Information on Incisional Hernias

Did you know?
Laparoscopic (keyhole) surgery is possible for many incisional hernias
Most incisional hernias can be repaired
In experienced hands, the risk of an incisional hernia coming back after repair is less than 10%
Most patients are fully active within days of the operation
We have a highly experienced surgical and nursing team

So, what is an incisional hernia?

An incisional hernia develops within the scar of a previous operation. Abdominal surgery weakens the abdominal wall muscles which may lead to the development of an incisional hernia (the term ventral hernia may be used in America).

The likelihood of a hernia developing is increased if the scar becomes stretched during pregnancy or if the original operation was complicated by a wound infection which can impair healing. An incisional hernia develops after 2-10% of all abdominal surgeries.

If these hernias are repaired by simply re-stitching the muscle back together again, there is a much increased chance that the hernia will return (20-45%). However, if synthetic mesh is used to reinforce the repair, the risk of the hernia returning is substantially reduced (less than 5%). Most surgeons now use mesh to reinforce incisional hernia repairs.

Epigastric hernia

Usually a small hernia. It rarely contains bowel and may be difficult to push back due the small size of the defect in the muscle

Who is likely to get an incisional hernia?

An incision in your abdominal wall will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, injury or following an infection at that site following surgery. They can occur immediately following surgery or may not become apparent for years later following the procedure.

Although even the very young can develop incisional hernias after surgery, they are more common as we get older. Certain activities may increase the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining.

What are the symptoms of an incisional hernia?

A hernia is usually recognized as a bulge on the abdomen. It may not cause any discomfort at all, but you may feel pain when you lift heavy objects, cough, strain during urination or bowel movements or with prolonged standing or sitting. The discomfort may be sharp or a dull ache that gets worse towards the end of the day.

Any continuous or severe discomfort, redness, nausea or vomiting associated with the bulge are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and you should contact your doctor urgently if any of these symptoms were to develop.

How are the treatment options for an incisional hernia?

There are few options available for a patient with an incisional hernia. Incisional hernias do not get better and frequently enlarge over time. An abdominal wall binder may be helpful in some patients who do not want to consider surgery or those who are not really fit enough to consider for operation. Many patients find binders/supports to be uncomfortable and are often ineffective.

Surgery is the preferred treatment and is performed in one of two ways.

The open approach uses an incision in abdominal wall which is near to or incorporates the old incision. The surgeon reduces the hernia back into its proper position and repairs the defect or weakness in the tissues with stitches. Frequently, it may be necessary to also use a synthetic mesh in order to reinforce the repair and reduce the risk of the hernia coming back again. This technique is most often performed under a general anaesthetic but in certain situations may be done under spinal anaesthesia.

The second approach is a laparoscopic incisional hernia repair. In this approach, a laparoscope (a long thin tube which shines a light into the abdomen and also has a small high definition camera attached which sends images to a television monitor.

The laparoscope and TV camera/monitor allow the surgeon to view the hernia from the inside. Other small incisions will be required for extra ports for placement of other long thin instruments to remove any scar tissue and to insert a surgical mesh into the abdomen.

This mesh, is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. Usually, three or four 5-12 mm (1/4 inch to 1/2 inch) incisions are necessary. This operation is usually performed under general anaesthesia.

Incisional hernia surgery

What are advantages and disadvantages of open and laparoscopic procedures?

The long term results depend more on the patient’s overall condition, the size of the hernia and the experience of the surgeon, rather than the type of operation.

It is important to remember also that it is not always possible to perform a laparoscopic operation. However, despite these limitations, some studies suggest that there may be a benefit to the laparoscopic approach.

Possible advantages with a laparoscopic approach may include:

Less post-operative pain
Shortened hospital stay
Faster return to regular diet
Quicker return to normal activity

Are there non-surgical options to treat an incisional hernia?

In adults, the hernia is very unlikely to go away on its own. It may stay unchanged and give rise to similar symptoms that you are currently getting. If left alone, you run the risk that it may get bigger and cause increasing discomfort.

