Incisional and large hernia repair with mesh

An incisional hernia forms in the scar of a previous abdominal operation: the wall has not healed properly and lets part of the abdominal contents bulge under the skin. It shows as a swelling that increases when standing and on exertion. Excess weight, smoking, diabetes or a wound infection at the time of the first operation make it more likely. Some very wide umbilical or epigastric hernias are treated in the same way. The repair consists of returning the contents, bringing the muscles back together and reinforcing the wall with a mesh. Depending on size and location, the mesh is placed behind the muscles through an open approach, or inside the abdomen by laparoscopy. For very wide incisional hernias, muscle release techniques make it possible to close the wall without tension. Surgery is offered when the incisional hernia is bothersome, painful, growing, damaging the skin or has already caused episodes of obstruction. For large hernias, it is often useful to prepare for surgery: weight loss, stopping smoking, good diabetes control. At Clinique Pasteur Tunis, incisional hernia repair is planned in consultation with a CT scan of the abdominal wall, which measures the size of the defect and guides the choice of technique. The length of stay depends on the extent of the repair.