Incisional Hernia - Abdominal Wall

An incisional hernia is a type of hernia that develops at the site of a surgical incision or scar in the abdominal wall. It occurs when tissue, such as part of the intestine, protrudes through a weakened area of the abdominal muscles or fascia, causing a visible bulge or lump.

Incisional hernias can occur weeks, months, or even years after surgery and may cause discomfort, pain, and complications if left untreated.

Causes and Risk Factors
The primary cause of an incisional hernia is a weakening or disruption of the abdominal wall at the site of a previous surgical incision. Several factors may contribute to this weakening, including:

1. Infection: Postoperative infection at the incision site can impair wound healing and weaken the abdominal wall, predisposing it to herniation.
2. Obesity: Excess body weight can put increased pressure on the abdominal wall and surgical incisions, increasing the risk of hernia formation.
3. Chronic Cough: Persistent coughing, such as that associated with smoking or lung conditions, can strain the abdominal muscles and contribute to the development of hernias.
4. Malnutrition: Inadequate nutrition or poor wound healing can impair the strength and integrity of the abdominal wall, increasing the risk of hernia formation.
5. Age: Older adults may be at higher risk of developing incisional hernias due to age-related changes in the abdominal wall and decreased tissue elasticity.

Symptoms
The symptoms of an incisional hernia can vary depending on the size and location of the hernia and whether any complications are present. Common symptoms may include:

1. Visible Lump or Bulge: The most prominent symptom of an incisional hernia is a visible bulge or lump at the site of a previous surgical incision, particularly during activities that increase abdominal pressure, such as lifting, coughing, or straining.
2. Discomfort or Pain: Discomfort or aching sensation at the incision site, especially when lifting heavy objects, coughing, or bending over.
3. Nausea and Vomiting: In some cases, an incisional hernia may cause symptoms such as nausea, vomiting, or indigestion, particularly if the hernia compresses nearby organs or disrupts digestive function.
4. Tenderness and skin change: The area around the hernia may be tender to the touch and red, especially if the hernia becomes inflamed or incarcerated (trapped).
5. Changes in Bowel Habits: In rare cases, large incisional hernias may compress the intestines or disrupt bowel function, leading to changes in bowel habit.

Diagnosis
Diagnosing an incisional hernia typically involves a physical examination and may include additional imaging tests. Common diagnostic methods may include:

1. Physical Examination: A healthcare provider may perform a physical examination to feel for a lump or bulge at the site of a previous surgical incision and assess its size, location, and reducibility (whether it can be pushed back into the abdomen).
2. Ultrasound: An ultrasound scan may be used to visualize the hernia and surrounding structures to confirm the diagnosis and assess for any complications.
3. CT: This is often used to look at the contents of the hernia, measure the size of the hernia defect and exclude other small defects. This information allows for proper operative planning and is especially crucial when repairing large incisional hernias.

Treatment
Treatment for an incisional hernia depends on the size, location, and severity of the hernia, as well as the presence of symptoms or complications. Treatment options may include:

1. Watchful Waiting: In cases where the hernia is asymptomatic and not causing complications, a healthcare provider may recommend watchful waiting and monitoring for any changes in size or symptoms. This decision may also be appropriate in patients with multiple health problems who have a longstanding incisional hernia.
2. Laparoscopic Surgery: In some cases, minimally invasive laparoscopic surgery may be performed, involving small incisions and the use of a camera and specialized instruments to repair the hernia.
3. Robotic Surgery: Minimally invasive surgery using small (8mm) incisions and attached to robotic instruments (controlled by the surgeon) can be superior to open surgery in some patients with incisional hernia.
4. Open Surgery: Traditional open surgery may be necessary for larger or more complex hernias, involving an incision in the abdomen to access and repair the hernia with the use of mesh.