There is a small chance that the contents of the hernia could become strangulated. This would require emergency and somewhat more complex surgery with a longer stay in hospital if it occurred.

Want to see a specialist about your hernia?

Contact the Scottish Hernia Centre

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What can I expect after incisional hernia surgery?

If the operation is a day case, most people go home once they have recovered from the anaesthetic. Anyone who has a general anaesthetic will need to arrange for a friend or relative to drive them home and stay with them for the next 24 hours.

A general anaesthetic can temporarily affect co-ordination and reasoning skills, so people are advised to avoid driving, drinking alcohol or signing legal documents for 24 hours.

Before discharge, you will be advised about caring for stitches and bathing. An appointment for clinic review will also be made (usually around six weeks later). Once home, painkillers may be taken as advised by the doctor or nurses.

Whether recovering from open or laparoscopic surgery, it will be necessary to take it easy for the first two or three days. You will be given specific advice about resuming normal activities.

In general you should be able to move around freely but should avoid strenuous exercise and lifting for at least the first few weeks. Most people continue to experience some discomfort for a few weeks after surgery, but this will gradually settle.

In experienced hands, the long-term success rate for surgery is high with a less than 5% risk of the hernia coming back again.

Incisional Hernia surgery

What are the side-effects or complications of surgery?

Side-effects of surgery:

Side-effects are the unwanted but usually temporary effects of a successful procedure. Examples include feeling sick as a result of the general anaesthetic or painkillers.

Complications of incisional hernia surgery:

Complications are unexpected problems that can occur during or after the operation. However, most people undergo incisional hernia surgery without difficulty. As with any surgery, there is a very small risk of developing an unexpected reaction to the anaesthetic. Other rarely encountered problems include excessive bleeding, pneumonia, infection or developing a blood clot within the leg veins (deep vein thrombosis).

To help prevent this, most people are given compression stockings to wear during the operation. They may also be given a drug to thin the blood and reduce the risk of clots. There is also a risk of abdominal bruising, although this usually settles without treatment.

Other complications more specific to the procedure include possible injury to the intestines or other abdominal organs. If an infection occurs in the mesh, it may need to be removed or replaced. Also, there is always a small risk that the hernia could come back after repair. The long-term recurrence rate is between 0-5% when synthetic mesh is used.

As the laparoscopic approach has not been used for as long as the open approach, it’s long-term success rate is not certain, but early results indicate that it is as good as the open or traditional approach. Your surgeon will help you decide if the risks of laparoscopic incisional hernia repair are less than the risks of leaving the condition untreated.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health.

What can I do to avoid an incisional hernia?

In most instances, an incisional hernia develops for reasons beyond a patients control e.g. the development of a wound infection after the first operation. Other factors such as having to have an emergency operation and poor general health also cannot be avoided.

After operation, the single most important factor that a patient can directly influence is avoiding lifting heavy weights or over-burdening the abdomen/wound in the healing phase. Abdominal incisions may gain strength for up to 6 months after an operation. Using lifting equipment for heavy loads, and using safe lifting and carrying techniques, to avoid excessive or repeated straining.

Other factors that may help include the following

Maintaining muscle strength by taking regular daily exercise
Avoiding constipation by eating a healthy high-fibre diet that contains plenty of fruit, vegetables and whole grain cereals, such as wholemeal bread and brown rice
Stop smoking
Losing weight (if overweight)

Can I undergo incisional hernia surgery at the Scottish Hernia Centre?

Yes. Richard Molloy undertakes incisional hernia surgery on a regular basis at the Scottish Hernia Centre, based at Ross Hall hospital Glasgow. At the initial consultation, your hernia and any other medical problems will be assessed before discussing the surgical options for repair.

The Scottish Hernia Centre in Glasgow is Scotland’s premier private specialist hernia centre, where highly trained nursing and medical staff work within a state of the art hospital enabling our surgeons to safely treat even the most complex hernia within a safe and comfortable high tech environment.