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A hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity.
TYPES OF HERNIA
Epigastric
Para umbilical
Umbilical
Spigelian
Inguinal
Femoral
Gluteal
Sciatic etc
CAUSES OF HERNIA :
Any condition that raises intra-abdominal pressure, such as powerful muscular effort, may produce a hernia. Whooping cough is a predisposing cause in childhood. Chronic cough, straining on micturition, or straining on defecation may precipitate a hernia in an adult. Hernias are more common in smokers, which may result from an acquired collagen deficiency increasing an individual’s susceptibility to the development of hernias.
TREATMENT
The basic principle in the treatment of hernia can be divided into
1. Herniotomy – opening of the hernial sac
2. Herniorrhaphy – repair of the underlying defect
3. Hernioplasty – reinforcement of defect with a prosthetic mesh Epigastric hernia (synonym: fatty hernia of the linea alba) An epigastric hernia occurs through the linea alba anywhere between the xiphoid process and the umbilicus, usually midway between these structures. (Between the upper abdomen and naval area.
We present an interesting case of a 54yr old man who had undergone a Laparoscopic Epigastric hernioplasty with a Dual mesh placed intra-peritoneally (IPOM-Intraperitoneal Onlay mesh) for Epigastric Hernia.
This patient presented with multiple discharging abdominal sinuses with pus and pain abdomen and was treated with antibiotics and no relief of symptoms.
He was planning for a Diagnostic laparoscopy to detect the source of infection, remove the source of infection and repair it.
He had omental adhesions at the site of the IPOM and the mesh inverted into the hernia site and diversification of the rectus with abscess.
Adhesiolysis was done and pus was drained and the mesh was removed.
Discharging sinuses were excised completely and closed with non-adsorbable sutures.
Any foreign body kept inside the abdomen in contact with the intestine and omentum is likely to develop adhesions, infection and prolonged pain, hence open hernia repairs are still a safer option to have lasting results with most minor complications.
Conclusion
Although in common practice mesh infection is still a concern in laparoscopic and open repairs, it is preventable using the selection of the type of surgery, mesh material, maintaining sterility of prosthesis and operating set up, proper disinfection and sterilization of scopes and adequate antibiotic coverage as an when required. Re-sterilization of mesh though proven effective is not indicated given the morbidity associated with mesh infection. Treatment of infected mesh is possible by local debridement, irrigation, mesh removal, and systemic antibiotics, but still, it would be worth emphasizing.

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