Ventral/Incisional Hernia Repair (Open and MIS Approaches)
This chapter describes the surgical procedure for ventral/incisional hernia repair as performed by the following approaches: open and MIS. Indications for the procedure include the presence of an epigastric, ventral or incisional hernia, and a staged closure of a large omphalocele. The procedure-specific risks include recurrent hernia, enterocutaneous fistulas, adhesions, granulomas, chronic pain and, if mesh is utilized, mesh infection or migration. Alternatives to the procedure (except in the case of strangulation/incarceration) are symptom management. Variations in the procedure include robotic, laparoscopic, and open hernia repairs, the latter two of which will be described. A description is provided of the following critical concepts for this procedure: identification of hernia sac with reduction of hernia contents and adhesiolysis, identification and freshening of the fascial edges, primary fascial closure or closure with mesh, and incisional closure. If mesh is utilized in an open repair, the mesh may be placed in an underlay, sublay, inlay, or onlay repair. The underlay and sublay approaches will be reviewed.