Incisional Hernias

  • Carmelo MilitelloEmail author
  • Franco Mazzalai


The incisional hernia is an ever more frequent complication of laparotomy which frequently occurs in elderly people. The main problems in the management of incisional hernia are discussed.

Special attention is paid to the surgical approach. The classic Rives–Stoppa technique is described as well as modern laparoscopic methods. The feasibility of these in the elderly is demonstrated.

The use of prosthetic meshes is the gold standard for the repair of incisional hernias. The main materials are described with their advantages and problems.

The therapeutic and physiopathological problems are emphasized, especially with respect to the large incisional hernias and their clinical implications in the elderly.

The importance of systemic impairments such as hypertension, diabetes, respiratory disease, and obesity, which are both etiologic and risk-increasing factors, is underlined.

The advances in the knowledge of both loco-regional abdominal wall impairment and distant troubles (initially respiratory) are emphasized.

Finally, the care in preoperative preparation and postoperative observation is pointed out together with the closing of the wall defect with restoration of a correct abdominal pressure.


Hernia Incisional hernia Prosthetic mesh Elder Elderly Large incisional hernia Open incisional hernia repair Laparoscopic incisional hernia repair Incisional hernia physiopathology 


  1. 1.
    Caglià P, et al. Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg. 2014;12(Suppl 2):S164–9.CrossRefGoogle Scholar
  2. 2.
    Langer C, et al. Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia. 2005;9:16–21.CrossRefGoogle Scholar
  3. 3.
    Deerenberg EB, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicenter, randomised controlled trial. Lancet. 2015;26:1254–60.CrossRefGoogle Scholar
  4. 4.
    Ohira G, et al. Synthetic polyglycomer short-term absorbable sutures vs. polydioxanone long-term absorbable sutures for preventing incisional hernia and wound dehiscence after abdominal wall closure: a comparative randomized study of patients treated for gastric or colon cancer. Surg Today. 2015;45:841.e–5.e.CrossRefGoogle Scholar
  5. 5.
    Tandon A, et al. Parietex™ composite mesh versus DynaMesh®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study. Ann R Coll Surg Engl. 2016;98:568–73.CrossRefGoogle Scholar
  6. 6.
    Zhang Y, et al. Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg. 2014;38:2233–40.CrossRefGoogle Scholar
  7. 7.
    Al Chalabi H, et al. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65–74.CrossRefGoogle Scholar
  8. 8.
    Kössler-Ebs JB, et al. Incisional hernia rates after laparoscopic or open abdominal surgery. A systematic review and meta-analysis. World J Surg. 2016;40:2319–30.CrossRefGoogle Scholar
  9. 9.
    Le Blanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2016;20:85–99.CrossRefGoogle Scholar
  10. 10.
    Pawlak M, et al. Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial. Surg Endosc. 2016;30:1188–97.CrossRefGoogle Scholar
  11. 11.
    Abet E, et al. Laparoscopic incisional hernia repair: long term results. J Visc Surg. 2014;151:103–6.CrossRefGoogle Scholar
  12. 12.
    Ahonen-Siirtola M, et al. Complications in laparoscopic versus open incisional ventral hernia repair. A retrospective comparative study. World J Surg. 2016;39:2872–7.CrossRefGoogle Scholar
  13. 13.
    Bondre IL, et al. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res. 2016;200:488–94.CrossRefGoogle Scholar
  14. 14.
    Wantz GE. Atlas of hernia surgery. New York: Raven Press; 1991.Google Scholar
  15. 15.
    Chevrel JP. Classification of the incisional hernia of the abdominal wall. Hernia. 2000;4:7–11.CrossRefGoogle Scholar
  16. 16.
    Romano G, et al. Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant. Aging Clin Exp Res. 2016;29(Suppl 1):173–7.PubMedGoogle Scholar
  17. 17.
    Klinge U, et al. Development and pathophysiology of abdominal wall defects. Chirurg. 1997;68:304–9.CrossRefGoogle Scholar
  18. 18.
    Franz MG. The biology of hernias and the abdominal wall. Hernia. 2006;10:462–71.CrossRefGoogle Scholar
  19. 19.
    Trivellini G, et al. Traitement chirurgical des grandes eventrations. Etude d’une technique adaptée aux troubles de la compliance respiratoire. Chirurgie. 1984;110:116–22.PubMedGoogle Scholar
  20. 20.
    Jensen KK, et al. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery. 2017;161:517–24.CrossRefGoogle Scholar
  21. 21.
    Goni Moreno I. Les pneumopéritoines dans la reparation pré-opératoire des grandes éventrations. Chirurgie. 1970;9:581–5.Google Scholar
  22. 22.
    Rives J, et al. Major incisional hernias. New York: Springer; 1987. p. 116–44.Google Scholar
  23. 23.
    Munegato G, et al. Respiratory physiopathology in surgical repair of large abdominal hernias. In: Crovella F, et al., editors. Incisional hernia. New York: Springer; 2008. p. 57–70.CrossRefGoogle Scholar
  24. 24.
    Renard Y, et al. Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery. 2016;160:426–35.CrossRefGoogle Scholar
  25. 25.
    Elstner KE, et al. Preoperative progressive pneumoperitoneum complementing chemical component relaxation in complex ventral hernia repair. Surg Endosc. 2016;31(4):1914–22.CrossRefGoogle Scholar
  26. 26.
    Angelici AM, et al. Measurement of intra-abdominal pressure in large incisional hernia repair to prevent abdominal compartmental syndrome. G Chir. 2016;37:31–6.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Geriatric Surgery UnitUniversity of PaduaPaduaItaly
  2. 2.General SurgeryTreviso HospitalTrevisoItaly

Personalised recommendations