الفهرس 
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Abstract
Incisional hernia is one of the most common complications of abdominal surgery
The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection
The incisional hernia usually starts as an asymptomatic bulge noticed by the patient Pain is not a common early complaint, but with time, incisional hernia enlarge and become symptomatic. Pain with movement, straining, or coughing becomes more frequent
Vomiting, constipation, and severe pain are usually associated with incarceration or strangulation of intestinal structures, resulting in emergency operations. The diagnosis is established by physical examination. The swelling of the hernia may be seen, or it may be palpated. Having the patient cough or strain, at which time an impulse can be seen or felt, the typical hernia pattern with a fascial gap and protruding hernial sac can be evaluated by the ultrasound: CT and MRI are not the first methods of choice in the diagnosis of abdominal wall hernia. However, these methods are useful in distinguishing hernia from benign, malignant, or inflammatory lesions of the abdominal wall and their correlation to the intraabdominal cavity.
Not all postoperative incisional hernia need to be repaired. One frequently finds a low, wide bulge down the length of the old incision. When it does not bother the patient and shows no signs of growing, there is no indication for reoperating. For most other types, repair should be undertaken a wide belt or corset gives a patient with a large hernia some comfort and may be used for palliation when surgical treatment is contraindicated
Operation may be indicated for esthetic reasons for a large and unsightly hernia. And should be indicated for large hernia with small openings having a high risk of strangulation and when there is a history of recurrent attacks of subacute obstruction, incarceration, irreducibility or strangulation. using prostheses in the repair of incisional hernia become mandatory in case of recurrence following incisional hernia repair, presence of large defect with loss of substance of the abdominal wall, obesity, pulmonary diseases such as severe emphysema, chronic bronchitis and severe cough, patients who perform heavy work as weight lifters, patient on prolonged steroid therapy as the liability for recurrence is high and irradiation as it reduces healing of wounds and causes atrophy of the tissues due to impairment of blood supply. Laparoscopic repair can be indicated when ventral hernia more than 3 cm size. Obesity and recurrent incisional hernia even in small size and Swiss cheese type hernia, because it is more clear laparoscopically but laparoscopy become contraindicated in patients in whom a safe intra-peritoneal access cannot be obtained, as in patients with multiple scars on the abdominal wall. The laparoscopic repair should not be attempted in patients with large defects where a 3 to 5 cm overlap of the mesh is not possible intra-abdominally Also patients with a large amount of redundant skin and fat on the abdominal wall are better suited for an abdominoplasty procedure. The other relative contraindications are poor cardiovascular or respiratory reserve. Bleeding disorders and coagulation defects are also contraindications, as for any other surgery
Different techniques have been described as different options in the surgical management of incisional hernia including open repair varying from primary closure only, Complex apposition (Overlap methods) , repair with prosthesis and laparoscopic repair primary .suture repair has a Reported failure rate range between 25% and 52% that recurrence rate become lower with prosthetic repair but still in the range of about 10%.open repair has the risk of bleeding because of the extensive dissection and risk of seroma formation which is a problem in that procedure and of particular significance with prosthesis and risk of wound infection increasing the risk of repair failure.
Laparoscopy has revolutionised the practice of surgery by imparting the ability to avoid major abdominal-wall incisions Thus, laparoscopic surgery is expected to reduce the burden of incisional hernias, but such morbidity of the era of conventional.
Recurrence rate become more lower with laparoscopy to about 4.3% part of that success because that the laparoscopic repair affords the surgeon the ability to clearly and definitively define the margins of the hernia defect and to identify additional defects that may not have been clinically apparent preoperatively. Seroma formation is not unique for laparoscopy, most seromas resolve with time, some requiring eight to 12 weeks for complete resolution.
Mesh infection remains a serious complication with laparoscopic incisional hernia repair. Although the incidence is very low, the consequences are severe.
Laparoscopic repair has an increased postoperative pain following laparoscopic ventral hernia repair when compared to open and the most serious complication, some what unique to laparoscopic incisional hernia repairs, remains the potentially devastating risk of a missed enterotomy. This complication seems to be more common early in the learning curve in patients requiring extensive adhesiolysis.
It is appeared that laparoscopic repair is more superior than open repair but still having risk of complications not unserious the most important is risk of bowel injury which is unique to laparoscopy requiring surgical awareness and to be ready for conversion to open and should be considered that not all patients are suitable for laparoscopic repair but patient selection is an important part of management plan for laparoscopy depending on general condition and hernia size and type.