What is an incisional hernia?
Approximately one third of patients will develop an incisional hernia after abdominal surgery. An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes.
Incisional Hernia Causes
Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision. An incisional hernia can occur for a number of specific reasons; individuals who participate in excessive or premature physical activity after surgery, gain considerable weight, become pregnant or increase abdominal pressure in any other way before the incision is fully healed are especially at risk for an incisional hernia. Incisional hernias are most likely to occur within three to six months post-surgery but can happen at any time.
Incisional Hernia Diagnosis
To identify an incisional hernia, a health care provider may use multiple diagnostic techniques but will begin with a medical history and physical examination. The provider will inquire about and/or look for:
Constipation, "narrow" or "thin" stool
Lump or protrusion in the abdomen at or near the site of a previous incision; the patient may be asked to stand and cough, which tends to make the hernia more pronounced
Nausea, vomiting, fever or rapid heart rate
Pain in the abdomen, especially around the protrusion
Previous surgeries, locations and outcomes
If the protruding portion of intestine has become trapped (incarcerated) within the abdominal wall, the blood supply to the intestine can get cut off (strangulation), causing further complications such as necrosis (tissue death). If your provider suspects this is the case, additional diagnostics may include:
Blood tests to look for infections caused by intestinal blockage or necrosis
Ultrasound, MRI, CT or other imaging to check for blockage or actual location of the intestinal protrusion
Additional techniques may also be used if the health care provider believes the rupture has resulted in the movement or protrusion of other organs in addition to intestines.
Incisional Hernia Treatments
Specific treatment for an incisional hernia will be determined by your doctor based on multiple factors such as your general health, anatomy, extent and location of the hernia, and desired level of future physical activity. The treatment will also depend on whether the hernia has negatively affected the results of the original surgery, requiring additional procedures before the hernia can be closed. Treatment will generally consist of one of two types of surgeries:
Open hernia repair
In this surgical procedure, also known as herniorrhaphy, the surgeon makes an incision in the abdomen above the hernia, pushes any protruding intestine back into the abdomen and repairs the opening in the muscle wall. Sometimes, in a procedure known as hernioplasty, the weak area is repaired and reinforced with mesh.
In this minimally invasive surgical procedure, the surgeon makes several small incisions in the lower abdomen and first inserts a tubelike instrument, called a laparoscope, equipped with a camera into one of the incisions. The internal images are displayed on a large monitor that the surgeon uses to guide small instruments inserted through the other incisions to repair the hernia.
Robotic-assisted repair is similar to laparoscopy, but the surgeon operates from a console controlling robotic arms. In this minimally invasive surgical procedure, the hernia contents are returned to their natural position in the abdomen and the muscle wall is repaired and reinforced with mesh.