Incisional Hernia

The incisional hernia occurs when an organ or an intestine protrudes through an incision made previously in the wall.

Unfortunately, they occur frequently after abdominal surgery as a result of an operative procedure. You may be at higher or lower risk for developing an incisional hernia, depending on certain factors.

Find out more about incisional hernias, including their symptoms, causes, and treatment options, below. 

What Is Incisional Hernia?

As the name suggests, incisional hernias occur after surgery when the surgical incision in the abdominal wall fails to close properly. When the abdominal muscles weaken, they can allow the nearby organs or intestines to protrude through them, resulting in a bulge. 

After surgery, patients are particularly susceptible to incisional hernias during the healing period of up to 6 months. Doctors typically advise not to engage in intense physical activities like lifting heavy objects and exercising during this healing window. Ignoring these instructions can result in an incisional hernia. 

Here are some of the common causes of incisional hernia:

• Becoming pregnant before the incision heals
• Engaging in physical activities shortly after the surgery
• Considerable weight gain after the surgery
• Increased abdominal pressure

Generally, incisional hernias are not serious, but they can get larger over time, causing breathing and movement difficulties.

Symptoms of Incisional Hernia

A lump or bulge in the abdomen close to the surgical incision is the main symptom of an incisional hernia. Incisional hernias also cause pain, which is often worse when standing and better when lying down, as well as bowel obstructions, which cause nausea and discomfort.

Common symptoms of incisional hernia include:

• Constipation
• Nausea
• Fever
• Lump or bulge in the incision area 
• Feelings of ache, burning, or gurgling

If you experience one or more of these symptoms for a long period of time, it is best to contact your doctor for a diagnosis.

Incisional Hernia Diagnosis

An incisional hernia can be diagnosed using various diagnostic techniques, but it typically begins with a physical examination and medical history. Upon reviewing your medical and surgical history, your doctor will thoroughly examine your abdominal area. A doctor may ask you to cough and stand so that he or she can feel a bulge that indicates a hernia.

Your doctor is likely to inquire about symptoms like nausea, rapid heart rate, pain in the abdomen, and constipation. Your doctor may order imaging tests if you have an incisional hernia, including:

• Ultrasound - this test involves taking pictures (also known as sonograms) of organs, tissues, and other structures in the body using sound waves. Ultrasounds do not use radiation like x-rays. It can also be used to show motion in the body, such as the heart beating or blood flowing.
• Computed Tomography (CT) scans - used for visualizing nearly all parts of the body and for diagnosing diseases or injuries as well as planning medical, surgical, and radiation treatments.
• Magnetic Resonance Imaging (MRI) scans - an imaging technique used to establish anatomical and physiological images of the body. In an MRI scanner, strong magnetic fields, gradients of magnetic fields, and radio waves are used to produce images of the organs.

Once your incisional hernia is diagnosed, the doctor will suggest a relevant treatment to move forward.

Treatment Options for Incisional Hernia

The treatment suggested by your doctor for incisional hernia will depend upon your condition. In cases of a small hernia, the doctor might recommend observing the hernia until further action is needed. However, hernias can only be treated properly with surgery. 

Here are the different types of hernia surgeries to treat incisional hernia:

• Open Repair Surgery - this is the oldest method of treating hernia. It involves making incisions in the groin area, which the surgeon uses to push the hernia back into its place. The defect in the abdominal muscles is strengthened using synthetic mesh and stitches. The recovery time of an open repair surgery is about 3 weeks. Patients, however, are not allowed to engage in intense physical activities for about 6 weeks.
• Laparoscopy - in this minimally-invasive procedure, several small incisions in the lower abdomen are made, and an instrument called a laparoscope is inserted through them, which consists of a camera. Small instruments are inserted through other incisions to repair the hernia using the images displayed on the monitor. This is the latest method of treating hernia and offers a quicker recovery time. 
• Robotic Hernia Repair - A newer method of repairing hernias is robotic surgery. A laparoscope is used for robotic surgery, and it's done the same way (small incisions, tiny camera, inflation of the abdomen, projected image of inside abdomen) as laparoscopic surgery. Unlike traditional surgery, robotic surgery involves the surgeon sitting at a console and handling the surgical instruments. 

In some cases, incisional hernias reoccur after treatment. This mostly happens if the post-surgery instructions are not followed or if the muscle defect is not repaired properly. To avoid any such unfortunate incidents from happening, make sure you only visit and get treated by a professional.