Incisional Hernia

What Is a Hernia?

 

Incisional Hernia, Hernia

 

“A hernia occurs when an organ is squeezed through an opening in the muscle or tissue that holds it in place. In some cases, the intestines may protrude through a weakened area in a patient’s abdominal wall.”

– Dr Ganesh

 

Hernias occur mostly in the abdomen region, but they can also appear in the upper thigh, belly button, and groin areas. While most hernia conditions are not immediately life-threatening, they often require surgery to prevent potentially dangerous complications.

 

Is a Hernia Considered an Emergency? 

 

In some instances, whether it’s in adults or children, hernias can cause life-threatening complications. It is recommended that you seek emergency care if you experience symptoms such as nausea or vomiting, fever, or sudden pain.

 

Early medical care and changes can minimise symptoms. However, surgery is the only way to treat a hernia effectively. There are different types of surgeries available for hernia repairs, and your surgeon can advise on which one is recommended for you. 

 

While the prognosis for hernia repair surgery is typically very good, it is also dependent on the nature of the hernia, your symptoms and overall health. Occasionally, the hernia may recur following repair.

 

What Happens When You Experience a Hernia?

 

One of the most common symptoms of a hernia is a bulge or lump in the affected area. For example, in the case of an umbilical hernia, it occurs as a bulge that shows through the weakened spot near the belly button or navel. 

 

One in five babies is born with an umbilical hernia. However, if the hernia does not resolve when the baby reaches four years of age, treatment may be required. You might also experience some pain and discomfort in the area around the lump.

 

In some types of hernia, such as hiatal hernias, specific symptoms may be observed, such as heartburn, trouble swallowing, and chest pain.

In many cases, hernias have no symptoms, and you may not know you have a hernia unless it shows up during a routine check-up or a medical examination for an unrelated problem.

 

 “It’s important to take note of and recognise the symptoms of a hernia and to see your doctor if you suspect that you have one. An untreated hernia won’t go away by itself. Your doctor can assess your hernia and recommend a suitable treatment for your condition.”

– Dr Ganesh

 

Another form of hernia, known as an incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. It may frequently occur as a complication of wound healing after surgery. Careful treatment and precautions are crucial to avoid its development.

 

A case of incisional hernia was reported in 2008, documenting a 55-year-old female who showed up at the medical institute with a massive bulge under her clothes. Further investigation uncovered an incisional hernia that has been present since 19 years ago after she did a removal of a branched stone from her right kidney and had repeated sutures. 

 

Although the size of the hernia was reasonably large (10cm in diameter), the patient decided to decline surgery and preferred conservative management of the hernia with frequent follow up.

 

What Is an Incisional Hernia?

 

An incisional hernia is one that happens through a previous incision or scar in your abdominal wall from a previous abdominal operation you had undergone. It is relatively common between 12 to 15 percent of abdominal operations leading to incisional hernia.

 

A surgeon had made the incision to reach an internal organ in your body, such as an appendix or a caesarian section. After the operation, the surgeon would have stitched together the layers of your abdominal wall. In cases where the stitches fail to heal correctly or come apart with time, this results in an incisional hernia. A partial segment of your organ, muscle or tissue may protrude through the open and weakened surgical opening and place pressure under your surgical scar. This causes pain, swelling or fever and is known as an incisional hernia.

 

While an incisional hernia can develop or get larger a few months or years after surgery, most cases happen within three to six months post-surgery, where your incision is the weakest.

 

What Causes an Incisional Hernia?

 

An incisional hernia may be caused by an infection, poor wound care, improper surgical techniques and other factors that interfere with the healing of your surgical wound or a past surgical wound.

 

You would be at a higher risk if you

  • Have had a wound infection after surgery or more than one surgery through the same incision
  • Are overweight or obese
  • Have gained a significant amount of weight after surgery
  • Are older
  • Are pregnant
  • Participate in strenuous exercise such as heavy lifting
  • Have frequent cough or sneezing which places internal pressure on your organs
  • Overstrain during bowel movement

 

What Are the Symptoms of an Incisional Hernia? 

 

One of the most common symptoms of an incisional hernia is a noticeable bulge or swelling near the incision site. This bulge may be most visible when you strain your muscles, such as when you stand up, carry weights or lifting or when you cough.

 

Other signs and symptoms of an incisional hernia include:

  • Fever and aching
  • Pain and swelling
  • An infection which may be indicated by redness
  • Bulging (lump on surgical scar)
  • Visible protrusion (internal segment coming out of a surgical wound)

 

In emergency medical conditions:

  • Severe and persistent abdominal discomfort and pain
  • Difficulty in passing gas or bowel movement (strangulation of intestines)

 

How Is an Incisional Hernia Diagnosed? 

 

During a consultation session, your doctor will be able to diagnose an incisional hernia during a physical examination. Hernia becomes noticeable only when you perform activities that place extra pressure on your abdomen. You may be asked to cough or strain so that your doctor can observe if the hernia bulges out.

 

Should you need further tests to screen for complications, you may be scheduled for an X-ray, abdominal ultrasound or blood tests.

 

What Happens During the Diagnosis?

 

Based on the state of your hernia, your doctor may be able to assess and categorise the condition into two categories: Reducible or Irreducible.

