Definition
An incisional hernia is a bulging which occurs through a defect in the site of a previous abdominal incision or scar.
Who commonly presents with it?
Any person that has undergone previous abdominal surgery can develop a weakness at the site of the previous scar. Obesity is a common risk factor. It is also more common in patients that may suffer from chronic constipation or a chronic cough, who tend to strain quite a lot.
How does it present?
An incisional hernia usually presents with a ‘bulging’ at or close to the site of the abdominal scar. It is usually more visible on standing or lifting heavy objects and usually disappears on lying down. The hernia usually gets bigger over time and can be painful as well as unsightly. Other more serious complications include bowel obstruction presenting with nausea, vomiting and gross swelling of the abdomen. In some cases, the bowel’s blood supply can be cut off resulting in a condition called a ‘strangulated hernia’, this is a recognised surgical emergency.
What can be done?
Simple treatment measures involve the use of a specially designed corset or belt to support the hernia. Surgery is recommended to reduce the size of the hernia and help control some symptoms of pain. The operation involves reducing the contents of the hernia into the abdomen and repairing the defect in the abdominal wall by using a suitably sized mesh, which reinforces the repair. The operation can be performed by the conventional open technique utilising the previous incision or by a keyhole technique. Your surgeon will discuss the best type of repair for your incisional hernia at consultation.
How long will your recovery take?
Recovery is based on the type of operation that you have. Open surgery recovery is dependent on the size of the hernia and generally patients are encouraged to start mobilising gently immediately after surgery and refrain from lifting heavy objects for at least three or four weeks. A return to full activities is expected within 6 weeks. Keyhole surgery has a quicker recovery time, but patients may experience similar pain that can be expected from an open repair for the first few days after surgery. Keyhole repair also has the advantage of a reduced hospital stay.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and specifically for open and keyhole incisional hernia a risk of recurrence of the hernia of up to 10%, which can be higher for much larger incisional hernia. There is also a risk of bowel and other abdominal organ complication, re-operation and if you have high medical risk factors such as heart and lung disease small risk to your life especially of the hernia is considered large and complex. for advice on mesh please see https://mailchi.mp/23a275fbe343/j114lk1gnu
Seroma
Keyhole incisional hernia repair also carries a risk of ‘seroma’ formation. This is fluid collecting in the space left between the abdominal wall and the skin, originally occupied by the hernia contents. Usually this fluid is managed conservatively and left alone. In some cases, the fluid is aspirated with a needle, but this carries a risk of seroma infection. Most seromas resolve after 6-8 weeks.