Laparoscopic incisional hernia repair at Nuffield Health at St Bartholomew's Hospital

What is an incisional hernia?

An incisional hernia is caused by a weakening in your abdominal wall at the site of an scar from previous surgery.

If the wound from the original surgery doesn't heal properly, this weakness can lead to the contents of the abdomen pushing through, producing a lump.

A hernia can be dangerous because the intestines or other structures within the abdomen can get trapped and have their blood supply cut off (strangulated hernia). That's why it's important to seek help as soon as possible if you suspect you have a hernia.

What are the benefits of laparoscopic incisional hernia repair?

You should no longer have a hernia, which will prevent serious complications.

If you are female, let your surgeon know if you are planning to become pregnant. Pregnancy increases the size of your abdomen and may undo the hernia repair.

How long do the benefits last?

There's a small chance that the hernia can come back, even many years later, so you may need another operation if so. This all depends on:

• the size of the hernia
• the strength of your abdominal muscles
• whether you're overweight or have underlying medical problems.

What happens during laparoscopic incisional hernia repair?

This procedure is usually performed under general anaesthetic and can take several hours.

Laparoscopic (keyhole) surgery is associated with less pain and scarring than open surgery, as well as a faster return to normal activities.

In some cases, laparoscopic surgery can't be performed, and you may need to have open surgery instead. Your surgeon will carefully assess you beforehand. 

Before the procedure

There are a few things you can do in the lead up to the procedure to make sure everything goes as smoothly as possible:

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly – but don't do anything that involves heavy lifting or makes your hernia painful
• In the week before the operation, don't shave or wax the area where a cut is likely to be made
• Try to have a bath or shower either the day before or on the day of the operation
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

During the procedure

1. Once you're under anaesthetic, your surgeon will make a small cut on or near your belly button and insert an instrument to inflate your abdominal cavity with carbon dioxide
2. They'll then make two more cuts on your abdomen so they can insert surgical instruments, as well as a laparoscope (tiny telescope), via thin tubes
3. Your surgeon will free up the structures from your abdomen that are stuck in the hernia and reinforce the area with surgical mesh and staples 
4. Finally, they'll close the cuts with stitches or glue.

After the procedure

You'll be taken to the recovery room where you'll wake up. A nurse will be there to look after you.

You may have a tube in your wound to drain away fluid that can sometimes collect.

Recovery from laparoscopic incisional hernia repair

Most people make a good recovery and return to day-to-day activities within 2 weeks. You'll have some more scarring, which should fade over time.

Short-term recovery 

Once you're back in your room, the healthcare team will check on you to make sure you're recovering well. You'll either be given injections of local anaesthetic or medication to control the pain, which is important so that you can move about and cough freely.

After keyhole surgery it's common to have some pain in your shoulders due to the small amount of carbon dioxide gas that may be left under your diaphragm. Your body will absorb the gas naturally over the next 24 hours, which will ease these symptoms.

Our team of specialist physiotherapists will provide expert treatment, rehabilitation and advice during your hospital stay and, if appropriate, follow-up as an outpatient to support your full recovery. 

You should be able to go home the same day or you may need to spend one night in hospital. If you home on the day of the procedure, for the first 24 hours:

• you’ll need someone to take you home and stay with you overnight
• don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and co-ordination
• you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

You should get plenty of rest for the first 24 hours, but then it’s important to stay active to avoid blood clots. Make sure you follow the instructions from our healthcare team on medication or special compression stockings. 

Here are a few things you can do to make sure you recover well:

• Gradually increase how much you walk over the first few days
• Regular exercise should help you return to normal activities
• Don't do any strenuous exercise for 3 weeks
• You don't need to avoid heavy lifting, but you may find it uncomfortable to do so in the first 2–4 weeks
• Wait until about 2 days after your procedure before you shower, removing any dressings beforehand – it's okay to let the little pieces of tape (steri-strips) get wet and these will start to peel off around a week afterwards
• Don't bathe or use pools or hot tubs for 2 weeks after surgery.

If you notice any of the following symptoms, let the healthcare team know straightaway as it can be a sign you have a serious complication.

• Pain that gets worse over time or is severe when you move, breathe or cough
• A high temperature or fever
• Dizziness, feeling faint or shortness of breath
• Feeling sick or not having an appetite, which gets worse after the first 1–2 days
• Not opening your bowels and not passing wind
• Swelling in your abdomen
• Difficulty passing urine.