An incisional hernia is a type of hernia that sometimes develops in individuals who have had abdominal surgery.
A weakness in muscles around an area where a surgical incision was made sometimes reduces tissue strength enough to allow intestines and other organs or tissues to protrude. When this happens, a bulge under the skin is usually noticeable.
of this nature are usually small enough so that only the lining of the abdominal cavity (peritoneum) comes through.
Incisional Hernia Causes and Symptoms
In order for a hernia to be classified as incisional, a patient must have had prior abdominal surgery. The risk of developing this type of hernia increases if multiple abdominal surgeries have taken place. It's also more likely that an incisional hernia will develop if an individual gains significant weight following surgery, becomes pregnant after surgery, or returns to a job that involves frequent heavy lifting. While it is possible for incisional hernias to develop slowly over several months or years after abdominal surgery, they are more likely to occur within 3-6 months after surgery. Noticeable symptoms and signs associated with this type of hernia may include:
- Tenderness in the abdominal area
- Pain, aching, or swelling
- A visible abdominal bulge
- Foul-smelling drainage after abdominal surgery when the wound is still healing
- Bowel obstruction
- Fever and other signs of a related infection
Diagnosing an Incisional Hernia
An incisional hernia sometimes "appears" and "disappears" based on what type of activities or movements a patient is making. For this reason, diagnosis may involve asking a patient to cough or make some type of abdominal exertion to create the abdominal bulge. Standard testing may be done if it's suspected that more than the abdominal lining is protruding.
Conservative Treatments and Surgery
If the protrusion is minor and not producing serious discomfort, treatment may involve wearing a hernia truss or a similar type of compression garment. When an incisional hernia is constantly bulging out (incarcerated hernia), cutting off the blood supply to the tissue that's protruding (strangulated hernia), or causing serve pain, surgery may be recommended.
Typically, laparoscopic methods are used to reposition the protruding structures or tissues and repair the muscle defect. Small defects are usually sutured closed. If the defect is large, a mesh graft may be performed to effectively cover the hole and prevent protrusion from occurring again. Using a mesh graft also reduces the odds of recurrence with larger protrusions. If laparoscopic techniques are used, the incision is closed with either a special type of glue or sticky bandages (steri-strips).
If surgery for an incisional hernia is necessary, most patients are able to return to their normal activities in about 2-4 weeks. During the initial recovery period, anything that creates excessive abnormal pressure should be avoided, including straining while making bowel movements, forceful sneezing or coughing, and lifting anything heavy. Since incisional hernias are related to abdominal surgery, the most effective preventative step may be for patients to make an effort to strengthen abdominal and core muscles as much as possible following any type of surgery in this area.