Incisional hernia (medical: incisional hernia) is a complication that occurs during abdominal surgery. The incisional hernia must be operated on in any case. If the intestine becomes trapped, there is an acute danger to life, so that the fracture is treated as part of an emergency operation.
What is incisional hernia?
A scar hernia is a soft tissue hernia that usually occurs after an operation. The scar that was created when the abdominal wall and muscle were sewn together cannot withstand the pressure and is displaced. As a result, there are protrusions that can reach sizes of up to 30 centimeters. If a secondary hernia occurs as a result, which can occur as part of an incisional hernia, and if parts of the intestine become trapped in the hernial orifice, there is a risk of death. See photionary for Hyperostosis 101.
The pressure that occurs in the abdomen can be increased by being overweight, coughing, straining, pregnancy or abdominal dropsy (so-called ascites); this leads – in the case of an acquired weak point (scar) in the connective tissue or in the abdominal wall – to a scar hernia. An incisional hernia can also occur if the patient lifts heavy loads after surgery without rest.
Symptoms, Ailments & Marking
Incisional hernia usually occurs within the first postoperative year. The patient notices a tactile and visible protrusion that occurs in the area of the surgical scar. The bulge occurs when standing, pressing, or engaging in physical exertion and may increase in size over time.
Sometimes pain during defecation, coughing or even physical exertion can occur. Digestive problems or a disturbed symmetry of the abdomen are also possible. Symptoms may vary depending on the size of the hernia. In the case of small incisional hernias, there are often no symptoms at all.
Incisional hernias are characterized by the fact that the bulge can be pushed into the abdomen; as a rule, this process does not cause any pain. If the patient complains of severe pain and suffers from nausea and vomiting, the intestines or sections of intestine are trapped. The bulge, which can usually be pushed back into the abdominal cavity, remains hard and immobile.
Diagnosis & course of disease
During the physical examination, the doctor can determine relatively quickly whether it is a hernia or not. He feels the affected area with his fingers and can “feel” the hernial sac or hernial orifice. If the doctor is unsure, further tests can be carried out.
These include ultrasound examinations (sonography), X-rays or computer tomography. Sometimes a colonoscopy can be done to confirm the diagnosis. Other examination procedures are usually used for people who are very overweight or have very small fractures.
The incisional hernia is – in almost all cases – harmless. If the fracture is not treated, it can increase in size, so small fractures that are less than four centimeters in size can spread to as much as 30 centimeters. However, if a secondary hernia occurs, it can lead to a life-threatening intestinal obstruction.
If this circumstance occurs, the patient must be operated on immediately. Since the intestines or sections of the intestine are trapped, there is an acute danger to life due to the fact that the trapped parts of the intestine can die.
A hernia is already a complication of a previous abdominal operation. It is favored by various risk factors such as obesity, wound infections, hereditary predisposition and age. However, an incisional hernia should always be operated on because there is a risk that fatty tissue or even intestinal tissue may become trapped. In addition, if left untreated, the fracture will constantly expand and can then even assume monstrous proportions with a diameter of more than ten to fifteen centimeters.
With this size, parts of the abdominal viscera always push into the hernia. The risk of the abdominal tissue or intestine being trapped depends on the size of the hernia. The smaller the hernia gap, the greater the risk of entrapment. Entrapment of part of the bowel is always a medical emergency that requires immediate attention. Severe abdominal pain occurs within a short time, which can be permanent or colicky.
A very pressure-sensitive abdomen is typical. There is also nausea, vomiting, fever and chills. If surgery is not performed immediately, the trapped part of the bowel dies and the contents of the bowel spill out into the abdomen. As a result, peritonitis develops, which, if left untreated, leads to death. Long-term consequences of incarcerated hernias can also be adhesions, chronic inflammation and constant accumulation of faeces up to intestinal obstruction.
When should you go to the doctor?
Scar symptoms such as itching or inflammation do not necessarily have to be treated by a doctor. However, should complications arise or even scarring occur, a doctor must be consulted immediately. People who notice bleeding or a complete tear in the area of the scar are best informed by their doctor. If the scar hernia is treated immediately, another tear and the associated complications can usually be avoided. However, if left untreated, serious infections can occur. Therefore, the first signs of an incisional hernia should be clarified.
People suffering from connective tissue disease or who are bleeding should go to the nearest hospital immediately. However, this also depends on the size of the scar. Smaller scars often heal quickly despite a scar fracture, while large scars always require medical attention if a scar fracture occurs in the affected region. An incisional hernia can be treated by a general practitioner, a dermatologist or a surgeon.
