Definition
An incisional hernia is recognised as an abdominal wall defect and can also be called a ‘Ventral Hernia’. It is a protrusion, which occurs through a defect in the site of a previous abdominal incision/ scar.
Who commonly presents with it?
Any person that has undergone previous abdominal surgery can develop a weakness at the site of the previous scar. Obesity is a common risk factor. It is also more common in patients that may suffer from chronic constipation, a chronic cough and/or possible difficulty in passing urine. It is unsightly and only ever increases in size, so to control the symptoms associated with it a corset is advised to be worn during the day and taken off at night.
How does it present?
An incisional hernia usually presents with a 'bulging' at or close to the site of the abdominal scar. It is particularly apparent on standing, lifting heavy objects and can disappear on lying down. The hernia presents and progresses over time and can be painful as well as unsightly. Other more serious complications include bowel obstruction presenting with nausea, vomiting and gross swelling of the abdomen. In some cases the bowel's blood supply can be cut off resulting in a condition called an 'incarcerated hernia', this is a recognised surgical emergency and requires admission to hospital.
What can be done?
Upon diagnosis, simple treatment measures involve the use of a specially designed corset or belt to support the hernia. Surgery is recommended to reduce the size of the hernia and help control some symptoms of pain. The operation involves reducing the contents of the hernia into the abdomen and repairing the defect in the abdominal wall by using a suitably sized mesh, which reinforces the repair. The operation can be performed by the conventional open technique utilising the previous incision or by a keyhole technique. The surgeon determines the type of repair possible after consultation.
How long will your recovery take?
Recovery is based on the type of operation that you have. Open surgery recovery is dependant upon the size of the hernia and generally patients are encouraged to start mobilising gently immediately after surgery and refrain from lifting heavy objects for at least two to three weeks. A return to full activities is expected within 6 weeks. Keyhole surgery has a quicker recovery time but patients may experience similar pain that can be expected from an open repair for the first few days after surgery. Keyhole repair also has the advantage of a reduced hospital stay.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and specifically for open and keyhole incisional hernia a risk of recurrence of the hernia of up to 10%, which can be higher for much larger incisional herniae. There is also a risk of injury to the underlying bowel and other abdominal organs and is emphasised as the worst possible risk. For older and patients with many risk factors such as heart and lung disease there is always a small risk to life.
Seroma
Keyhole incisional hernia repair also carries a risk of 'seroma' formation, which is fluid collecting in the space left between the abdominal wall and the skin, originally occupied by the hernia contents (usually fat and/ or intestines). Usually this fluid is managed conservatively, by no intervention and will be left alone. In some cases the fluid is 'aspirated' withdrawn off, but there is a risk of seroma infection as well. Most seromas resolve after 6-8 weeks but some/ very few require additional surgery.