Incisional hernia is a common complication after abdominal surgery, occurring when the abdominal wall fails to heal properly at the site of a previous incision. While primary repair and even mesh-based open repairs are effective in many cases, recurrence remains a significant challenge, especially in patients with risk factors such as obesity, diabetes, chronic cough, smoking, or multiple prior surgeries. Recurrent incisional hernias are often more complex due to adhesions, weakened tissues, and distorted anatomy.

With the advancement of minimal access surgery, laparoscopic repair of recurrent incisional hernia using Prolene mesh has become a standard and effective approach. It combines the benefits of laparoscopy—reduced postoperative pain, fewer wound complications, faster recovery—with the durability of mesh reinforcement to significantly lower recurrence risk.

Introduction

Recurrent incisional hernias can severely impact patient quality of life, presenting with:

Visible or painful abdominal bulge at or near the previous repair site.

Discomfort, particularly during activity or straining.

Functional limitations due to weakened abdominal wall integrity.

Psychological concerns due to repeated failure of prior repair.

Traditional open re-repair carries high risks of wound infection, seroma, and re-recurrence. By contrast, laparoscopic repair allows for safe dissection, broad mesh coverage, and durable results with fewer complications.

Indications for Laparoscopic Repair

Recurrent incisional hernia after open or laparoscopic repair.

Symptomatic hernias with pain, discomfort, or functional impairment.

Moderate to large defects where primary suture repair is not feasible.

Patients seeking minimally invasive treatment with faster recovery.

Contraindications include strangulated hernia requiring emergency laparotomy, unfit patients for general anesthesia, or extremely large defects requiring component separation.

Preoperative Preparation

Clinical evaluation to assess hernia size, reducibility, and prior surgical scars.

Imaging (CT scan) is often recommended to delineate defect size, location, and presence of adhesions.

Optimization of comorbidities such as diabetes, COPD, or obesity to reduce recurrence risk.

Smoking cessation and weight management are encouraged.

Antibiotic prophylaxis is administered to prevent surgical site infection.

Surgical Technique

Anesthesia and Positioning

General anesthesia is required.

The patient is placed in a supine position, often with slight Trendelenburg or lateral tilt depending on defect location.

Port Placement

Pneumoperitoneum is established using a Veress needle or open technique.

A 10 mm camera port is inserted away from prior scars.

Additional 5 mm working ports are placed under vision for triangulation.

Adhesiolysis

Adhesions around the hernia sac and previous repair site are carefully released.

Special care is taken to avoid bowel injury, which is a higher risk in recurrent cases.

Hernia Content Reduction

Any omentum or bowel protruding through the defect is reduced.

The defect margins are inspected for healthy tissue.

Mesh Placement

The recurrent defect is covered with a large Prolene mesh (polypropylene mesh).

The mesh is tailored to ensure at least 5 cm overlap beyond all margins of the defect to prevent recurrence.

The mesh is introduced intraperitoneally and positioned against the abdominal wall.

Mesh Fixation

Mesh is fixed with a combination of transfascial sutures and laparoscopic tackers for secure placement.

Ensuring firm fixation minimizes the risk of migration or folding, which could cause recurrence.

Completion

Pneumoperitoneum is released gradually.

Port sites are closed securely, particularly larger ones, to prevent port-site hernia.

Postoperative Care

Early ambulation is encouraged to reduce thromboembolic risk.

Oral fluids are resumed within hours, progressing to a soft diet.

Pain management is usually straightforward with oral analgesics.

Discharge is possible within 24–48 hours in most patients.

Patients are advised to wear an abdominal binder and avoid heavy lifting for 6–8 weeks.

Advantages of Laparoscopic Repair with Prolene Mesh

Minimally invasive approach with less pain and faster recovery.

Wide mesh overlap covering weak areas reduces recurrence risk.

Fewer wound-related complications compared to open repair.

Superior visualization of abdominal cavity allows thorough adhesiolysis and identification of occult defects.

Durable results with low recurrence rates when mesh is properly placed and fixed.

Complications

Although safe, certain risks exist:

Bowel injury during adhesiolysis (higher risk in recurrent cases).

Seroma or hematoma formation under the mesh.

Chronic pain from sutures or tackers.

Mesh infection (rare but serious, requiring removal).

Recurrence if mesh overlap or fixation is inadequate.

With meticulous technique, these risks are minimized.

Conclusion

Laparoscopic repair of recurrent incisional hernia with Prolene mesh is a highly effective procedure that addresses the challenges of recurrent abdominal wall defects. It allows comprehensive adhesiolysis, secure closure, and reinforcement with durable mesh, all through a minimally invasive approach. Patients benefit from less pain, quicker recovery, and reduced wound complications compared to open surgery.

By ensuring adequate mesh overlap, strong fixation, and careful patient selection, this technique provides lasting repair and restores both function and confidence to patients who have struggled with repeated hernia recurrences.