Incisional Hernia
What is an Incisional Hernia?
An incisional hernia is a postoperative complication, most often after abdominal surgery, due to a weakness in the scar tissue that forms as the body heals. It presents as a pathological movement of abdominal tissue or organs, called a hernial sac, through an opening in the surgical scar. An incisional hernia is more likely to develop if the surgical wound is large or if the wound became infected postoperatively.
Incisional Hernia – Causes
An incisional hernia forms at the previous surgical site because scar tissue is less resistant than normal tissues to the forces exerted by sneezing, coughing, constipation, or during pregnancy where intraabdominal pressure increases. Additional risk factors include:
- Large incisions from an extensive surgery
- Surgical site infection
- Mobilizing too quickly after surgery
- Intense exercise or sexual intercourse too soon after surgery
- Obesity, due to poor wound healing and greater risk of infection
- Diabetes, due to poor wound healing
- Smoking, due to poor wound healing
- Aging, due to natural skin and tissue weakening
- Pregnancy, especially after a previous cesarean section
- Surgical technique, e.g., sutures placed too far apart or with excessive tension
Incisional Hernia – Symptoms
A characteristic symptom of an incisional hernia is the appearance of a palpable lump or thickening under the surgical scar, accompanied by a sensation of pulling, discomfort, pain at rest, or pain that radiates somewhere else during physical activity. Although contents of the hernial sac usually return to the abdominal cavity when intraabdominal pressure decreases, there is a serious risk that they may become stuck in the hernia through a process called incarceration. Should symptoms such as pain, nausea, vomiting, fever, and gas or stool retention develop, immediately contact a physician as they may be due to hernia strangulation, a potentially fatal complication of incarceration.
Incisional Hernia – Diagnosis
The diagnosis of an incisional hernia involves careful palpation during which the physician looks for the characteristic subcutaneous bump around the surgical scar. Additional imaging, such as an abdominal ultrasound, may be necessary to fully evaluate the severity and stage of the disease. Should an incisional hernia be diagnosed, and especially if it expands, surgical intervention becomes necessary to avoid the risk of hernia incarceration and strangulation.
Incisional Hernia – Treatment
Surgery is the only option because incisional hernias do not disappear on their own and tend to expand over time. Correction of an incisional hernia may be done via classic (open) or minimally invasive techniques, such as laparoscopic or robotic surgery. This procedure is performed under general anesthesia and, depending on the size of the hernia, can last between 30 and 90 minutes.
Incisional Hernia Repair – Classic (Open) Technique
This method involves the removal of the surgical scar along with surrounding skin, subcutaneous tissue, and in some cases, muscles. Next, the defect in the abdominal wall is identified and closed using sutures. In the case of large hernias where suturing alone would cause excessive tension on the surrounding tissues, a medical mesh is placed to properly close the defect and reinforce the abdominal wall.
Incisional Hernia Repair – Minimally Invasive Technique (Laparoscopic or Robotic Surgery)
Minimally invasive techniques avoid making another large incision in the skin. Instead, access is achieved using only 3-5 much smaller incisions, whose diameter is less than 1cm. These tiny openings serve as gates for all the surgical instruments, including an endoscopic camera to properly visualize the area. Next, the surgeon identifies the defect and closes it, placing a special medical mesh underneath the defect to strengthen the abdominal wall if needed. Sometimes laparoscopy is challenging or impossible to perform in patients with previous surgeries, difficult physical access, or an unusual hernia location. Robotic surgery can overcome all of these obstacles and effectively treat even the most challenging hernias. Minimally invasive surgery offers patients several key advantages over classic, open techniques. Namely, there is less intraoperative blood loss and a lower risk of surgical site infection. The postoperative recovery period is also shorter and less painful, allowing patients to return to their daily routines sooner. Finally, scars are often barely visible when healed, achieving a vastly superior cosmetic effect for patients as compared with classic, open surgery.
Incisional Hernia – Recovery
Hospitalization after incisional hernia repair depends on the extent of the procedure and the method used. However, one can expect to remain hospitalized for about 1-3 days. The recovery period ranges from 4 to 6 weeks, during which patients must avoid lifting heavy objects and intense physical exertion, including sexual intercourse.
Incisional Hernia – Price
The price of an umbilical hernia repair depends on the stage of disease, the type of mesh used to reinforce the abdominal wall, and whether it is done classically, laparoscopically, or robotically. All details of the operation and possible treatment options are always discussed together with the attending physician during the initial consultation where you are qualified for the procedure.
