Incisional hernias rarely resolve spontaneously. Without surgical repair, the defect usually enlarges over time and may lead to life-threatening complications. Surgical repair is the only definitive treatment, and laparoscopic techniques have become the standard of care for many patients.

Laparoscopic Repair: Step-by-Step
Anesthesia and Positioning

The procedure is performed under general anesthesia. The patient is placed in a supine position, and the abdomen is prepared for laparoscopic access.

Port Placement

A 10 mm camera port is inserted, typically away from the hernia defect.

Two or three 5 mm working ports are placed to allow instrument manipulation.
This setup ensures optimal access to the hernia site.

Adhesiolysis

Adhesions between the hernia sac and abdominal organs are carefully dissected. This step requires precision to avoid injury to the bowel, especially in recurrent or large hernias.

Reduction of Hernia Contents

The herniated structures, such as omentum or intestines, are returned to the abdominal cavity. Complete reduction is necessary for effective repair.

Defect Measurement

The size of the defect is measured. Adequate assessment ensures that the mesh will cover the defect with at least 3–5 cm of overlap in all directions, reducing the risk of recurrence.

Mesh Placement

A composite mesh (safe for intraperitoneal use) is rolled and inserted through the port. Once inside, it is spread across the defect to provide a strong barrier.

Mesh Fixation

The mesh is secured using:

Transfascial sutures that pass through the abdominal wall

Tackers or absorbable fixation devices applied laparoscopically around the perimeter
This dual fixation ensures stability and prevents mesh migration.

Irrigation and Closure

The abdominal cavity is inspected for bleeding. Ports are removed, and incisions are closed with sutures.

Benefits of Laparoscopic Repair

Minimally Invasive: Small incisions result in less scarring and quicker healing.

Better Visualization: Magnified laparoscopic view allows precise dissection.

Less Pain: Reduced postoperative discomfort compared to open surgery.

Lower Infection Risk: Avoids reopening of scar tissue and minimizes wound complications.

Durable Repair: Large mesh overlap ensures long-term strength.

Faster Recovery: Most patients are discharged within 1–2 days and return to work sooner.

Risks and Challenges

Although safe, laparoscopic repair does carry risks:

Bowel injury during adhesiolysis

Bleeding or injury to surrounding structures

Seroma (fluid collection at the hernia site)

Mesh-related complications such as infection or shrinkage

Recurrence if mesh placement is inadequate

These risks are rare when surgery is performed by an experienced laparoscopic surgeon.

Postoperative Care

Patients are encouraged to mobilize early to prevent complications.

Pain is managed with oral medications.

A light diet is resumed within 24 hours.

Physical activity, including heavy lifting, is restricted for several weeks.

Long-term care includes weight management and control of chronic cough or constipation to prevent recurrence.

Outcomes and Success Rates

Multiple studies have shown that laparoscopic incisional hernia repair has success rates above 90–95%, with lower rates of wound complications compared to open repair. Patients report high satisfaction due to smaller scars, less pain, and quicker return to normal activities. Recurrence rates remain low when mesh overlap and fixation are adequate.

Conclusion

The laparoscopic repair of incisional hernia is a modern, effective, and patient-friendly solution to a long-standing surgical challenge. By combining minimally invasive access with durable mesh reinforcement, it ensures better cosmetic results, faster recovery, and strong long-term outcomes.

For patients living with the discomfort and risks of incisional hernia, laparoscopic repair offers hope of lasting relief and restored quality of life.