Expert Incisional & Ventral Hernia Repair in Bathinda — Dr. Raman Garg

An incisional hernia develops at the site of a previous abdominal surgery — where the muscle and fascia have not healed properly, creating a weak point through which abdominal contents can protrude. Incisional hernias affect up to 10–15% of patients who have had abdominal surgery — making it one of the most common long-term complications. Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda is highly experienced in complex incisional and recurrent hernia repairs, including cases that have failed elsewhere.

What is Incisional Hernia?

When an abdominal incision (surgical cut) is closed, the muscle layers heal gradually over weeks to months. However, in some patients — due to infection, obesity, malnutrition, poor healing, or excessive strain on the wound — the fascial layers do not heal completely, leaving a gap. Over time, abdominal fat or intestine pushes through this gap, causing a bulge under or through the surgical scar.

Types of Incisional / Ventral Hernias

• Midline incisional hernia: At the midline abdominal scar (most common after laparotomy)
• Paramedian hernia: Just beside the midline
• Pfannenstiel hernia: At the lower abdominal (bikini line) incision — common after C-section
• Subcostal hernia: Under the ribcage (e.g., after open cholecystectomy)
• Epigastric hernia: Between sternum and navel — not always at surgical site
• Recurrent hernia: Hernia at a previously repaired site — technically more challenging
• Giant incisional hernia: Large hernia with loss of domain (significant abdominal content has migrated to hernia sac)

Risk Factors for Developing Incisional Hernia

• Obesity (BMI >30) — most significant risk factor
• Wound infection after previous surgery
• Malnutrition or anaemia
• Diabetes — impairs wound healing
• Steroids or immunosuppressive medications
• Chronic cough or constipation — repeated straining
• Heavy lifting too soon after surgery
• Emergency surgery (vs. planned surgery)
• Multiple previous abdominal surgeries

Symptoms of Incisional Hernia

• Visible bulge at or near a previous surgical scar
• Bulge enlarges on standing, coughing, lifting
• May reduce (disappear) when lying down
• Aching or discomfort at the site
• If incarcerated: painful, irreducible bulge
• If strangulated: severe pain, vomiting, fever — surgical emergency

Laparoscopic IPOM Repair — Dr. Raman Garg's Technique

The gold standard for incisional hernia repair is Laparoscopic IPOM (Intraperitoneal Onlay Mesh). Dr. Raman Garg uses this technique for most incisional hernias:

1. Three to four small port incisions (5–12 mm) — placed away from the hernia
2. Hernia contents reduced (pushed back into abdomen)
3. Hernia sac not excised (left in place) — reducing complications
4. A composite mesh (smooth side towards bowel, rough towards abdominal wall) placed inside the abdomen — covering the hernia defect with at least 5 cm overlap on all sides
5. Mesh secured with tacks and transfascial sutures for permanent fixation
6. Fascial defect may be closed primarily before mesh placement (IPOM-Plus)
7. Discharge within 24–48 hours

Advantages over Open Repair for Incisional Hernias

• No large incision over the scar — avoids wound complications in patients with difficult skin
• Mesh placement provides wider, more uniform coverage
• Lower recurrence rate (5% vs. 15–20% for open primary suture repair)
• Faster recovery
• Suitable even for obese patients where wound healing after open surgery is a major concern

Post-Caesarean (C-Section) Hernia

Many women develop hernias at the pfannenstiel (bikini-line) C-section scar. These are more common after multiple C-sections or post-operative infections. Dr. Raman Garg provides specialised laparoscopic repair for post-C-section hernias, taking into account female anatomy and future pregnancy plans.

Recurrent Hernia — When Previous Repair Has Failed

Hernia recurrence after previous mesh repair is a particularly challenging scenario. Dr. Raman Garg has extensive experience in managing recurrent hernias — whether after open or laparoscopic repair — using careful dissection, proper mesh positioning, and secure fixation to achieve durable results.

Frequently Asked Questions