Hernia of the Operative Site

What Is an Incisional Hernia?

An incisional hernia occurs when internal organs or fatty tissue protrude through a weak spot in the abdominal wall at the site of a previous surgical incision. Incomplete healing of the surgical wound is the primary risk factor for developing this type of hernia.

Hernias may remain small and asymptomatic, but some can become more prominent over time, leading to discomfort and complications.

Causes and Risk Factors of Incisional Hernia

Previous Abdominal Surgeries: Poor healing of a past surgical incision can increase the risk of hernia formation.

Obesity: Excess weight puts added pressure on the abdominal wall, making it more prone to hernias.

Heavy Lifting or Increased Intra-abdominal Pressure: Lifting heavy objects too soon after surgery may impair proper healing of the abdominal muscles.

Chronic Cough or Constipation: Prolonged straining that raises abdominal pressure may lead to hernia development.

Impaired Wound Healing: Conditions such as diabetes, poor nutrition, or smoking can negatively affect the healing process.

Symptoms of Incisional Hernia

Symptoms may vary depending on the size and severity of the hernia:

Swelling or Bulge at the Surgical Site: A visible lump, especially noticeable when standing or straining.

Pain or Tenderness: Especially felt during physical activity, coughing, or exertion.

Pressure or Fullness Sensation: A feeling of discomfort or heaviness in the abdominal area.

Emergency symptoms may occur if the hernia becomes incarcerated (trapped) or strangulated (restricted blood flow):

Severe abdominal pain

Nausea and vomiting

Firmness and extreme tenderness at the hernia site

In such cases, immediate surgical intervention is necessary.

Diagnosis of Incisional Hernia

Incisional hernias are typically diagnosed through physical examination, though imaging tests may be needed in some cases:

• Ultrasound: Used to assess the structure and contents of the hernia.
• CT or MRI: Recommended for larger or more complex hernias.

Treatment Options for Incisional Hernia

1. Small and Asymptomatic Hernias

Small incisional hernias may be managed with regular follow-up, but they tend to enlarge over time and typically require surgical intervention.

2. Surgical Repair

Open Hernia Repair

• The hernia is repaired through a direct incision in the abdominal wall.
• Muscle and fascia are sutured and reinforced.
• A mesh (synthetic patch) is often used to reduce the risk of recurrence.

Laparoscopic Hernia Repair (Minimally Invasive Surgery)

• Minimally invasive procedure performed through small incisions.
• Offers reduced pain and a faster recovery time.
• Mesh (synthetic patch) is invariably employed.

Preventive Measures Against Incisional Hernia

Certain preventive measures can reduce the risk of developing a hernia:

Avoid heavy lifting after surgery.

Maintain a healthy weight to reduce intra-abdominal pressure.

Prevent and manage chronic cough or constipation.

Support wound healing through proper nutrition and care.

Avoid smoking, as it impairs wound healing.

Conclusion

Incisional hernias often require surgical repair, especially when they become large or painful. If you notice swelling, pain, or tenderness near a previous surgical site, it is important to consult a general surgeon specialist for evaluation.