What is Incisional Hernia?

Hernia is a common condition in which part of an internal organ or tissue bulges through a muscle. An incisional hernia is a type of hernia occurs when the intestines or fat from the abdomen bulge through abdominal wall at the site where an incision was made in a previous abdominal surgery.

1. Causes of Incisional hernia

Hernias basically occur due to a weakness in the muscles of abdominal wall. During abdominal surgery, an incision is made in the abdominal wall and its muscles. A scar is formed at the incision site after healing. The scar is weaker than the normal muscle and may result in a gap between the muscles. When you are suffering from any medical condition that increases the pressure within the abdomen (such as chronic cough, constipation and obesity), the raised pressure will cause the contents of the abdomen to bulge from the weakened incision site, resulting in incisional hernia.

2. Symptoms of Incisional hernia

Many persons are unaware of the incisional hernia and it is only first seen incidentally or on the routine physical examination. If incisional hernia is causing problems, you will experience one or more of the following symptoms:

A small bulge at or around the incisional site. It typically increases in size on standing and disappears when lying down. It becomes prominent upon coughing and straining as the pressure increases inside the abdomen
Discomfort, pain, or gurgling sensation at the incisional site
Heavy or dragging sensation at the incisional site

3. Risk Factors of Incisional hernia

Abdominal surgery
Pregnancy
Obesity
Lifting heavy objects
Chronic constipation and straining
Chronic coughing
Fluid within the abdomen (ascites)

4. Prevention of Incisional Hernia

The risk of incisional hernia can be reduced by decreasing the intra-abdominal pressure. It can be achieved by:

Maintaining a healthy weight
Preventing constipation by consuming high-fiber foods
Avoiding heavy lifting
Stopping smoking

5. Complications of Incisional hernia

Most cases of Incisional hernia are not life threatening. Rarely, incisional hernias may become strangulated or incarcerated. In these cases, a part of intestine becomes trapped within the hernia and the bulge does not go back inside abdomen. The blood supply to the trapped part of intestine is also reduced, resulting in ischemia and gangrene of the part of intestine. It is a surgical emergency and surgery is needed to relieve the trapped part of intestine. The common symptoms of a strangulated or incarcerated incisional hernia are:

Extreme pain, tenderness and redness in the area of the bulge
Nausea and vomiting
Constipation
Fever
Rapid heart rate

6. Diagnosis of Incisional hernia

Your doctor will make a diagnosis of incisional hernia by taking a detailed history and physical examination. Your doctor will ask you to stand and cough to feel the hernia as it bulges out from or around the incisional site. Your doctor may also check to see if the hernia can be gently massaged back into its proper position in the abdomen. The diagnosis of incisional hernia is made on clinical grounds and usually no other tests are required.

7. Treatment of Incisional hernia

If your incisional hernia is not causing any symptoms and is not uncomfortable, your doctor may advise for a “wait and watch” approach.

Surgical Management of Incisional hernia

Surgery is the only treatment to get rid of incisional hernia if the hernia has become strangulated or incarcerated. Hernia surgery is also called herniorrhaphy. There are two main types of surgery to repair hernias. These are open hernia repair and laparoscopic hernia repair.

Open hernia repair:

In open hernia repair, your doctor will make an incision in the abdominal wall at or around the incision site. After incision, your doctor will move the hernia and its contents back into the abdomen, and will then close the abdominal wall with stitches to fill the gap and prevent the hernia from recurring. Your doctor may also place a synthetic mesh to provide additional support.

Laparoscopic hernia repair:

In laparoscopic hernia repair, your doctor will make several small, half-inch incisions in the abdominal wall. Your doctor will then insert a laparoscope (a thin tube with a tiny video camera attached). Your doctor will then push back hernia into the abdomen and will repair the defect using synthetic mesh.

8. When you should have Surgery for Incisional hernia?

Your doctor should recommend a surgery for your incisional hernia, if you have one or more of the following symptoms:

Incisional hernia continues to enlarge over time
Incisional hernia is very large and cosmetically unappealing
Incisional hernia bulge remains even when the patient is relaxed or laying down
Incisional hernia causes pain

9. Diet and Exercise

To prevent constipation, increase your water intake, use stool softeners, and increase dietary fiber intake. No limitations on physical activity. Standard moderate physical activity of at least 30 minutes for at least five days per week is recommended.

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