Incisional Hernia: Get the Facts

An incisional hernia arises when abdominal tissue begins to poke through a soft spot in the wall of the abdomen. This type of hernia only occurs as the result of the incision made in a prior abdominal surgery. An incisional hernia may be the result of poor healing, infection, or technical problems a the site of the original surgery. Although it is very small in size, in severe cases, organs may move through the weak hole in the muscle, resulting in severe problems. It usually happens when the wound from the abdominal surgery heals incompletely, resulting in the hernia being able to push through the wound. The risk of getting an incisional hernia after having an abdominal surgery depends on the size and location of the surgery. Incisional hernias are not the same as recurrent hernias. About 75% percent of incisional hernias occur in men. 

An incisional hernia can be identified if it is visible when one is standing up or engaging in strenuous activity; a significant bulge at the sight of healing swill be visible. Of all abdominal hernia cases, incisional ones account for approximately twenty percent. However, these hernias are less severe than other types, since in most cases, only the abdominal tissue is protruding through. However, they do require surgery to be fixed most of the time. 

Who Is At Risk of an Incisional Hernia?

Obese people and pregnant women are more prone to developing this kind of hernia. However, they must have had a history of abdominal surgery in the past. People who gain weight after the surgery, become pregnant, or lift heavy objects that put a lot of pressure on their abdomen are at more risk of getting an incisional hernia. The incised area is the weakest point and is more vulnerable to hernias while it is still healing. Most incisional hernias happen 3-6 months after surgery, but they can also develop or enlarge months or even years after surgery. Malnutrition, smoking, and connective tissue disorders are also risk factors for an incisional hernia, albeit rarer ones. 

The most common risk factors of an incisional hernia listed are below:

• Obesity
• Pregnancy
• Recent surgery, within 3-6 months
• Poor wound care
• Overexertion
• Infection
• Poor surgical techniques

Incisional hernias are actually more common than one would think. Approximately fifteen percent of through who undergo abdominal surgeries then suffer from incisional hernias. Since they are a type of ventral hernia, occurring at the front of the abdomen, they exhibit many of the same symptoms. Would dehiscence, poor technique, broken sutures, and tension at the wound site are all surgery-related factors that can then contribute to the occurrence of an incisional hernia. 

Diagnosis of Incisional Hernias

The following tests are used to diagnose and screen for an incisional hernia. These are required in order to best diagnose the hernia for the doctor to then judge what treatment is needed. In very mild cases, surgery may not be required.

• Probing near or around the surgical wound
• Blood tests
• X-rays
• CT scans

Incisional hernias occur after an abdominal surgery; they are not usually noticeable unless the person performs an activity that puts pressure on the abdomen, such as sneezing, coughing, lifting heavy objects or straining during bowel movement. The visible hernia is easy to diagnose and often needs no further testing other than a physical examination. The doctor may ask you to cough or bear down in order to see the hernia more visibly. If the hernia is quite large, further testing may be required.

Symptoms aside from the obvious visible bulge include nausea, vomiting, mild discomfort or pain in the abdominal area. In some cases, a fever may even be present. If you feel you may be suffering from an incisional hernia, see your doctor immediately. An incisional hernia isn't something you can just leave and hope to go away. Immediately attention is required. 

Treatment of Incisional Hernias

An incisional hernia is very small and surgery is not always required. If it is small, it can be pushed back into place by the doctor. Do not attempt to push it back in yourself. If it is large, painful or growing steadily, surgery may be needed. A truss is another option for treating hernia. It is a garment similar to a weight belt or girdle that constantly applies pressure on the hernia. This option is used if the incisional hernia is not advanced. 

When is Incisional Hernia Surgery Essential?

An incisional hernia surgery is required if:

• It is quite large and growing steadily
• It is visibly unappealing
• The hernia is painful
• The bulge is visible even when the patient is relaxed

When Is an Incisional Hernia an Emergency?

An incisional hernia can be an emergency if the hernia becomes strangulated. In this case, the tissue that bulges out doesn’t receive enough blood. Untreated strangulated hernias can be lethal and they are therefore considered medical emergencies. A strangulated hernia may or may not be painful. Some other symptoms of this condition are nausea, vomiting, abdominal swelling and diarrhea.

The following types of hernias are related to incisional hernias:

• Hiatal hernia: This kind of hernia is very dangerous, as it occurs when the upper stomach shifts into the chest cavity. 
• Inguinal hernia: This type of hernia is most common in men, and occurs when the intestine moves from the abdomen into the groin area and begins to protrude.
• Umbilical hernia: This type of hernia usually occurs near the navel.
• Epigastric hernia: A weakness or opening in the upper abdomen, allowing for protrusion.
• Femoral hernia: This type of hernia is more common in women than in men, and occurs in the upper groin area.

Surgery

Incisional hernia surgeries are performed after numbing the area with general anesthesia. It is usually done using the laparoscopic method, which is a non-invasive method, and makes small incisions to insert surgical devices rather than a single large cut. Using the various devices, the surgeon isolates the part of the abdominal lining that is squeezing through the muscle. The surgeon then returns the hernia sac to its proper position and starts repairing the muscle defect. If the defect is small, it may be closed with sutures. If the hernia is large, the surgeon places a mesh graft to cover the hole. Once the mesh is placed or the muscle has been stitched, the incision is closed. The mesh aids in preventing recurrence.

Open hernia repair is also at option. This involves making another incision over the skin at the affected site, effectively repairing the hernia. The majority of incisional hernias do not reappear once fixed, but occasionally someone who is particularly susceptible will find themselves requiring another repair. 

Most hernia patients return to their normal activity within 2 to 4 weeks after surgery, so one must take precautions during this period as suggested by the doctor. You can avoid the risk of an incisional hernia by taking necessary precautions after your primary surgery. These include refraining from sexual activity, sports, and generally overexerting yourself, limiting activity that puts pressure on the wound, avoid smoking, treat constipation, and try to cough and sneeze as little as possible. It is also important to be aware of how age and overall health can affect your recovery rate and future risk to incisional hernias.