 

  • Reducible hernias are hernias that can reduce in size. They can be pushed back in, and they may also shrink when you lie down.
  • Irreducible hernias happen when part of the intestine pushes into the hernia, making it hard to move the hernia back in.

 

Irreducible hernias may lead to bowel obstruction, and in some cases to a strangulated hernia. When that happens, it is recommended to seek medical attention immediately.

 

If you should notice that the bulge has turned dark red or purple or you feel severe pain, the recommended advice is to seek medical attention as well.

 

Do Incisional Hernias Go Away on Their Own?

 

It is important to note that incisional hernias do not heal on their own. Depending on the condition of the hernia, they may require surgical treatment to repair. 

 

People who recently went through abdominal surgery are at risk of developing incisional hernias. The risk factor is higher in the initial three to six months following the procedure when the tissues are healing from the incision.

 

What Potential Complications May Occur From an Incisional Hernia? 

 

Small hernias that go untreated tend to increase in size over time. If a hernia grows too big, it can cause swelling and pain in your abdomen and eventually become irreducible. The swelling can be noticeable as this happens because it tends to cause much discomfort.

 

The most severe complications of incisional hernias are bowel obstruction and strangulation. Bowel obstruction occurs when the tissues around your hernia or intestines become blocked by the hernia. This tissue may die if not immediately treated with surgery. 

 

One further complication is if your intestine happens to be strangulated, this leads to a cut off of blood supply to the region, resulting in the death of tissue and formation of gangrene. 

 

If treatment is not carried out promptly, peritonitis, which is infection and inflammation of the abdomen lining and its contents, may occur. Peritonitis is a life-threatening condition which should be avoided.

 

In the experience shared by Europe PMC, a 60 years old lady presented the medical centre with a ruptured incisional hernia following a bout of cough. She developed an incisional hernia following a tubectomy at the age of 30. The patient was recommended surgery for an incisional hernia in the past but refused to undergo the same.

 

Due to the seriousness of the condition, surgery was planned, and hernia repair was immediately administered. Thankfully, the operation went through successfully, and the wound healed well without any infection. Three months later, the patient showed no signs of complications during the follow-up.

 

While spontaneous rupture of an abdominal hernia is an infrequent complication, the rupture of an abdominal hernia is recommended for emergency surgery. This case is presented to emphasise the need for early operative intervention to prevent complications of incisional hernia.

 

How Is an Incisional Hernia Treated? 

 

Surgery is the only way to remove the incisional hernia altogether and prevents serious complications which may otherwise occur. 

 

An incision hernia typically does not reduce in size or go away by itself. The hernia would continue to grow larger. Planned surgery is recommended to avoid an emergency as it would involve fewer complications.

 

If an incision hernia is diagnosed promptly and suitably treated with surgery, the chances of it recurring is only between five to ten per cent. Should the incision hernia get to a stage which requires emergency surgery, surgical complications can be more severe than that of the planned surgery.

 

When treating an incisional hernia, there are two ways that the repair surgery may be performed. This is either an open hernia repair or laparoscopic hernia repair.

 

Open Hernia Repair

 

During a conventional open hernia repair, your doctor will make an incision to access the hernia over the bulge site. Doctors will then move tissue, intestine, and other organs forming the hernia back into the abdomen and close the opening.

 

Mesh patches are used to reinforce and support the area where the hernia developed. These mesh patches are attached to the tissue surrounding the hernia, forming a layer that will be absorbed by your abdominal wall. Applying a mesh would also help reduce the chances of a recurrence of the hernia in the region.

 

Laparoscopic Hernia Repair

 

A laparoscopic hernia repair is a less invasive procedure, and your doctor will make several smaller incisions around the hernia bulge site. A long, thin tube with a lighted camera on its end is inserted into one of the incisions, allowing doctors to see inside your abdominal cavity on a video screen.

 

The goal of either type of procedure is the same. The surgeon would place the bulging intestine or other intra-abdominal tissue and lining back through the hole in the abdominal wall. The hole is then sewed closed. A synthetic mesh material may be inserted into the abdomen to strengthen the area.

 

What Happens After I Treat My Hernia?

 

After your surgery, it is normal to experience pain around the surgical site. To aid this, your surgeon will prescribe medication to help ease this discomfort as you recover.

 

Tending to your wound would require extra care. You are advised to carefully follow your surgeon’s instructions to prevent complications or infections during your recovery.

 

Open surgery typically requires a longer recovery process when compared to laparoscopic surgery. Your surgeon will let you know when you can return to your normal routine.

 

Following a hernia repair, you may be unable to move around naturally for several weeks, and you may be advised to avoid strenuous or heavy activity. Additionally, you should avoid carrying and lifting heavy objects during this recovery period. This is to prevent adding stress and strain to the wound.

 

Due to the nature of a hernia, stay away from heavy lifting. Weightlifting could cause further herniation and deterioration of the condition, so it is advisable not to weight lift whilst you have the hernia.

 

In an article posted on ACI Health, Tracey documented her experience managing her incision hernia.

 

Tracey experienced an incisional hernia because a previous operation’s scar line had weakened her stomach. While lifting heavy objects, Stacey noticed her bulge was getting larger.

 

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