Incisional Hernia Surgery in Ankara, Turkey

Incisional hernia surgery is performed to repair a hernia that develops along the incision line after previous surgical operations. These hernias may cause abdominal organs to protrude outward and can lead to serious complications.

In incisional hernia, surgical repair is usually performed with mesh material. This method strengthens the abdominal wall and prevents the hernia from recurring. The type of surgery is planned according to the size of the hernia and the patient’s general condition.

In the postoperative period, regular monitoring of wound healing is important. Appropriate care methods should be applied to reduce the risk of infection and increase durability along the wound line. Lifestyle changes by the patient support the process.

There is a risk of recurrence after incisional hernia surgery. Factors such as obesity, chronic cough, and carrying heavy physical loads increase this risk. Therefore, reducing these risks is recommended in the postoperative period.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Incisional Hernia Surgery in Ankara, to get information about Incisional Hernia Surgery prices, the process, and the hospital where Incisional Hernia Surgery is performed.

What Is an Incisional Hernia?

After a surgery you have undergone, the healing process of the muscle and fascia layers that the surgeon has brought together may not always be perfect. An incisional hernia is a failure of this healing process. This condition is not merely a mechanical event like “the stitches coming apart”; the underlying reason is that the tissue in that area remains biologically weak. When collagen production and remodeling, which are our body’s natural repair mechanisms, do not occur as they should, the repaired tissue remains fragile. This fragile line slowly stretches over the years with even the slightest strain that increases intra-abdominal pressure—such as coughing, straining, or heavy lifting—and eventually tears.

This is essentially a wound healing problem. Because the tissue itself does not fuse solidly, no matter how well it is sutured, it may eventually give way. There are some important risk factors that increase the likelihood of this condition. These factors are generally related to the person’s own health status or the conditions of the initial surgery.

Some conditions related to the person that increase the risk of hernia are:

• Excess weight (Obesity)
• Uncontrolled diabetes
• Smoking
• Poor nutrition
• Long-term corticosteroid use
• Immunosuppressive medications

There are also risk factors related to the process and conditions of the initial surgery:

• Being performed under emergency conditions
• Development of a wound infection after surgery
• Vertical incisions made along the midline of the abdomen
• Incorrect suturing technique used during surgery

In Which Cases Is Incisional Hernia Surgery Performed?

Not every incisional hernia has to be operated on immediately. Small hernias that cause no complaints can be followed for a while. However, when the hernia begins to affect a person’s quality of life or indicates a dangerous situation, surgical repair becomes inevitable. The most important factors leading to the decision for surgery are the discomfort the hernia causes and the potential dangers.

For example, if the swelling in the hernia area has started to cause pain, restrict daily movements, or bother the person cosmetically, surgery may be planned. Hernias tend to grow over time. A tear that is small today may become much larger and more complex to repair a few years later. To stop this growth process and avoid a bigger surgery in the future, intervening in the early period is generally more reasonable.

The most important reason for surgery is the risk of “hernia strangulation” (strangulation). This occurs when a piece of intestine entering the hernia sac becomes trapped in the tear and its blood flow is impaired. If not treated urgently, this is an extremely dangerous, life-threatening condition that can lead to necrosis and perforation of the intestine. Sudden severe pain in the hernia area, redness, bruising, and the inability to push that swelling back in may be signs of strangulation. To avoid this risk, having surgery under planned and safe conditions is always the most appropriate approach.

For a successful surgical outcome, surgical technique alone is not sufficient. It is equally important for the patient to undergo surgery under the best possible conditions. Therefore, some preparations are made before surgery. These preparations include:

• Quitting smoking at least 4 weeks in advance
• Bringing blood sugar levels under control
• Losing weight to get closer to an ideal weight
• Improving nutritional status

These steps are not taken to postpone surgery, but are critical steps taken to increase the chance of success by maximizing the body’s wound-healing potential.

What Are the Risks of Incisional Hernia Surgery?

By nature, every surgical intervention carries certain risks, and incisional hernia surgeries are no exception. However, thanks to modern surgical techniques, anesthesia methods, and postoperative care protocols, these risks have been minimized. With detailed preoperative evaluations, the patient’s personal risks are identified and measures are taken to reduce them. When deciding on surgery, the risks created by the current state of the hernia and the potential risks of surgery are always weighed against each other. In general, the dangers of leaving the hernia untreated are far greater than the risks of a planned surgery.

Among the general surgical risks of the operation are complications such as undesired anesthesia-related events, bleeding, or postoperative clot formation in the vessels. However, these are quite rare. There are also some potential problems more specific to hernia surgery and more commonly encountered:

Some risks specific to this surgery are as follows:

• Seroma (accumulation of clear body fluid in the surgical area)
• Hematoma (accumulation of blood in the surgical area)
• Wound infection
• Recurrence of the hernia (recurrence)
• Chronic pain (long-lasting discomfort in the surgical area)
• Injury to neighboring organs (especially the intestines)
• Rare problems related to the mesh used

Most of these risks are manageable and treatable conditions. For example, seroma usually resolves on its own, while the risk of infection is significantly reduced with minimally invasive methods and preoperative preparations. The risk of recurrence is reduced to the lowest level with the right surgical technique and the use of high-quality mesh.

How Is Incisional Hernia Surgery Performed?

