurrence rate for all hernias. Over 5% of hernias will recur after a mesh repair; without a mesh repair the recurrence rate is 35-50%. Since you have had several recurrences, you must be repaired with a large mesh. The advice given to you sounds correct. The operation is likely to be difficult. I think that laparoscopic repair may be slightly easier in your case, since neither of the previous repairs was laparoscopic. It should do no harm to consult a laparoscopic surgeon who has extensive experience with incisional hernia repairs. The results are almost as good as those after open repair.


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