Treatment & Therapy
Since the scar hernia does not recede on its own, surgical treatment is usually required. The incisional hernia – if it is not treated – increases and with it the danger that parts of the intestines are sometimes pinched. Even if the incisional hernia does not cause any symptoms, it is advisable to treat the hernia surgically.
Minor fractures do not require immediate surgery; however, the longer one waits before the intervention, the more the hernia increases in size. It should be noted that the primary surgery that ended up causing the hernia was three to six months before another surgical procedure took place. In order for a successful incisional hernia operation to be carried out, the original operation scar must have healed completely.
However, if there are life-threatening circumstances that make an immediate operation necessary, such a period cannot be awaited. During the procedure, the incisional hernia is exposed and the resulting hernia sac is relocated to the abdominal cavity. The doctor then closes the hernial gate; Various suture techniques or plastic meshes are available here, which ensure that the hernial opening remains closed.
Which variant the doctor ultimately decides on also depends on the size of the fracture and the physical condition of the patient. Sometimes the circumstances of why the hernia occurred must also be taken into account. Smaller hernias, which have a diameter of just four centimeters or less, are closed using a special suture technique.
For larger hernias, which can also be up to 30 centimeters in size, the plastic mesh is mainly used. This should stabilize the weak point and ensure that no further breakage occurs.
Outlook & Forecast
An incisional hernia is usually unproblematic. The fracture is surgically closed and the wound is treated directly and with medication. With modern surgical procedures and plastic implants, even larger injuries can be reliably closed. If the incisional hernia is not treated or treated too late, it will continue to expand. Possible complications include gastrointestinal problems, severe pain and intestinal obstruction.
The prognosis can deteriorate if the patient is overweight or has a weak connective tissue. The prognosis depends on the size and location of the scar and the patient’s state of health. The type of scar and the chosen treatment method are also important factors. When using a suture-only procedure, there is a greater risk of the scar reopening. That is why meshes or implants, which are less prone to recurrences, are usually used nowadays.
Modern procedures such as laparoscopic treatment provide information about the condition of internal scars. This enables targeted treatment and prevention of scar hernias. If the treatment is timely, the incisional hernia will subside without further complications. The patient can lead a symptom-free life. Life expectancy is not affected by a positive incisional hernia.
In order to prevent an incisional hernia, the patient should avoid risk factors that sometimes cause a scar book or minimize them in such a way that the risk can be significantly reduced. After the operation, the patient should therefore avoid lifting heavy loads for around six months. If you are overweight, the focus is on weight reduction; Smokers should stop smoking or quit smoking altogether.
After an incisional hernia operation, after a period of rest, the patient can get up about one to two hours later to go home. Usually, no major follow-up care is required, but physical rest should be ensured for the first week after the procedure. It is also important that the patient does not lift heavy loads of more than 20 kilograms for up to three months. Pronounced physical movements must also be avoided.
Depending on the profession the person concerned is in, the incapacity to work lasts between two and three weeks. After 14 days, the patient may resume light physical activity. Longer stays after the operation should be avoided in order to counteract possible risks such as thrombosis (blood clots) and an embolism. Mild analgesics can be administered to relieve the pain.
A normal intake of food is usually possible after the surgical procedure. If necessary, a special diet can be built up step by step. In order to check the progress after the incisional hernia operation, ultrasound examinations (sonography) are carried out.
Immediately after an incisional hernia operation, the patient often puts on a special abdominal girdle. It is elastic and can be worn both day and night for several weeks. The skin sutures are removed around ten to twelve days after the surgical procedure.
You can do that yourself
Patients with an incisional hernia should avoid pressure in the abdomen. This occurs mainly when you gain weight or are overweight. Weight reduction should therefore take place as a preventive measure and meals should not be too lavish.
Physical overexertion of the affected body region should also be avoided. Sports activities must be adapted to the needs of the organism. Sufficient rest is necessary after an intensive activity and taking regular breaks is recommended. Operations such as coughing or straining have a negative impact on the symptoms of the hernia. Therefore, the affected person should prevent the development of infectious diseases or influenza in good time. With a reduction in the general risk of illness, symptoms can be alleviated. For this, the organism needs a stable and strong immune system. This can be acquired with a healthy and balanced diet.
In addition, the consumption of harmful substances such as nicotine should be avoided. Since constipation leads to tension in the abdominal wall and an unhealthy diet promotes the formation of air in the abdomen, nutritional advice can be helpful. A complete change in food intake prevents the symptoms and alleviates existing symptoms. In the case of a hernia, the scar must be checked regularly for damage. If tears occur, sterile wound care is necessary.