What are the other Names for this Condition? (Also known as/Synonyms)

• Hernia due to Surgery
• Hernia due to Incision

What is Incisional Hernia? (Definition/Background Information)

• When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region
• Medically, there are various types of hernia and the most common ones are:
  • Inguinal hernia
  • Incisional hernia
  • Femoral hernia
  • Umbilical hernia
  • Hiatal hernia         
• A hernia that occurs through a surgical scar is called an Incisional Hernia. Nearly 70% of all hernias are considered to be Incisional Hernias. In this condition, the intestine protrudes through a defect (or weakening) in the abdominal wall, where a previous abdominal surgery was performed. The hernia can appear as a bulge under the skin and can become very painful at times
• Apart from a bulge in the abdomen, other signs and symptoms may include nausea, severe discomfort, difficulty having proper bowel movements, and even strangulation. In strangulation, the intestine gets caught outside the defect and the blood supply to the intestine gets “cut off”, resulting in death of the intestinal tissue. Strangulation is an emergency medical condition
• Symptomatic and large Incisional Hernias require surgical correction; though, most do not require an immediate repair (surgery). However, in cases where surgery is not immediately advised, individuals are advised to immediately visit their healthcare provider, if any symptoms or complications develop. The prognosis for Incisional Hernia is good with proper surgical treatment

Who gets Incisional Hernia? (Age and Sex Distribution)

• As Incisional Hernias occur following a surgery. It is more commonly observed with increasing age, due to the fact that the probability of having surgeries increases with age. Moreover, the process of wound healing gets qualitatively poorer with age
• Nevertheless, individuals of any age can get Incisional Hernia. Up to 10% of all belly hernias are due to Incisional Hernias
• They are 2 times more common in women than men, probably due to surgeries related to childbirth

What are the Risk Factors for Incisional Hernia? (Predisposing Factors)

The most important risk factor is a previous history of belly or abdominal surgery. Other factors that may compound one’s risk of Incisional Hernia include:

• Wound infection after a stomach/abdominal surgery can increase the risk of acquiring a hernia in the future
• Improper surgical techniques used during belly surgeries
• History of multiple abdominal surgeries
• Prior history of Incisional Hernias
• Overweight or obese individuals
• History of, or associated ventral hernias, such as umbilical or epigastric hernias
• Medical conditions in which there may be poor wound healing such as diabetes mellitus
• Use of steroids (corticosteroids) for other medical conditions
• Activities that put pressure on the abdomen, such as weightlifting, or the use of improper lifting techniques
• Conditions that increase intra-abdominal pressure such as chronic cough or constipation
• Age: Elderly adults are more likely to be affected because the healing process becomes poor with aging
• Pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Incisional Hernia? (Etiology)

Incisional Hernias only occur in individuals with a past history of surgery of the stomach or abdomen (belly). The following factors may provoke an Incisional Hernia:

• Weaknesses of surgical wounds that may be due to:
  • Hematoma - a collection of blood outside of the blood vessels, which gathers in the body tissues or cavities
  • Seroma: It is a pocket of serous fluid (fluid other than blood) that develops in the body after surgery
  • Infection: Invasion of the body region by disease causing organisms
• Increased intra-abdominal pressure that may be due to:
  • Chronic cough
  • Constipation
  • Urinary obstruction
  • Pregnancy
  • Ascites (fluid in the peritoneal cavity)
• Incisional Hernia can be caused by inefficient surgical procedure techniques adopted by the surgeon. This could include not choosing the right closure technique, poor choice of suture (stiches) material, etc.
• Up to 10-15% of belly surgeries are known to be complicated by Incisional Hernias. This percentage is lower for laparoscopic belly surgeries and higher for open (bigger wound) belly surgeries

What are the Signs and Symptoms of Incisional Hernia?

In Incisional Hernia, the weakness of the muscle, associated tissues (fascia), and scar is due to an incision made during a previous abdominal surgery. The signs and symptoms of Incisional Hernia may be:

• Bulge in the belly area where the surgical incision was made. The bulge may disappear on lying down or can be pushed back by the affected individual. Sometimes, intestinal movements can be noticed in the area of the bulge
• The bulge usually increases in size with time. It also becomes bigger during strain, while involved in activities such as lifting heavy objects, coughing, bowel movements, etc. The healthcare provider may check for this with a technique called “Valsalva” during physical examination
• The intestine loop may get stuck (incarcerated) in the hernia cavity (sac). This may present with additional signs and symptoms such as:
  • Abdominal pain
  • Nausea and vomiting
  • Inability to have proper bowel movements
• Incarceration (confinement) can progress to strangulation. In strangulation, the intestine gets caught outside the defect and blood supply to the intestine gets “cut off”, which may cause death of the intestinal tissue. This is an emergency medical condition; such individuals may also have the following signs:
  • Continuous and severe discomfort or abdominal pain
  • Inability to pass gas or bowel movement

How is Incisional Hernia Diagnosed?

