Incisional Hernia – Causes and Treatment

1. INCISIONAL HERNIA – CAUSES AND TREATMENT By Dr. Valeria Simone MD (Southlake General Surgery, Texas)

2. OVERVIEW • An incisional hernia is a bulge or protrusion that occurs at the site of previous abdominal surgery. The bulge consists of abdominal contents, including the intestine and/or omentum, pushing through the weakened area of the abdominal wall. In medical terms, incisional hernias are sometimes also known as ventral hernias. • They are relatively common, occurring in up to 20% of patients who have undergone abdominal surgery. • Incisional hernias are discussed further down the page, along with their causes, symptoms, risk factors, and possible treatments.

4. Causes of Incisional Hernia Surgical incisions that fail to heal properly might result in incisional hernias. As a result, your abdominal muscles may get weakened, which increases the risk of developing a hernia. • Incomplete healing of the surgical incision can be caused by several factors, including: • conceiving a child prior to the wound’s complete recovery • exerting an excessive amount of pressure on the abdominal region • resuming strenuous activity too soon after surgical recovery The failure of a surgical wound to heal might occur for seemingly no reason at all. If you’ve recently had an emergency surgery or one that involved a major incision, you may be at increased risk for developing a hernia. Hernia risk is increased if the surgical incision does not heal properly due to misaligned wound edges. The incision’s healing potential may also depend on the type of stitches used to close it. Incisional hernias are also more common in people over the age of 60. If you are at risk for an incisional hernia, it is important to talk to your doctor about ways to prevent the condition.

5. Symptoms of Incisional Hernia An incisional hernia occurs when abdominal contents protrude through a surgical incision that has not healed properly. Instances of physical exertion, such as standing up, lifting, or coughing, tend to highlight the condition. This type of hernia can be painful and may cause serious health complications if left untreated. Symptoms of an incisional hernia may include: • nausea and vomiting • fever • abnormally rapid heart rate • constipation • feces that is thin and narrow • discomfort and pain in the midsection, especially at the hernia site • pain or inflammation at the hernia site • diarrhea Hernias can arise at any time, either before or after the normal recovery period of three to six months following surgery. However, the risk of developing a hernia during this period is the highest.

6. Reducible Hernia and an irreducible hernia There are two main types of hernias, the reducible and the irreducible: • Reducible Hernia. It is a type of hernia that can be pushed back into the body cavity. This type of hernia is less serious than an incarcerated or strangulated hernia because the hernia can be easily treated. However, if a reducible hernia is left untreated, it can become incarcerated hernia or strangulated hernia. Symptoms of a reducible hernia include: a bulge or protrusion at the site of the hernia, pain, or discomfort at the site of the hernia, and/or difficulty moving or coughing. • Irreducible hernias. It is a type of hernia that cannot be pushed back into the body cavity. This type of hernia is more serious than a reducible hernia because it cannot be easily treated. If an irreducible hernia is left untreated, it can become incarcerated or strangulated. Symptoms of an irreducible hernia include: a bulge or protrusion at the site of the hernia, pain, or discomfort at the site of the hernia, and/or difficulty moving or coughing. It is possible for an irreducible hernia to cause a bowel obstruction, which in turn could cause a strangulated hernia. This calls for quick medical attention. If the swelling turns a deep red or purple color, or if you are in excruciating pain, you should seek medical attention immediately.

7. Risk factors of Incisional Hernia The possibility of a patient acquiring a hernia in the postoperative period is increased by several circumstances, including the following: • pre-existing diseases or illnesses, such as diabetes, chronic lung disease, or kidney failure • medications, such as steroids and immunosuppressants • an infection of the wound • smoking • obesity By giving yourself the necessary time to recover from abdominal surgery, you can lessen your chances of developing a hernia. Even without pre-existing risk factors, hernias can still occur, underscoring the importance of adhering to postoperative recovery protocols as prescribed by a doctor. You shouldn’t engage in exercise or other physically demanding activities until your doctor gives you the all-clear, even if you feel well.

8. Treatment of Incisional Hernia Hernias can’t be fixed without surgery because they don’t heal on their own. The first step in treating an incisional hernia is to see a doctor. The doctor will likely order a CT scan or other imaging test to confirm the diagnosis. Once the diagnosis is confirmed, the doctor will discuss treatment options with the patient. The goal of treatment is to close the hole in the abdominal wall and prevent the hernia from recurring. Treatment of small or reducible hernias It is possible that you will be able to postpone surgery without putting your health in jeopardy if you have a hernia that is either small or reducible. When determining whether surgery is necessary to treat the hernia, your healthcare practitioner will consider your medical history in addition to other relevant variables. If your hernia isn’t making you extremely uncomfortable, you might be able to wait out the discomfort without resorting to surgery. However, it is worth noting that larger hernia repairs may be more challenging than smaller ones. If you choose not to have surgery, your doctor may recommend wearing a special belt to retain pressure on the hernia and keep it from protruding.

9. Treatment of Large or irreducible hernias If your hernia worsens or becomes inconsolable, surgical intervention will be required. In most cases, the course of treatment that is suggested will be determined by the symptoms you are experiencing, the severity of the hernia, and the overall health history. Open Hernia repair In open hernia repair, an incision is made directly in the hernia sac. A hernia is a hole in the abdominal wall that can only be repaired by surgically repositioning the intestine and other affected organs back into the abdominal cavity. In some cases, mesh patches are used to further fortify the area around the hernia. You’ll have a mesh patch sewed onto your abdominal wall around the hernia, and your body will gradually absorb it. Laparoscopic Hernia repair Instead of one huge incision, laparoscopic hernia repair uses a series of smaller incisions. These cuts let doctors insert hollow tubes, which are then filled with air to inflate the patient’s stomach and expose the internal organs. A surgeon will then use the tubes to insert surgical instruments, such as a mini camera, and execute the necessary procedures. It is possible to employ mesh in a laparoscopic repair. In some cases, particularly those involving large or severe hernias, open surgery may be more beneficial than its less intrusive laparoscopic counterpart.

10. What are the complications of Incisional Hernia? If an incisional hernia is left untreated, it can lead to serious health complications. These complications can include – incarcerated hernia, strangulated hernia, and/or intestinal obstruction. An incarcerated hernia occurs when the hernia becomes trapped in the abdominal cavity and cannot be pushed back into the body. A strangulated hernia occurs when the hernia is trapped in the abdominal cavity and the blood supply to the hernia is cut off. • Let’s explore more: Incisional Hernia – Causes and Treatment - Southlake General Surgery

11. Appointment For more information on Incisional Hernia – causes, symptoms, diagnosis, treatment, or consultation with Dr. Valeria Simone MD, at Southlake General Surgery, Texas. You can contact our healthcare expert today for a quick appointment at +1 (817) 748-0200. You can also make an online appointment with us. • Follow us on Facebook and YouTube. • Source: Incisional Hernia – Causes and Treatment - Southlake General Surgery

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