Incisional Hernia

Incisional Hernia / Ventral Hernia

Incisional hernias are a common complication of abdominal surgery, affecting approximately one in three patients. While not usually serious, incisional hernias can lead to complications if untreated. Understanding the signs and symptoms of an incisional hernia is important for early detection and appropriate management.

What Is an Incisional Hernia?

An incisional hernia is a type of ventral hernia that can occur after an abdominal surgery, typically close to or along surgical scars. It happens when tissue pushes through a weakened area of the abdominal wall at a previous incision site.

While all incisional hernias are ventral hernias due to their location, not all ventral hernias are incisional. Ventral hernias can also arise from other causes, such as trauma or congenital defects.

What Causes an Incisional Hernia?

Incisional hernias are primarily caused by a combination of factors that weaken the abdominal wall at the site of a surgical incision, including:

• Wound Infection – Infections at the surgical site can impede healing, leading to a weakened abdominal wall and increasing the risk of hernia formation.
• Obesity – Excess weight places additional pressure on the abdominal wall, making it more likely for a hernia to develop, especially if the incision has not fully healed.
• Smoking – Smoking can impair blood circulation and wound healing, contributing to the risk of incisional hernias.
• Excessive Abdominal Tension – Activities that increase intra-abdominal pressure, such as heavy lifting, chronic coughing, or straining during bowel movements, can stress the incision site and lead to herniation.
• Improper Surgical Techniques – Using inadequate sutures or failing to close the incision correctly can contribute to the development of incisional hernias.

Signs and Symptoms of an Incisional Hernia

Patients who have had abdominal surgeries are especially susceptible to incisional hernias three to six months after the procedure, though they can develop at any time. If they occur, they may present several signs and symptoms, including:

• A Bulge Near an Old Surgical Incision – The most noticeable symptom is a protrusion or bulge at the site of a previous surgical incision, which may become more prominent when standing, lifting, or straining.
• Pain – Patients may experience pain, especially during physical activities that pressure the abdomen. Depending on the size and location of the hernia, the pain can range from mild discomfort to severe.
• Aching, Burning, or Gurgling Sensations – These sensations can occur around the hernia site and indicate discomfort or irritation in the affected area.
• Vomiting – Vomiting is a serious complication that can occur if the hernia leads to complications such as bowel obstruction or strangulation, which may require urgent medical attention.

Complications of Incisional Hernias

Incisional hernias are a type of hernia that can grow larger over time, increasing the risk of complications, including:

• Incarceration: The hernia can become stuck. In large hernias, this might not cause problems, but in smaller hernias, it can be painful and more serious.
• Obstruction: This occurs when the hernia blocks the bowel, leading to more severe issues such as strangulation or even perforation of the intestines.
• Strangulation: Incarceration or obstruction can progress to strangulation, a dangerous condition where the blood supply to the intestines is cut off. This requires emergency treatment.

Possible Risks of Incisional Hernia Surgery

Incisional hernia surgery may carry potential risks, such as:

• Mesh Complications – In rare cases, the mesh used in repair may cause infection, migration, or erosion into nearby tissues, requiring further surgery.
• Wound Healing Issues – Delayed healing or chronic wounds can occur, especially in patients with obesity or diabetes.
• Hernia Recurrence – Even after surgery, hernias can return if the repair isn't strong enough or risk factors persist.

Recovery After Incisional Hernia Surgery

Recovery time after incisional hernia surgery can vary depending on the individual and the complexity of the repair. Most patients can return home on the same day once they are able to pass urine and walk.

During the first week after surgery, patients can expect some soreness but should be able to return to non-physically demanding work. In most cases, follow-up appointments are not needed and patients should be able to fully recover after three to six weeks.

Essential Tips to Support Recovery

• Avoid heavy lifting or strenuous activity for at least six weeks.
• Support yourself with your arms when standing to reduce strain on your abdomen.
• Gently brace your abdomen with a pillow when sneezing or coughing to protect the incision.
• Prevent straining by eating a fibre-rich diet and staying hydrated; consult your doctor about gentle laxatives if needed.