الفهرس 
INCISIONAL HERNIAOnly 14 pages are availabe for public view
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Abstract
An incisional hernia has been defined as a bulge visible and palpable when the patient is standing, seen over previous abdominal scar and often requiring support or repair. It is a common complication of abdominal surgery, reported in up to 11 percent of patients generally and in up to 23 percent of those who develop postoperative wound infection.
The diagnosis can usually be made by clinical examination. In addition, CT scan may be a useful adjunct in confirming the diagnosis as well as determining the contents and extent of the hernia.
In general, factors causing incisional hernia development can be identified. First of all, conditions associated with impaired wound healing e.g. wound infection, diabetes mellitus and high age with atrophic abdominal wall.
Summary
Secondly, conditions associated with increased abdominal cavity pressure e.g. chronic cough, ascitis and constipation. Moreover, factors related to surgical technique and suture materials used. Some types of incision, such as the lateral paramedian and transverse incisions have proven to cause less incisional hernia than, for example, the midline incision.
The length of the suture used should exceed the length of the wound by at least 4 times. Multifilament sutures result in an increased incidence of wound infection and should therefore not be used.
Treatment involves further major surgery and the results may be poor. A wide spectrum of surgical techniques has been developed and recommended, ranging from sutured techniques to the use of various types of prosthetic mesh.
The use of prostheses has become essential for repair of all hernias since the recurrence rates are consistently lower when they are used; and to fulfill this requirement, a variety of novel meshes have been engineered.
Summary
Surgeons should acquire adequate knowledge of all different types of prostheses in order to select an appropriate one for a given case. Prosthesis with either an absorbable or a non-absorbable barrier should be used for intra-abdominal placement to prevent bowel adhesions. Selection of an optimum size and its proper fixation are mandatory. Complications may be avoided or minimized with proper selection of cases and performance of a meticulous technique.
Laparoscopy has revolutionized the practice of surgery by imparting the ability to avoid major abdominal wall incisions. Laparoscopic incisional hernia repairs have become increasingly popular because of the decreased hospital stay, decreased complication rates, and lower recurrence rates. The laparoscopic approach utilizes the intra-peritoneal space to place the mesh directly onto the peritoneum thus minimizing the amount of soft tissue dissection necessary to attain adequate mesh overlap.
Summary
Another benefit of the laparoscopic approach is identifying small fascial defects, known as ‘‘Swiss cheese’’ defects, which may be missed during an open repair. These small fascial defects are a source of incisional hernia recurrence; therefore identification is important for a successful hernia repair.
It appears that laparoscopic repair has many advantages over conventional repair. However, laparoscopic repair demand advanced laparoscopic skills, and are not devoid of serious complications. Meticulous technique, a high index of suspicion in regard to possible bowel injury and surgical awareness of conversion to open procedure should make this approach a safe and better alternative to open incisional hernia repair.