An incisional hernia occurs where a previous surgical incision was made during a different operation. It results from incomplete healing of that previous incision. This can occur immediately after the surgery or many years later. Several factors contribulte to incisional hernias including diabetes, smoking, obesity, poor nutrition, chronic cough, chronic illness, and overactivity following a surgical procedure(i.e. heavy lifting or straining). Incisional hernias tend to enlarge with time and usually require repair.
Symptoms of an incisional hernia include a bulge or pain underneath an incision. An examination by a surgeon is usually all that is needed to confirm the diagnosis. Occasionally a CT scan or ultrasound is helpful. Though usually a non emergent problem, delaying repair allows the hernia to get larger and risks intestine getting stuck in the hernia, occasionally requiring an emergency operation.
Because any previous abdominal incision can lead to incisional hernia, there are as many types of incisional hernias as there are surgical incisions. There are nearly as many methods of repair. The operation might be very short and simple, or quite long and involved. Hernia surgeons at Rocky Mountain Surgical Associates choose the type of repair best suited to the particular abdominal wall defect and the many varying patient characteristics. Repair nearly always involves patching the hole in the muscle with a piece of mesh, made from a soft permanent material. Depending on the size and location of the hernia, repair may be performed laparoscopically, robotically, or through an incision directly over the hernia. In this image, the mesh is placed beneath(behind) the muscle using a laparoscopic technique. For very small hernias, simply opening the old incision and patching the hole with mesh is often preferred. Very large incisional hernias, as well as those with high risks of recurrence, demand more advanced abdominal wall reconstruction techniques. In these situations, portions of the abdominal wall muscle are released so that the muscle can be brought together again, and mesh is positioned below the muscle as reinforcement. Your surgeon can discuss the technique best suited for your hernia.
Recovery from incisional hernia repair is quite variable, depending on many factors including size of the hernia, method of repair, patient age and general health. Small hernias can be repaired as an outpatient. Larger, more complicated hernias require hospitalization, occasionlly for several days. Similarly, long term recovery and activity restrictions are extremely variable. Your surgeon will discuss this with you during your consultation. The biggest risk of incisional hernia surgery is recurrence of the hernia. This is influenced by many patient factors such as weight, smoking, diabetes, and adherence to post operative instructions.