What Is An Incisional Hernia?

They are hernias that occur at the incision sites of previous abdominal operations.

WHY DOES AN INCISIONAL HERNIA DEVELOP?

Incisional hernias are caused by inadequate closure and inadequate healing of the anterior abdominal wall or due to the effects of chronic and prolonged high levels of intra-abdominal pressure. Many factors may cause the development of this type of hernias:

• 1. Technical inadequacies in surgery
• 2. Inadequate or poor quality suturing material
• 3. Factors that may impair wound healing: obesity, wound site infection, advanced age (over 60 years), postoperative lung problems, postoperative abdominal distention and intestinal obstruction, cancer surgery, emergency surgical interventions, steroid use, and ascites in the abdomen.

Local factors rather than systemic factors are involved in the development of incisional hernias. Wound site infection is one of the most important risk factors. It increases the risk of developing an incisional hernia alone 4 times.

HOW OFTEN ARE INCISIONAL HERNIAS SEEN?

They occur after 1–14% of all hernia operations. Of all previous abdominal operations, 2-11% result in incisional hernias. Most studies highlight that incisional hernias occur most frequently in the first three years after surgery, especially in the first postoperative year.

WHAT ARE THE SYMPTOMS?

The most common symptom is swelling in the abdominal incision site. Swelling usually occurs during standing or walking. The swelling disappears in the lying position because the internal organs move back into the abdominal cavity. Swelling grows over time, adversely affecting a person’s daily life and may limit his/her movement and activity levels. It may cause intestinal obstruction in some patients and cause nausea and vomiting. If the patient develops pain, there may be an impairment in the blood supply to the intestine, suggesting a strangulated hernia.

HOW IS IT DIAGNOSED?

The diagnosis of inguinal hernias is usually made by physical examination. In these patients, contrast-enhanced abdominal tomography may be useful not to miss the diagnosis of small incisional site hernias.

WHAT IS INCISIONAL HERNIA TREATMENT AND HOW IS SURGERY PERFORMED?

An incisional hernia should be operated at the time of diagnosis. Delays in surgery may cause hernias to grow and may result in hernia strangulation, complicating the treatment of the patient.

WHICH METHODS ARE USED IN SURGERY?

Open or laparoscopic surgery can be performed in these patients. In both types of surgery, synthetic patches called mesh are used to repair hernias. With this technique, recurrence rates are generally reported as 6%.

In recent years, laparoscopy has started to take a primary place in the repair of incisional hernias. The laparoscopic technique is a reliable, effective, and feasible method for incisional hernia repairs. It causes less pain because less dissection is performed in laparoscopy compared to open surgery. Recurrence rates are reported as 4 -6% in a variety of references and it is stated that this technique will be the standard method in the treatment of incisional hernias in the near future. The patches used in this method are different from patches used in open surgery because they are placed inside the abdomen and come into contact with the intestine. Composite or dual mesh patches are preferred for these types of surgery.

IS SURGERY DIFFICULT? HOW LONG DOES IT TAKE FOR THE PATIENT TO RETURN TO DAILY LIFE?

Hernia operations should be performed in experienced hands and by using the appropriate technique. Especially laparoscopic operations require serious experience. After the operation, the patient can stay at the hospital 1-2 days depending on the condition of the hernia. He/she starts walking on the same day and can return to daily life in an average of 7-10 days. We advise the patients not to lift heavy objects after the surgery, not to bend or stand up suddenly, and to avoid engaging in heavy physical activities. We recommend that the patients perform Islamic praying (namaz) in the sitting position in the following 2 weeks after the operation.

WHAT ARE THE SYMPTOMS OF INCISION SITE HERNIA?

• Swelling In The Incision Site.
• Pain During Movements Involving the Abdomen.
• Difficulties in moving, bending, or straightening.
• Later difficulties in walking.

HOW IS A HERNIA DIAGNOSED?

• The diagnosis of incision site hernias is usually made during physical examination. Contrast-enhanced abdominal tomography is necessary for a clear evaluation of the hernia.

WHAT ARE THE TREATMENT OPTIONS FOR INCISION SITE HERNIAS?

• Incision site hernias can be treated with surgery. Surgery can be performed by laparoscopy or using the open method. Laparoscopic surgery is nowadays widely performed.