Incisional Hernia
Also known as: ventral hernia
What is it?
A hernia is the protrusion of an organ through the
wall that normally contains it. An incisional hernia
occurs in the abdomen in the area of an old surgical
scar. A part of an organ in the abdomen, such as the
bowel or intestines, protrudes through the weakened
area of the abdominal wall.
Who gets it?
Incisional hernias occur in people who have had
previous abdominal surgery, and are more likely to
occur in people who are obese or pregnant.
What causes it?
Incisional hernias are caused by thinning or
stretching of scar tissue that forms after surgery.
This weakened scar tissue then creates a weakness in
the abdominal wall. Excessive weight gain, physical
activity that places pressure on the abdomen,
pregnancy, straining during bowel movements because of
constipation, severe vomiting, or chronic and intense
coughing causes the scar tissue to thin or stretch.
Because the abdominal wall is weak, the hernia occurs
during abdominal strain.
What are the symptoms?
An incisional hernia causes a bulge in the abdominal
area. This type of hernia is often painless, but may be
tender and can cause discomfort during any type of
physical strain, such as lifting or coughing. The bulge
may disappear when the patient is lying down, and be
more visible when standing up. A hernia can often be
pushed gently back into place. This is called a
reducible hernia. When a hernia cannot be pushed back
into place, it means a piece of the organ has become
trapped, or incarcerated. Symptoms include pain,
nausea, vomiting, inability to have a bowel movement,
and a bulge that remains even when lying down. When a
portion of an organ is incarcerated, its blood supply
can be cut off, which means the organ’s tissue will
die. This condition is called a strangulated hernia.
Incisional hernias can increase in size with time.
How is it diagnosed?
To diagnose an incisional hernia, a doctor must
perform a physical examination. Your doctor will look
for a bulge in the abdominal area and may ask you to
cough as he puts light pressure on the area. Coughing
causes the hernia to bulge out further.
What is the treatment?
Patients with incisional hernias can wear a special
type of belt, called a truss, to support the hernia and
keep it from bulging out. They should also avoid any
activities that cause abdominal strain. However, most
patients elect surgery to repair incisional hernias and
avoid the possibility of a strangulated hernia. The
procedure to repair a hernia involves pushing the piece
of the organ back into place and repairing the
abdominal wall so the organ cannot push through again.
Hernia surgery, called herniorrhaphy, used to involve a
large incision and a long recovery period. However,
many hernia repairs can now be performed through
laparoscopic surgery. The surgeon uses a special
viewing instrument called a laparoscope, inserted
through a small incision in the abdomen. The
laparoscope is like a tiny video camera that gives the
surgeon a clear view of the abdominal area. Other small
incisions are made to insert the surgical instruments
used to push the organ into place and repair the
abdominal wall. The surgeon may use a procedure called
hernioplasty to reinforce the entire weakened area with
synthetic material, like a tire patch. Laparoscopic
hernia surgery can be performed on an outpatient basis.
Incarcerated and strangulated hernias require emergency
surgery and hospitalization. Laparoscopic surgery may
not be recommended for very large hernias.
Self-care tips
You can help reduce your risk for an incisional
hernia by following a healthy diet that is high in
fiber and drinking plenty of fluids to prevent
constipation, maintaining a healthy weight through diet
and exercise, and avoiding cigarette smoking, which can
cause chronic coughs. If your job requires heavy
lifting, learn the proper way to lift and wear a
support garment.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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