The following exams and procedures may be used to diagnose an Incisional Hernia:

• A physical examination and evaluation of medical history by the physician is normally sufficient to diagnose the condition
• Hernia becomes noticeable only when activities that increase the pressure on the abdomen are undertaken. Hence, the physician will ask the patient to cough or strain to observe the hernia, as it bulges out
• Additional diagnostic tests may be required if any complications are suspected. These may include:
  • Abdominal x-ray
  • CT scan of abdomen        

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Incisional Hernia?

The possible complications of an Incisional Hernia include:

• Incarceration (getting stuck) of the portion of the intestine that herniated through the defect, causing severe pain, discomfort, nausea, vomiting, and decreased bowel movements
• If the portion of the intestine dies (strangulated hernia) due to ongoing incarceration and lack of blood supply, it may lead to sepsis (infection of the blood), multi-organ failure, and even death, if the condition is left untreated

An Incisional Hernia repair (surgery) can lead to the following complications:

• Fluid buildup in the area where the mesh (artificial support structure) has been placed, which may sometime require to be drained-off (removal of fluid)
• Excess bleeding after the surgery
• Pain in the sutured area that requires the use of pain-controlling medicines and anti-inflammatory drugs
• Chances of injury to various internal organs such as the intestines and liver; an injury to the nerves may also occur
• Fever, which may occur as a result of wound infection
• Abscess in the abdominal wall
• Urinary retention - lack of ability to urinate
• Blood clot in the legs may occur as a result of decreased mobility after surgery. The blood clots (thrombus) occurring in the legs may travel to the lungs (pulmonary thromboembolism) and cause respiratory problems. This may even result in death, if the embolus/clot is large

How is Incisional Hernia Treated?

Typically, a hernia cannot be repaired or treated using medications. Surgery is the only option available for repairing an Incisional Hernia.

• All hernias do not have to be repaired immediately, especially if there are no symptoms other than a bulge. In such cases, the following may be tried:
• Use of a truss (binder), which is a garment (very much like a weight belt or girdle) to hold the organs in place
• Surgery for hernia will be required:
  • If the hernia grows in size over time
  • It becomes very large
  • When it looks ugly with respect to appearance (cosmetic)
  • The bulge remains, even when the patient is lying down or relaxing
  • When it is painful       
• When hernia is in the stuck-out position, it is called as an incarcerated hernia. When this incarcerated hernia becomes a strangulated hernia (when the tissue that protrudes is devoid of blood supply), the hernia has to be treated on an emergency basis and surgery should be done immediately

Surgery may be performed by using the laparoscopic method or open method using general anesthesia, by a general surgeon.

• The hernia sac is put back into its original position and then the weakened muscles are approximated with sutures
• If the muscle defect is small, then sutures alone are used to close the gap (herniorrhaphy with no mesh). But with this technique, there is an increased chance of recurrence of the hernia
• If the defect in the muscle is large, a mesh graft is used to cover the hole

How can Incisional Hernia be Prevented?

The following measures may be adopted to prevent Incisional Hernias:

• Decrease the amount and duration of pressure on the abdominal organs; for example:
  • Cough medications may be taken for cough, so as to avoid unnecessary increase in abdominal pressure
  • For chronic constipation, the amount of fiber in one’s diet should be increased. Also, drinking plenty of water can help solve this condition and help in preventing Incisional Hernia         
• Smoking should be completely stopped, because it can cause cough and may also be a reason for poor wound healing
• A suitable, nutritious diet before and after surgery can help with better recovery and good wound healing process
• Obsess or overweight individuals should reduce their body weight to reduce the risk of Incisional Hernias
• Occurrence of incisional hernias can also be decreased, when surgeon adopts appropriate surgical techniques and treats wound infection promptly with antibiotics and drainage

What is the Prognosis of Incisional Hernia? (Outcomes/Resolutions)

The prognosis for Incisional Hernia is generally good, if surgery is performed early, before any complications develop.

Additional and Relevant Useful Information for Incisional Hernia:

• An Incisional Hernia is a type of acquired ventral (belly) hernia. The other congenital ventral hernias are umbilical hernias, epigastric hernias, and Spigelian hernias
• An incisional hernia repair or incisional herniorrhaphy is a surgical procedure performed to repair an incisional hernia

The following article link will help you understand incisional hernia repair surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/incisional-hernia-repair/