Ventral &
Incisional Hernia
Restoring the abdominal wall, not simply covering a defect.
Three pathways. Tailored to the hernia.
Different hernias need different solutions. I favour the smallest operation that gives a reliable repair.
Suture repair
For selected very small umbilical or epigastric hernias, particularly in thin patients with good-quality tissue, a suture repair without mesh may be appropriate.
Very small defects in selected patients.
IPOM+ (laparoscopic)
For selected smaller ventral or incisional hernias, the fascial defect can be closed laparoscopically and reinforced with intraperitoneal mesh.
Small to moderate primary or selected incisional hernias.
Retrorectus reconstruction
For larger ventral and incisional hernias, reconstruction of the abdominal wall with closure of the fascial defect and mesh reinforcement behind the rectus muscles is often appropriate.
Larger, recurrent or more complex abdominal wall hernias.
Why I favour retrorectus repair
For larger ventral and incisional hernias, I commonly use a retrorectus approach, with closure of the fascial defect and broad mesh reinforcement behind the rectus muscles.
Placing the mesh in the retrorectus plane allows the repair to be reinforced while keeping the mesh outside the abdominal cavity and away from the bowel.
The aim is to restore the abdominal wall as a functional structure rather than simply bridge or cover the hernia opening.
Mesh choice
Mesh selection is tailored to the individual patient, the type of hernia and the operation being performed.
Options include permanent synthetic meshes as well as long-term resorbable meshes such as Phasix (P4HB).
Resorbable mesh can be an attractive option in selected patients because it provides reinforcement during healing and remodelling before gradually being absorbed.
There is no single mesh that is right for every patient. Mesh type, position and the overall repair strategy are considered together.
Permanent and resorbable meshes each have potential advantages. The choice depends on the anatomy of the hernia, the strength of the tissues, previous surgery, contamination risk and the durability required from the repair.
The journey
Let’s find the right repair for you
Every hernia and every patient is different. An individualised plan can be made after assessment.