Complications of Incisional Hernia Repair

Complications after open or laparoscopic approaches to ventral or incisional hernia repair with mesh span a wide range of severity. Intraoperative injuries to the bowel are rare but may necessitate a change in the operative plan. Postoperative complications are comprised of those common to all general surgery, for example, thromboembolism and superficial surgical site infection, and are typically managed no differently. Unique to recovery from hernia surgery however can be increased pain after mesh placement, seroma related to large dissection planes, infections of the mesh, as well as pulmonary insufficiency due to changes or loss in abdominal domain. Laparoscopic approaches to ventral or incisional hernia have dramatically affected the morbidity of surgery but may introduce complications unique to that approach. More serious long-term complications include chronic pain, chronic mesh infections, as well as the rare, but highly morbid, enterocutaneous fistula involving mesh. Complications such as these, likely require revisional surgery for resolution. Finally, hernia recurrence remains a low, but reliable risk, and although newer techniques continue to evolve and promise better results, the perfect approach to hernia surgery has yet to be defined. Time and experience will continue to shape our attempts at better hernia surgery.