الفهرس 
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Abstract
Summary
Summary
Incisional hernia is a diffuse extrusion of the abdominal contents through a weak scar after an operation. It represents a partial abdominal dehiscence where the deep layers separate but the skin remains intact.
It is a common complication after abdominal surgery and an important source of morbidity and mortality. The incidence of its occurrence has seriously increased over the past decade, jumping from 11%, up to 20%.
Several factors are known to predispose to the development of incisional hernia. A number of these factors are specially related to the performance of the operation. They include the type of incision, the type of suture material, the suturing technique, the type of closure, insertion of drains and postoperative wound infection.
Numerous authors have suggested that wound infection is the most important causative factor for the development of incisional hernia.
It is therefore very clear that surgeons, through choice of incision and suture material, careful surgical technique, adequate control of infection and sound preparative preparation of the patient, have the necessary knowledge and information to minimize the incidence of incisional hernias.
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Summary
Repair of incisional hernias is an ongoing challenge in general surgery. It requires adequate preoperative assessment by reduction of weight, treatment of associated medical conditions, skin preparation, prophylaxis against deep vein thrombosis and antibiotic administration.
A wide variety of surgical techniques designated to close the defect and reinforce the musculofascial tissues have been described and recommended. Starting from the classical methods of repair including primary suturing techniques and ending with the novel techniques of repair by prosthetic materials positional either via open or laparoscopic approach.
Larger or massive forms of incisional hernia require treatment using a replacement material to compensate for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. This could be accomplished with the use of a variety of prosthetic materials positioned either dorsal or ventral to the fascial defect. The failure of fascia lata and whole skin grafts naturally led surgeons to investigate the possible usefulness of other prosthesis, namely synthetic meshes in order to patch the defect and reinforce the muscles in a tension-free manner.
Polypropylene mesh is the most commonly used prosthetic material for repair. It is ideal, as it is available, flexible, can be cut to the required shape, inert, elicit little tissue reaction and incorporated by human tissues. Expanded polytetrafluoroethylene (ePTFE) mesh is
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Summary
recently discovered and has the same advantages as polypropylene but less commonly used.
The mesh may be implanted in several ways chosen on an anatomic basis either prefascial (onlay), subfascial (retrorectal) or intraperitoneal via open or laparoscopic surgery.
Of the many proposed techniques, subfascial or retrorectal placement of the mesh developed by Rives and Stoppa is preferred and applicable to all types of abdominal incisional hernias.
When the retromuscular space is undissectable, the prosthesis must be implanted intraperitoneally. This technique is indicated mainly in giant and recurrent hernias. It is simple and does not require dissection of the intermediate layers, thus decreasing the risk of seroma formation or infection.
In 1990, a new minimally invasive approach for fixation of the mesh intraperitoneally by laparoscopy was introduced. The laparoscopic approach has several advantages when compared to the traditional open repair. Patients are reported to have less time of hospital stay, less risk of haematoma and seroma.
Laparoscopic repair may be associated with complications related to laparoscopy, including trocar injuries to bowel or vessels, hernia formation at the trocar sites and subcutaneous emphysema. This method of repair is a valuable addition to the treatment of incisional hernias as it decreases the rate of both complications and recurrence.