A hernia is a protrusion of tissue, fat, bowel or organ from the structure that contains it. It results due to the weak spots in the area either in the abdominal wall muscles, upper thigh, or groin area.
A hernia can be treated only by surgical options. Hernia operations are among the most common procedures performed. There are various surgical options available to treat hernia and laparoscopic incisional hernia repair is found to be the most advanced technique used to treat them. Here we are going to discuss the differences between laparoscopic Vs open incisional hernia repair.
An incisional hernia is those that develop as a bulge through the healed incision of previous surgery in your abdomen. It usually results due to the weakness in the tissues and muscles of your abdomen. Let’s see how a laparoscopic incisional hernia repair can help get rid of it?
- Laparoscopic Ventral/Incisional hernia repair
Laparoscopic repair of ventral/incisional hernia depends upon its size, shape, location, recurrence, number, and symptoms of the hernia. The procedure involves
- Making an approach to the peritoneal cavity- The surgeon may assess the peritoneal cavity to reach the hernia site by inserting catheters or trocars inside the abdomen.
- Making space into the peritoneal cavity – Once the peritoneal cavity is approached your surgeon may examine the abdominal wall defect and herniated organs carefully. He may also reduce the incarcerated or strangulated organs by pulling them into the abdominal cavity with the help of endoscopic instruments. The space made into the peritoneal cavity is used to place the mesh. It is the most important step of the surgery.
- Adhesiolysis- After making a space, adhesiolysis is performed where the organs attached to the abdominal wall are separated or dissected using various techniques like blunt dissection, cold-scissor dissection, hot-scissor dissection, bipolar cautery dissection, and ultrasonic dissection.
- Managing intestinal injury caused during adhesiolysis – any injury to the intestinal organs should be managed effectively and the treatment of injured organs should be done first. It can be performed by the laparoscopic suturing process.
- Hernia repair – the last step of the laparoscopic repair of ventral/incisional hernia surgery is hernia repair which is done by two techniques:
- The primary closure technique – In this technique, the hernia is repaired by correcting the defects in the abdominal wall. This is done by suturing the sites after applying a mesh to the site.
- The bridging technique: The mesh is simply placed at the hernial site or between the defect.
Open Incisional hernia repair
In this procedure, the surgeon makes an incision about the length of the lump present. The subcutaneous layer and scar tissue were then dissected from the abdominal wall to identify and expose the hernia sac. The contents of the hernia sac were dissected from beneath the rectus abdominis muscles if possible. The defect was then closed and a mesh was placed preperitoneal or in the sublay position. Following the repair, the layers of the tissues are brought back together by suturing them.
Difference between Laparoscopic vs Open Incisional Hernia Repair
Numerous research studies have been conducted to understand the benefits of Laparoscopic incisional hernia repair over open repair. The studies suggest that Laparoscopic incisional hernia repair is performed comparatively less than open repair. It is because of the complexity of some incisional hernias which make laparoscopic surgery unsuitable as it may cause more severe complications than open repair.
The below table enlists some of the differences between the laparoscopic Vs Open incisional hernia repair
| S.no | Laparoscopic Incisional Hernia Repair | Open Incisional Hernia Repair |
| 1. | Operative time is around 90-100 minutes | Operative time is around 70-80 minutes |
| 2. | Estimated blood loss is around 10 mL during operation | Estimated blood loss is around 10 mL during operation |
| 3. | Less need for a wound drain around (3%) | Around 45% of wound drain is required in open surgery |
| 4. | Effective technique with lower recurrence rates | Lower recurrence rates similar to laparoscopic surgery |
| 5. | Depending on the severity of the condition hospital stay can range anywhere between 1.5 -4 days | Depending on the severity of the condition hospital stay can range anywhere between 2-5 days |
| 6. | Less postoperative pain and nausea compared with open incisional hernia repair | Patients experience post-operative pain and nausea |
| 7. | After laparoscopic surgery, patients are expected to mobilize and recover faster. | After open incisional hernia repair patients usually take some time to recover and mobilize |
| 8 | Chances of intestinal injury during the process is greater | Fewer chances of intestinal injury |
Summary:
Even though Open repair surgery is considered to be frequently used for treating incisional hernia. Currently, the incidence of laparoscopic hernia surgery has been gradually increasing. However, the laparoscopic technique for incisional hernia depends on the size, shape, location, number, recurrence, and symptoms of the hernia. So discuss with your surgeon which is more suitable for you.
