**3. Symptoms**

182 Updated Topics in Minimally Invasive Abdominal Surgery

Incisional hernia can be repaired by open or by laparoscopic approach and prosthetic meshes are nowadays implanted in most procedures. The use of laparoscopy for the treatment of incisional hernia was first reported in 1993 by LeBlanc and Booth [8]. With the introduction of modern two-layered mesh, laparoscopic incisional hernia repair has become an accepted therapeutic option. Feasibility and safety of laparoscopic incisional hernia repair

Developing a good classification for incisional hernias is much more difficult than for groin hernias or for primary abdominal wall hernias because of their great diversity. The classification as established and published by the consensus meeting of the European Hernia Society held in Ghent, Belgium, 2008, (Tab 1.) comprises a division of subgroups for incisional hernia, including localization, width, and length of the hernia [9]. The use of the classification of the European Hernia Society is nowadays recommended. The analysis of subgroups may define patients with high risk for recurrences and may lead to specific treatment options. This classification is applicable in laparoscopic and open incisional hernia

Table 1. European Hernia Society classification for incisional abdominal wall hernia

has been shown in various randomized controlled trials.

**2. Incisional hernia classification** 

repair.

A swelling or protrusion with or without abdominal pain can be observed in a patient with an incisional hernia when the patient sits up or coughs. In large incisional hernia peristaltic bowel movements can be observed through a thin skin, sometimes already accompanied with signs of a skin infection. Incisional hernias may occur along the full length of the incision with one or multiple hernial orifices. Incarceration is the main complication of an incisional hernia [10] and occurs in 1-3% of all hernias. Signs of incarceration are acute pain and vomiting. Clinically there is a tense, tender irreducible hernia. In these cases an emergency hernia repair is mandatory. Emergency hernia repair can also be performed by laparoscopy with an additional mini-laparotomy if bowel resection is necessary.

Incisional hernia can be diagnosed by physical examination. Additional ultrasound or CTscan examination are recommended in cases of uncertainty (Fig 2).

Fig. 2. CT-Scan of a patient with a large incisional hernia. The hernia contains small and large bowel.
