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Incisional
What Is an Incisional Hernia?

An incisional hernia happens when a weakness in the muscle of the abdomen allows the tissues of the abdomen to protrude through the muscle. The hernia appears as a bulge under the skin, and can be painful or tender to the touch.

In the case of an incisional hernia, the weakness in the muscle is caused by the incision made in a prior abdominal surgery. An incisional hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through.

In severe cases, portions of organs may move through the hole in the muscle.

Not entirely clear? During surgery an incision is made in the muscles that make up the abdomen. For some reason, that muscle doesn't heal, so a gap opens up as the muscles tighten and release during activities. Instead of a flat, strong piece of muscle, you have a piece of muscle that has a small gap in it. After a while, the tissues underneath realize there is an escape route through the muscle, and they start to poke through the opening, where they can be felt under the skin.

Who Is At Risk For an Incisional Hernia?

Incisional hernias are most likely to occur in obese and pregnant patients. A history of multiple abdominal surgeries may increase the risk of an incisional hernia. If a hernia develops in the abdomen and the patient has not had surgery, it is not an incisional hernia.

A patient who gains significant weight after an abdominal surgery, becomes pregnant or participates in activities that increase abdominal pressure like heavy lifting is most at risk for an incisional hernia.

The incision is weakest, and most prone to a hernia, while it is still healing. While incisional hernias can develop or enlarge months or years after surgery, they are most likely to happen 3-6 months after surgery.

Diagnosing an Incisional Hernia

Incisional hernias happen after an abdominal surgery and may seem to appear and disappear, which is referred to as a "reducible" hernia.

The hernia may not be noticeable unless the patient is involved in an activity that increases abdominal pressure, such as coughing, sneezing, pushing to have a bowel movement, or lifting a heavy object. The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician. The physician may request that you cough or bear down in order to see the hernia while it is "out".

Routine testing can be done to determine what area of the body is pushing through the muscle. If the hernia is large enough to allow more than the peritoneum to bulge through, testing may be required.

When Is Incisional Hernia an Emergency?

A hernia that gets stuck in the "out"position is referred to as an incarcerated hernia. While an incarcerated hernia may not be an emergency, medical care should be sought as it can become an emergency quickly. An incarcerated hernia becomes an emergency when it becomes a "strangulated hernia" where the tissue that bulges out is being starved of its blood supply. Untreated, a strangulated hernia can cause the death of the tissue that is bulging through the hernia.

A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.

Think of it as the hernia equivalent of typing a string around your finger until it turns purple and hurts and then you cannot get the string off.

Treatment for Incisional Hernia

Two recommended methods of repair would be either our open-mesh technique or Keyhole surgery. Deciphering which one to use depends on the hernia, the desired outcome, the patient and the Consultant. The type of repair is always tailored to the patient case and from the opinion of a Consultant. Our Open-Mesh repair technique gives the best results. The layer of the abdominal wall in which the mesh is placed is a really important factor.

Is no treatment an option?

If you leave an incisional hernia it will almost certainly enlarge and become more and more uncomfortable. Even though many hernias do not hurt and the temptation is to leave them and get on with life, the recommended option is always to seek treatment before the problem worsens. But failing to get medical advice can be damaging and is not recommended. If left the hernia will grow and discomfort and pain, even if negligible to start with, will intensify.