Incisional hernia in adults

An incisional hernia is the rarest type of hernia in which tissue protrudes through an incision made during a previous operation, but the incision has not yet fully healed. It may occur as a complication after abdominal surgery, but is more likely after emergency surgery. Hernial tissues can be part of the intestine, a portion of another abdominal organ, or connective, adipose tissue of the abdominal cavity (omentum, peritoneum, ligaments).

An incisional hernia is a hernia of the abdominal wall at the site of a previous surgical incision. In fact, it refers to a variety of ventral hernia. Median (along the white line of the abdomen) postoperative hernias are more common than other localizations. It can be a classic hernia with all hernial components: tissue defect, hernial sac and contents. Or it may be weakness of the abdominal wall with a shallow pouch and occasional, episodic bulges of the contents.

Incisional hernia is a common surgical problem. Surgeons are often asked to evaluate patients with incisional hernias as they may be symptomatic for patients. The classic presentation is a bulge with a positive cough impulse at the incision site. Patients with incisional hernias are also at risk of strangulation, obstruction (if the contents are a bowel loop) or inflammation.

What is an incisional hernia

An incisional hernia is a type of hernia that develops from a previous incision in the abdominal wall. In other words, this is a defect in place of the scar left from an earlier surgical operation. Incisions are made to access internal organs or possibly to perform a caesarean section. Thus, an incisional hernia has much in common with a recurrent hernia.

The previous incision after the operation is closed with sutures, but sometimes the sutures do not hold, proper healing does not occur, or the wound exfoliates over time. Incisional hernias may appear months or even years after surgery. A Danish study published in 2014 found that about two in 1000 women needed surgery for a hernia after a caesarean section that appeared within 10 years of their initial surgery.

Symptoms of postoperative hernia in adults

The clinical symptoms of an incisional hernia are a noticeable bulge or protrusion at or very close to the site of the previous surgical incision. Virtually any prior abdominal surgery can subsequently lead to the development of an incisional hernia in the immediate vicinity of the scar, for example, if an infection has prevented proper healing. Despite this, incisional hernias tend to be more common when the incision made during any abdominal surgery is located vertically, in the center of the abdomen, or very close to this area. Experience shows that surgical closure of these wounds can often be a difficult procedure.

The main symptom is swelling or bloating near the site of the surgical incision. Pain is also common and often worsens with standing upright and lessens with lying down. Another risk of incisional hernia is bowel obstruction, which can lead to nausea and pain.

Typical symptoms of incisional hernias include:

• a bump or bulge protruding from the surgical incision;
• abdominal pain;
• constipation;
• nausea;
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In the case of incisional hernias after a caesarean section, significant pain and discomfort can often occur, especially if the bulge is quite noticeable. Stomach upset, nausea and possibly vomiting are possible. If the intestines have shifted, this can also cause constipation or other problems with bowel movements.

Causes of incisional hernia in adults

An incisional hernia usually occurs due to tissue weakness that develops inside the surgical wound. This can be the result of a hematoma (a hard clot of blood and hardening of tissue), a seroma (a swelling caused by a buildup of fluid), or an infection, all of which can interfere with the normal wound healing process.

Additional reasons may include:

• increased pressure in the abdominal cavity due to chronic cough;
• excess weight;
• constipation;
• obstruction of the urinary tract due to problems with the prostate;
• pregnancy;
• ascites (fluid accumulation inside the abdominal cavity and pressure on the abdominal wall);
• several previous cuts in one region;
• poor surgical technique.

Treatment of incisional hernia in adults

Treatment of postoperative hernia is a second operation. It can be performed both open surgery and laparoscopically. The hernia will be pushed in and the weakened area of ​​the abdominal wall will be strengthened, sometimes with a mesh.

Diagnostics

In many cases, a doctor can diagnose an incisional hernia simply by observing its appearance and then performing a physical examination. However, some similar conditions may develop (especially after a caesarean section) that have symptoms similar to an incisional hernia, such as:

• abscess or wound infection;
• hematoma;
• endometriosis of the abdominal wall;
• uterine rupture.

In some cases, the doctor may decide to use internal imaging techniques, such as an ultrasound or CT (computed tomography) scan, to make a diagnosis, rule out other conditions, or check if the hernia contains any intestinal tissue.

Modern treatments

Although wearing an incisional bandage may relieve some of the symptoms, surgery remains the only definitive treatment for an incisional hernia. For women who have problems after a caesarean section, doctors usually do not recommend further surgery, except in the following cases:

• the hernia gets bigger;
• a hernia causes significant discomfort (everyday activities are disturbed);
• the hernia is strangulated (intestinal loops are stuck in it, which requires emergency care).

Surgical options are either conventional open or laparoscopic intervention, and the choice of method usually depends on the size and condition of the hernia, the needs of the patient, and the discretion of the surgeon performing the operation. In any case, it is likely that the new incision will be supported by a mesh covering the weak points, rather than stitching, which is not as well suited to such a procedure.

Open surgery, if done well, re-opens the original incision and then securely fixes the wound to avoid further damage.

Laparoscopy is a minimally invasive technique that uses surgical microscopes and micro-instruments to place a supporting surgical mesh inside the abdomen through small incisions near the original surgical wound.

Prevention of postoperative hernia in adults at home

Prevention of incisional hernia largely depends on following the advice of the doctor or surgeon after surgery and professionally applying high standards of surgical practice during all procedures.

Popular questions and answers

We asked questions regarding the development of hernias and their treatment, symptoms therapist, gastroenterologist Vera Samsonova