An incisional hernia (also known as an incision hernia or postoperative hernia) refers to hernias that occur at the site of a surgical incision. They typically develop around 3-4 months after the surgical procedure, where internal organs and tissues protrude through the incision site.
Incisional hernias can result from various factors such as infections at the incision site, improper selection of suture materials, weakness at the incision site, or excessive physical activity that increases intra-abdominal pressure. Patients usually present with complaints of swelling, protrusion, pain, or discomfort at the incision site.
To diagnose an incisional hernia, a thorough medical history should be taken regarding the previous surgery, followed by a physical examination where the swelling at the hernia site is checked. Maneuvers that increase intra-abdominal pressure, such as straining, coughing, or exertion, can help highlight the hernia during the examination.
Imaging techniques may also be used to detect incisional hernias. Ultrasound is the most commonly used method, allowing for assessment of the hernia's size and the organs within the hernia sac.
Computed tomography (CT) is preferred for a more detailed examination of the incisional hernia, and magnetic resonance imaging (MRI) can also be used to provide detailed views of the hernia structure and surrounding tissues.
Incisional hernias mostly arise due to complications at the site of a previous surgical operation. Insufficient tissue integrity from large surgical cuts, incomplete healing, and weakness can lead to the protrusion of internal organs through the incision.
Infections at the incision site can negatively impact wound healing, creating a conducive environment for hernia formation. Factors such as loosening of the suture material, inappropriate suture material, and conditions that increase intra-abdominal pressure (such as excessive straining, chronic cough, constipation, and heavy lifting),as well as connective tissue disorders or chronic illnesses that prolong wound healing, can lead to incisional hernias.
An incisional hernia can emerge anywhere from one week to several months after a surgical procedure. The timeline for hernia development is influenced by factors like the size of the surgery, presence of infection at the incision site, conditions that increase intra-abdominal pressure, selection and use of suture materials, and the patient's existing health conditions (like diabetes) that may delay wound healing. Symptoms such as swelling, pain, and discomfort may appear.
An incisional hernia after cesarean delivery is a hernia that occurs at the surgical incision site post-delivery. It is typically due to problems that arise during the healing process at the incision site. Factors such as insufficient suturing, inappropriate selection of suture material, infections, increased intra-abdominal pressure, heavy lifting, and excessive physical activity can contribute to hernia formation.
Patients may present with swelling, pain, and tenderness at the incision site. Diagnosis is made through physical examination and imaging techniques like ultrasound, followed by treatment planning.
Symptoms of an incisional hernia vary based on the location, size, and physical condition of the patient but generally include swelling, protrusion, pain, tenderness, and discomfort at the incision site. Symptoms may decrease at rest but can worsen with increased physical activity or actions that raise intra-abdominal pressure (such as coughing, straining, or lifting heavy objects).
An incisional hernia can cause pain due to compression and pressure on internal organs within the hernia sac. The intensity of the pain may vary based on the size and location of the hernia. Typically, pain is felt directly over or around the hernia.
Treatment for an incisional hernia usually depends on the size of the hernia, frequency, and severity of symptoms, as well as the patient’s overall health condition.
Surgical repair can be done using open or laparoscopic methods. In open surgery, an incision is made to access the hernia, and the organs within the hernia sac are pushed back into the abdomen. The hernia area is then closed with appropriate suture material, often reinforced with a mesh to increase tissue strength. Laparoscopic surgery involves making smaller incisions and using a camera for hernia repair.
Supportive treatments aim to reduce pressure and pain, often through the use of external braces and supportive garments. However, these methods are not curative. Surgical intervention remains the definitive solution and these treatments can be used for symptom relief until surgery.
Surgery for an incisional hernia is a procedure aimed at repairing the defect in the abdominal wall that caused the hernia. During the surgery, the contents of the hernia are returned to the abdomen, the hernia opening is closed, and a mesh may be placed to reinforce tissue integrity and reduce the chance of recurrence.
Incisional hernia surgery can be performed either openly or laparoscopically. The choice of surgical method depends on the hernia's location, size, and patient-specific factors.
Initially, the patient consults a doctor for examination, and necessary tests and imaging studies are ordered to determine the appropriate procedure. The patient is informed about the surgery, and an anesthesia consultation is arranged to determine the type of anesthesia to be used.
Post-surgery, the patient usually stays in the hospital for a duration determined by the doctor, typically until the following day. Patients receive guidance on what to do next, medications to take, wound care, and follow-up processes. Recommendations are provided regarding physical activities and precautions to take.
After incisional hernia surgery, attention should be paid to pain control, using prescribed pain medications and rest to manage discomfort. Wound care should follow the doctor's instructions, and any potential problems, such as redness, swelling, or discharge, should prompt immediate consultation with a doctor.
Patients should rest for the first few days and gradually return to simple activities while avoiding heavy lifting and strenuous physical activity that increases intra-abdominal pressure. Balanced nutrition and hydration are also important during recovery.
Mild swelling and bruising at the surgery site are common and usually resolve on their own, but patients should keep their doctor informed. Medications prescribed post-surgery should be taken as directed, and follow-up appointments are crucial for identifying any problems early.
Patients may experience pain after incisional hernia surgery, typically associated with the surgical intervention and manageable with appropriate care.
Pain at the surgery site may last from a few days to several weeks, depending on the healing process. Doctors will provide necessary pain relief options, and regular use of these medications is important for managing pain.
Rest and appropriate physical activity can help alleviate discomfort. If pain worsens significantly, it could indicate a problem, necessitating a consultation with the doctor.
Patients should avoid movements that increase pain (such as heavy lifting) and conditions that can exacerbate discomfort (such as constipation or coughing). Follow-up appointments are vital for early identification and management of any potential issues. Pain usually diminishes over time, but the duration varies from person to person.
The duration of incisional hernia surgery varies based on the surgical method chosen (open or laparoscopic),the hernia's location, its severity, the patient's overall health, and the experience of the surgical team. On average, an incisional hernia surgery lasts between 1-3 hours. Additionally, preparing the patient for surgery and their recovery in the operating room typically adds another 1-2 hours.
If a patient decides against surgery for an incisional hernia, they may face several potential issues. The hernia may progressively enlarge, and complaints of pain may increase. The internal organs within the hernia may become trapped, and the swelling may not reduce even at rest (incarceration).
If blood flow to the trapped organs is compromised (strangulation),it can lead to organ necrosis (tissue death) and necessitate emergency surgery. Activities that increase intra-abdominal pressure (such as heavy lifting, coughing, or constipation) can exacerbate pain and worsen the existing hernia.
Additionally, the patient may experience limitations in their social activities, and persistent pain can negatively affect their psychological well-being. Without treatment, hernia surgery may become more complicated, increasing associated risks.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
