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What is Incisional Hernia?
When the swelling appears in the area or vicinity of previous surgery or scar, we term it as an incisional hernia. The scar could be that of an appendicectomy, or gall bladder surgery, hysterectomy ( uterus removal), caesarean section scar etc. When one undergoes abdominal surgery, all the layers of the abdominal wall are cut. This may cause weakness in that area if not properly closed or if not properly healed. The reasons could be wound infection, or excessive coughing, sneezing during the previous surgery.
Obesity is one of the major reasons for developing incisional hernias.
The link between obesity and incisional hernia
Obesity significantly increases the risk of developing incisional hernias due to elevated intra-abdominal pressure, which strains the abdominal wall, particularly at surgical sites where the tissue may already be weakened. Additionally, obese individuals face higher surgical complications, such as infections and delayed healing, further contributing to hernia formation. The quality of connective tissues can also be affected by obesity, making the abdominal wall more susceptible to hernias. Addressing obesity through lifestyle changes or surgical interventions can help mitigate this risk and improve overall health outcomes.
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Table of Contents
Symptoms of Incisional Hernia
- Bulge or swelling near a previous surgical scar
- Pain or discomfort, especially when straining or lifting
- Weakness or pressure around the surgical site
- Nausea or vomiting in severe cases
- Difficulty performing daily activities due to discomfort
Who Is at Risk?
- Past abdominal surgeries
- Inadequate healing of surgical wounds
- Obesity or being overweight
- Heavy lifting or intense physical activity soon after surgery
- Chronic coughing, constipation, or infections at the surgical site
Complications of Untreated Incisional Hernias
Leaving an incisional hernia untreated can lead to severe complications, such as:
- Incarceration: The herniated tissue becomes trapped, causing significant pain.
- Strangulation: The blood supply to the herniated tissue is cut off, leading to tissue death and requiring emergency surgery.
Large Incisional Hernia
A large incisional hernia occurs when tissue protrudes through a weak spot in the abdominal wall at the site of a previous surgical incision. This can happen after surgeries such as appendectomies, cesarean sections, or any abdominal surgery. Over time, factors like increased abdominal pressure (from obesity, heavy lifting, or chronic coughing) can contribute to the development of the hernia.
Treatment Options for Incisional Hernia
Surgical intervention is typically required to repair an incisional hernia. There are two primary treatment methods:
Laparoscopic Hernia Repair
This minimally invasive option involves small incisions, a camera, and specialized tools to repair the hernia. Laparoscopic surgery usually results in quicker recovery times and less scarring.
Open Hernia Repair
The surgeon makes a single large incision at the hernia site, repositions the herniated tissue, and reinforces the abdominal wall using stitches and sometimes mesh.
Types of laparoscopic incisional hernia repair:
- Intraperitoneal Onlay Mesh Plus (IPOM Plus):A variation of IPOM where the defect is closed using sutures and then the mesh is placed inside the abdominal cavity and fixed with tacks and sutures.: Similar to IPOM, but with more robust fixation methods, including circumferential suturing of the mesh around the hernia defect.
- Intraperitoneal Onlay Mesh (IPOM) Repair:In this technique, the mesh is placed inside the abdominal cavity, directly over the hernia defect. The mesh is then fixed in place with tacks (metal or absorbable) or sutures, depending on the size and type of mesh.
- Sublay or Retromuscular Repair (Rives-Stoppa Technique):The mesh is placed underneath the abdominal muscles (retromuscular space) but above the peritoneum, the lining of the abdominal cavity. This type of repair avoids placing the mesh directly in contact with the intestines, reducing the risk of adhesions.
- Transabdominal Preperitoneal (TAPP) Repair: In this method, the surgeon accesses the preperitoneal space, which is the space between the abdominal wall and the peritoneum, to place the mesh. The mesh is positioned to cover the hernia defect without entering the abdominal cavity itself.
- Bridging Repair: In cases where the abdominal wall defect is too large to be closed with sutures, the mesh is used to "bridge" the gap between the edges of the hernia. The herniated tissue is reduced, and a mesh is placed over the defect without attempting to close the abdominal muscles
- Component Separation Technique (CST) with Mesh Reinforcement: Component separation is a technique used for large, complex hernias where the abdominal wall is severely weakened or stretched. It involves separating and rearranging the muscles of the abdominal wall to close the defect, often reinforced with mesh.
- Totally Extraperitoneal (TEP) Repair: This approach keeps the entire repair outside the peritoneal cavity, placing the mesh between the abdominal muscles and the peritoneum, similar to TAPP but without entering the peritoneal cavity at all.
- Hybrid Laparoscopic/Open Approach: In some cases, a combination of open and laparoscopic techniques is used to repair incisional hernias, particularly for large or complex cases.
Dr.Tulip has been improving the quality of life through better health
Dr.Tulip has been improving the quality of life through better health
- Dr. Tulip has been recognized by the Surgical Review Corporation USA as “Surgeon of Excellence”
- Successfully handled more than 2500+ procedures in diabetes and obesity surgery.
- Dr. Tulip has ventured to set up South India’s 1st Flagship Hospital dedicated to Obesity and Diabetes surgery.
- Excellence in the field of bariatric and metabolic surgery over 2 decades.
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FAQ
How is an incisional hernia diagnosed?
A healthcare provider in Bangalore usually diagnoses an incisional hernia through a physical examination and may use imaging tests like an ultrasound or CT scan.
Can an incisional hernia be treated without surgery?
While non-surgical options like pain management and supportive binders can help manage symptoms, surgery is often necessary to repair the hernia.
When should I consider surgery for my incisional hernia?
You should consider surgery if you experience pain, discomfort, or complications like strangulation of the intestine. Consulting a surgeon is essential for personalized advice.
What types of surgery are available for incisional hernias?
Common surgical options in Bangalore include open hernia repair and laparoscopic hernia repair. Your surgeon will recommend the best approach based on your condition.
How can I prevent an incisional hernia from recurring?
To help prevent recurrence, maintain a healthy weight, avoid heavy lifting, manage chronic coughs, and follow your surgeon’s post-operative care instructions.
Where can I find a good surgeon for incisional hernia treatment in Bangalore?
Bangalore has many reputable hospitals and clinics. Research options, read patient reviews, and consult with experienced surgeons to find the right fit for your needs.