The cornerstone of incisional hernia repair is placing a synthetic “mesh” in that area. Repairing weakened and poor-quality tissue by suturing alone is like stitching a worn fabric with a thin thread; it is almost inevitable that it will tear again shortly afterward. Therefore, while recurrence rates in hernia repairs without mesh can reach 50–60%, this rate decreases to below 10%, and even lower, when mesh is used. The mesh acts as a strong scaffold into which the body’s own tissue will grow and integrate over time, ensuring a durable repair.

Surgeries are basically performed with open or closed (minimally invasive) methods. Which method is chosen depends on the size and location of the hernia, the patient’s general condition, and the surgeon’s experience.

Open Surgical Methods

In this method, the hernia area is accessed directly through a single long incision made along the previous surgical scar. The success of open surgery depends on which layer of the abdominal wall the mesh is placed in. The main approaches used in this technique are:

• Onlay (on the muscle)
• Inlay (bridging)
• Sublay (behind the muscle)

Among these methods, the “Sublay,” or retromuscular technique, is accepted today as the gold standard of open surgery. In this technique, the mesh is placed behind the abdominal muscles and in front of the peritoneum. We can compare this to repairing a punctured car tire. Applying the mesh from the inside, where the pressure comes from (Sublay), instead of sticking it on the outside of the tire (Onlay), provides a much stronger and more durable repair. When intra-abdominal pressure increases, the muscles press the mesh and virtually rivet it to the wall. In addition, since the blood supply of this area is very good, the mesh integrates better with the body and the risk of infection is lower.

Closed (Minimally Invasive) Surgical Methods: Laparoscopy and Robotic Surgery

In this approach, instead of making a large incision in the abdomen, the surgery is performed through several small ports using a camera and special surgical instruments. The greatest advantages of this method are less postoperative pain, faster recovery, and most importantly, a much lower risk of wound infection.

Closed surgical approaches are as follows:

• Laparoscopic IPOM (intraperitoneal onlay mesh)
• Robotic Retromuscular Repair (r-TARM / r-eTEP)

Although laparoscopic IPOM was the first popular closed method, it has some disadvantages, such as the mesh being in direct contact with the intestines and the hernia defect generally not being closed. Robotic surgery is the latest and most advanced technology in this field. The robotic system offers wristed instruments that can rotate 720 degrees, eliminate even the slightest tremor of the surgeon’s hand, and provide three-dimensional, high-resolution imaging. Thanks to this technological superiority, “retromuscular repair,” which is the gold standard of open surgery, can now be performed flawlessly with a closed method through small ports. Robotic surgery represents the pinnacle of modern hernia surgery by combining the strength of open repair with the comfort of minimally invasive surgery. The mesh is placed into a safe pocket where it will not come into contact with the intestines at all, and the integrity of the abdominal wall is anatomically reconstructed.

Postoperative Process After Incisional Hernia Surgery

The postoperative period is the most important phase that reinforces the success of the repair. The recovery process may vary from person to person depending on the surgical technique applied and the size of the hernia. While recovery is generally faster and more comfortable after surgeries performed with closed (laparoscopic or robotic) methods, this process may be somewhat longer after large open surgeries.

The in-hospital process is generally based on pain control, early mobilization, and restarting nutrition. It is natural to have pain in the first few days after surgery, and this can be easily managed with effective painkillers. Getting up and starting to walk as soon as possible is very important to accelerate blood circulation, prevent risks such as clots, and ensure that the intestines function normally.

After discharge, the home care process is a period during which you need to give your body time to heal. There are some important points to pay attention to during this process. The main steps of this process are:

• Hospital stay
• Pain management
• Early mobilization (mobilization)
• Dietary routine
• Wound care
• Use of an abdominal binder
• Activity restriction

Your doctor will explain in detail how long you should avoid heavy lifting, and when you can return to your normal activities and work, specifically for you. Following these recommendations is vital for the health of the repair.

What Should Those Who Have Undergone Incisional Hernia Surgery Pay Attention to?

A successful hernia surgery is a joint team effort between the surgeon and the patient. While the surgeon performs the repair with the correct technique, the patient is responsible for protecting this repair. Making some lifestyle changes in the postoperative period and throughout the rest of your life is critical to minimizing the risk of recurrence. Remember, no matter how strong the mesh is, if it is continuously exposed to excessive load, it can eventually weaken.

There are some basic rules to protect your repair in the long term. These are important steps you will take not only for your hernia but also for your general health. Especially the first 3–6 months is the critical period during which the mesh integrates with the body and the repair becomes strongest. Protecting yourself during this period is particularly important.

The most important points to pay attention to in the long term are listed below.

• Avoiding heavy lifting and straining
• Maintaining an ideal body weight
• Quitting smoking completely
• Treating chronic cough
• Eating a fiber-rich diet to prevent constipation
• Strengthening the abdominal muscles with correct timing

In the early postoperative period, there are also some warning signs you should observe in your body. If you notice any of these symptoms, you should apply to your surgeon or the nearest healthcare facility without delay. Situations that may require urgent medical help are:

• High fever
• Increasing pain, swelling, redness, or discharge at the surgical area
• Severe nausea and vomiting
• Excessive abdominal bloating
• Inability to pass gas or have a bowel movement

Incisional hernia surgery is an important opportunity for you to regain your quality of life. Making the most of this opportunity, taking care of the surgical repair, and investing in your health is in your hands.