Incisional Hernia

A hernia arises when a spot in the muscles of the abdominal wall allows a segment of the intestine or abdominal tissue to protrude, however when a bulge occurs at the site of a healing surgical scar specifically, it is known as an incisional hernia.

The hernia can also be classified into 

Reducible hernia- These can be forced back in and might shrink when you lie down.

 Irreducible hernia- It occurs when a portion of your intestine pulls into the hernia, making it difficult to force the hernia back in. It leads to complications like bowel obstruction and the development of strangulated hernia that requires immediate treatment.

According to Healthline, it arises in 15-20 percent of individuals who have undergone abdominal surgeries involving incisions.They are also called ventral hernia as they occur in front of the stomach line.  However, certain factors might enhance the risk of the development of the incisional hernia. 

 

Cause

1. In the majority of the cases, the incision made during surgery heals after a while. However, in some cases, it doesn't further lead to the development of an incisional hernia. 
2. The abdominal site is weakened due to incomplete healing of the incision after the surgery. It can develop after weeks or even 3 to 6 months of the surgery. 
3. Other causative factors might be:
4.  Putting excessive strain on the abdomen after the surgery by:
5.  Lifting heavy objects
6.  Vigorous exercise
7.  Persistent coughing
8.  Fluid in the abdominal cavity
9. Gaining weight after the surgery
10.  Pregnancy
11.  It is observed that males in their older ages are more affected by incisional hernia.

 

CAUSES [2] [4] [5]

In the majority of the cases, the incision made during surgery heals after a while. However, in some cases, it doesn't further lead to the development of an incisional hernia. 

The abdominal site is weakened due to incomplete healing of the incision after the surgery. It can develop after weeks or even 3 to 6 months of the surgery. 

Other causative factors might be:

1.  Putting excessive strain on the abdomen after the surgery by:
2. Lifting heavy objects
3. Vigorous exercise
4. Persistent coughing
5.  Fluid in the abdominal cavity
6.  Gaining weight after the surgery
7. ● Pregnancy
8. ● It is observed that males in their older ages are more affected by incisional hernia.

 

Diagnosis

Your healthcare professional will look into your clinical records as well as other parameters.

An incisional hernia can be diagnosed by physical examination. Your doctor might ask you to cough or bear down for the physical examination.

The doctor will look for any symptoms indicating incisional hernia such as vomiting, constipation, thin stool, abdominal pain, previous surgeries, etc.

Other diagnostic techniques include:

 Blood tests: These are performed to identify any infection led by necrosis or intestinal blockage.

MRI, CT scan, and Ultrasound: These imaging tests aid in identifying blockage as well as the exact location of the disease.

 ECG test for heart patients or patients aged above 45 years

 

Treatment

 Most of the incisional hernias are small and reducible, and your healthcare professional might suggest waiting before opting for surgery.

 In such cases, you might be advised to wear an abdominal binder to support the abdomen.

 Moreover, the surgery can also be delayed if you develop a hernia within a few weeks of abdominal surgery. Your doctor will ask you to wait for the abdominal wall to heal.

However, if the incisional hernias are large and irreducible, you might be advised for immediate surgery.

 The procedure takes around 60-90 minutes, and you might be discharged on the same day if there are no complications.

The following are the methods of surgery that are advised by your doctor based on the size of the hernia, location of the hernia, your medical history, and your other symptoms.

Laparoscopic:

In this procedure, the surgeon utilises a camera inserted via multiple tiny openings to fix the hernia.

 Since the size of the cut is small, there are fewer chances of infection.

It is generally an outpatient procedure, i.e., you might get discharged the same day. 

 Open surgery:

In this, the surgeon creates an incision next to your hernia, then pulls the tissues firmly into alignment and sews the wound up.

You might feel pain after the procedure

You might not get discharged on the same day.

Mesh placement surgery:

 Hernia mesh or surgical mesh, is an implant that aids in the healing of injured tissue around hernias. 

 Surgeons apply the mesh to the area around the hernia, securing it with sutures, staples, or adhesive.Tissue can grow within the device because of the mesh's pores.

 It is a safe, reliable procedure and reduces the risk of recurrence. 

How to prepare for doctor's consultation

1. Before going to the doctor, you must pen down a few aspects you should talk about:
2. Ask your doctor about any changes in your diet and lifestyle.
3. Ask your doctor about the recovery period.
4.  Ask your doctor about any possible side effects.
5.  Ask your doctor about the severity of the disease.
6.  Ask your doctor about the risks and complications of the disease.
7.  In case the doctor advises you on surgery, discuss the procedure that is best for you.
8.  Discuss your medical history in detail.
9.  Your doctor might ask you about your family history with a hernia.
10.  Your doctor might ask you to get any of the diagnostic tests for identification.

 

1)Within a few months, the incisions are barely visible.

2)Benefits of laparoscopic hernia surgery include three tiny scars rather than one larger incision, less pain after surgery, a quicker return to work and a shorter recovery time