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What is an Incisional Hernia?

An incisional hernia is a post-operative condition characterized by a protrusion of the abdominal or intestinal tissues through an area of weakness in a previous surgical wound. Incisional hernias can occur following a C-section or any other abdominal surgery and usually develop within a few months of the procedure.

Causes of Incisional Hernia

An incisional hernia occurs when the surgical wound does not heal properly causing a gap to develop in the abdominal wall. Some of the factors that affect proper healing of the wound include:

  • Strenuous physical activity before adequate wound healing
  • Gaining weight or becoming pregnant after surgery
  • Straining during a bowel movement
  • Infection at the wound site
  • Hematoma at the wound site
  • Abdominal swelling due to fluid accumulation
  • Smoking

Symptoms of an Incisional Hernia

The most common symptom of an incisional hernia is a visible bulge formed at the surgical site. The hernia may sometimes be reducible i.e. its contents can slide back or be manually pushed back into the abdominal cavity. Some of the other symptoms include:

  • Pain near the hernia
  • Redness of the bulge
  • Abdominal pain during physical activity
  • Vomiting and nausea
  • Diarrhea
  • Constipation or thin stools
  • Intestinal blockage
  • Fever 
  • Wound infection

An incisional hernia that is fixed can become strangulated due to a lack of blood supply. This can lead to tissue damage due to necrosis or inflammation of the tissues involved in the hernia and is considered a medical emergency. Sometimes, scar tissue can develop causing an intestinal blockage.  

Diagnosis of an Incisional Hernia

Your doctor will review your medical history and symptoms and based on this a physical examination will be performed. You will be instructed to stand and cough while your doctor examines the bulge in the abdomen. Imaging tests such as ultrasound, CT and MRI scans may be ordered to view the abdominal or intestinal tissues. 

Treatment for an Incisional Hernia

Treatment for an incisional hernia is based on the severity of the condition. Severe cases may lead to strangulation where the blood supply to the tissues is blocked and is considered an emergency condition. Treatment includes:

Medications: Your doctor will prescribe over the counter pain medications to reduce pain and inflammation.

Surgery: Surgical treatment may include either open or laparoscopic surgery.

  • Open Incisional Hernia Repair
    • The procedure will be performed under general anesthesia.
    • Your doctor will make an incision over the hernia and any scar tissue will be removed.
    • Your doctor will then push the herniated tissues back into the abdomen.
    • If the hernia is small the defect in the muscles are sutured close (herniorrhaphy).
    • For larger defects, a natural or synthetic mesh is additionally placed over the defect to reinforce the closure (hernioplasty).
  • Laparoscopic Incisional Hernia Repair
    • This is a minimally invasive technique performed under general anesthesia.
    • Your doctor will make a few small incisions on the abdomen through which a laparoscope, a thin flexible tube with a light and a camera at its end, will be inserted along with other surgical instruments.
    • The camera captures images that are then displayed on a monitor to help your doctor carry out the procedure. The abdominal cavity is inflated with a harmless gas to improve the visualization of the structures. 
    • The protruding tissues or organs are returned back to the abdomen and the defect is closed with sutures or a mesh. The laparoscope and instruments are then removed.
    • The incisions will be then closed with stitches or surgical tape.

Prevention from Incisional Hernia

Some of the most common preventive measures for an incisional hernia include:

  • Maintaining a healthy weight
  • Avoid straining during bowel movements
  • Treat constipation (stool softeners may be recommended following abdominal surgery)
  • Avoid strenuous activity and place pressure over the area for support while performing activities that may strain the abdominal area
  • Use topical ointments for wound healing
  • Control your blood sugar level in case you are diabetic
  • Avoid smoking