About Incisional Hernia

Overview

An incisional hernia is a type of hernia that occurs when abdominal tissue or organs protrude through the abdominal wall, typically near or along a surgical scar. It is characterized by a bulging of the abdominal wall caused by the prolapse of internal structures, such as a segment of the small intestine, through the incision site. Incisional hernias can develop weeks, months, or even years after abdominal surgery. They may appear as a lump close to the scar, especially when coughing or straining the abdomen. While most incisional hernias are not serious, they can enlarge over time and potentially affect breathing and movement. In some cases, surgery may be necessary to repair the hernia. However, if the hernia is small, causing no problems, and has a low chance of complications, surgery may not be required. Immediate medical treatment is needed if the blood supply to the protruding tissue becomes cut off, which is a rare but serious emergency situation.

Causes and Risk Factors

The causes of an incisional hernia are excessive tension in the incision and poor wound healing.

Non-modifiable risk factors for an incisional hernia cannot be changed or controlled. These include:

• Advanced age
• Pulmonary diseases
• Metabolic diseases
• Diabetes mellitus
• Immunosuppression and corticosteroid drug use
• Oncological causes
• Postoperative chemotherapy and radiotherapy
• Using the same incision in multiple surgeries
• Inadequate surgical technique

Modifiable risk factors for an incisional hernia can be influenced or changed. These include:

• Obesity
• Postoperative surgical site infection
• Wound infection
• Leaving the fascia open in patients at risk of developing abdominal compartment syndrome.

It is important to note that while some risk factors can be modified or controlled, others cannot be changed. It is always best to discuss individual risk factors with your healthcare provider to determine the most appropriate preventive measures.

Symptoms

Common symptoms of an incisional hernia include:

• A visible bulge or swelling near the incision site, which is often more noticeable when you strain your muscles (such as when you stand up, lift something, or cough)
• Discomfort or pain in the area around the bulge
• Nausea and vomiting
• Fever
• Burning or aching near the hernia
• Abdominal pain and discomfort, particularly around the hernia
• Faster heartbeat than usual
• Constipation or diarrhea
• Thin, narrow stool
• In some cases, the hernia can become irreducible, meaning part of the intestine pushes into the hernia and cannot be pushed back in. This can lead to bowel obstruction, which requires immediate treatment.

Remember to consult with your healthcare provider for a proper diagnosis and treatment plan.

Diagnosis

To diagnose an incisional hernia, several examinations, tests, and procedures are commonly performed including:

• Physical examination: Your healthcare provider will examine the affected area, looking for a bulge in the abdomen or groin that may become more prominent when you stand, cough, or strain.
• Imaging tests: These tests help visualize the hernia and determine its severity. They include:
  • X-rays: An abdominal X-ray can provide a picture of the hernia.
  • Ultrasound: This uses sound waves to create an image of the structures inside the body.
  • CT scan: A computerized tomography scan provides detailed images of the hernia and surrounding structures.

Remember, it is important to consult with your healthcare provider who can recommend and interpret the most appropriate examinations and tests for your individual situation.

Treatment Options

The goals of treatment for an incisional hernia are to alleviate symptoms, prevent complications, and repair the hernia. Here are the different treatment options and how they work towards achieving these goals:

Surgical Repair: The primary treatment for an incisional hernia is surgery. There are two types of surgical approaches:

• Open Surgery: In this procedure, a surgeon makes an incision over the abdomen to push the protruding tissue back into the abdomen. They may also reinforce the weakened area with a mesh to strengthen the abdominal wall and reduce the risk of recurrence.
• Laparoscopic Surgery: This minimally invasive procedure involves making multiple small incisions and using a camera to guide the surgeon in repairing the hernia.

Supportive Measures:

• Abdominal Binder: For small hernias that are not causing problems, an abdominal binder can be worn to provide support to the abdominal wall.

It's important to note that there are no specific medications or therapies recommended for incisional hernia treatment. Health behavior changes such as maintaining a healthy weight, avoiding heavy lifting or straining, and quitting smoking can help prevent hernia recurrence.

Remember, treatment options may vary depending on individual factors. It is best to consult with a healthcare provider for personalized advice and recommendations.