What is an Incisional Hernia?
An incisional hernia is a hernia in the abdominal walls that occurs at the site where an incision was made due to surgery in the past.
How common is an incisional abdominal hernia?
Incisional abdominal hernia is an extremely common condition. The rate rises to 10-20% after abdominal surgeries, while the gender-based frequency is 1:1.
Hernia after previous laparoscopic surgery
Postoperative hernia may also occur at the site of a previous incision for laparoscopic surgery, although its extent is small. The incidence of this type of hernia (Port-site Incisional Hernia, PIH) ranges from 1-6%.
Hernia after Cholecystectomy
Incisional hernia after cholecystectomy occurs either in the right upper abdomen (when cholecystectomy was previously performed using the classic open technique), or at the site of one of the microincisions (usually near the navel), when laparoscopic cholecystectomy had been performed.
Hernia after caesarean section/ Hysterectomy
The occurrence of an incisional hernia after a previous gynaecological operation or caesarean section is not common, but its treatment is very complex and requires specific surgical manipulations.
Causes of Incisional hernias
Among the most common causes of incisional hernia -apart from a technical error during suturing in the initial operation-, are:
- inflammation or infection of the wound (of the initial operation)
- smoking
- obesity
- eating disorders, e.g. malnutrition
- treatment with immunosuppressive drugs
- diabetes mellitus
- high tension when suturing the abdominal walls.
What are the symptoms of incisional hernias?
The most common symptom of an incisional hernia is the sudden appearance of a lump in the abdominal area.
In addition, the patient often reports a feeling of discomfort, especially after coughing or some sudden movement. The possibility of incarceration is also common, as in any form of hernia and is accompanied by severe pain in the abdomen. The chances of developing intestinal obstruction are 10-15%.
How is an incisional hernia diagnosed?
The diagnosis of an incisional hernia is carried out primarily by clinical examination of the patient and review of his history. Performing a CT and/or MRI scan can give a full picture of the condition and estimate the size of the hernia.
When does an incisional hernia needs surgical treatment?
Incisional hernias always require surgical treatment, to avoid enlargement that will destroy the anatomy of the abdominal walls and prevent serious complications.
Surgical treatment of incisional hernias
The surgical management of incisional hernias is a situation that creates stress for the patient, as they must undergo surgery again. Modern treatment and the golden option in the majority of cases is now the minimally invasive /laparoscopic technique.
With the application of minimally invasive techniques, the specialized surgeon performs 3 incisions of a few millimeters, through which the laparoscope (camera) is inserted into the abdomen. With the enlarged image of the camera, it is possible to identify the hernia from the inside, dissect all the adhesions present in the abdomen from the initial operation, and repair the hernia with a special mesh that largely overlaps the gap of the hernia.
Advantages of Laparoscopic technique
The advantages of the laparoscopic surgical technique are remarkable, compared to the classic open surgery:
- minimal blood loss
- minor postoperative pain
- no new incisions are made
- no drains (tubes) are placed
- Early return to everyday life
- No prolong hospitalization
