Incisional hernia
Incisional hernia
What is an incisional hernia.
Why do incisional hernias occur?
Why have the deeper layers have failed to heal properly?
Are incisional hernias common?
What happens if I leave my incisional hernia?
Are incisional hernias dangerous?
What should I do – what are my options?
What is the best way to repair an incisional hernia?
click here to view Methods of repair of Incisional Hernias
What is an incisional hernia.
An incisional hernia is a hernia that occurs through an incision on the abdomen that was made for another previous operation. For example an operation to remove part of the bowel may have been carried out.
Why do incisional hernias occur?
The original incision in the abdominal wall had to be sewn up and ideally the rejoined edges should have joined together and healed. But sometimes there is a lot of tension – with the edges tying to pull apart. If the deeper layers do not heal well the join is weak and eventually the deep layers – the inside – pull apart, leaving a gap even though the top layer, the skin, has healed. [ like having your overcoat done up but your shirtbuttons and jacket unbuttoned.]
Why have the deeper layers failed to heal properly?
There are a number of reasons why this might occur.
1. poor healing – poor nutrition, other serious medical condition – e.g. after a cancer operation
2. serious wound infection – this leads to poor healing
3. excessive tension on the join or seam – did the abdomen swell a lot immediately after the operation? Has the person put on a lot of weight since the op.?
4. cigarette smoking – a well recognised cause of poor wound healing
5. poor sewing technique by the surgeon – this is probably fairly unusual. Most surgeons will sew an abdominal wound correctly and competently.
In all of the above situations using stronger suture material does not help. The strong stitches simply cut through the tissues at the wound edge. The situation is like forcing a foot into a shoe that is too small, then trying to lace it up with strong laces. They are likely to cut through the leather.
Are incisional hernias common?
Of all the abdominal operations that are carried out each year as many as15% will result in an incisional hernia. Even this figure may be an underestimate because lots of people don’t know they have one, or if they do they don’t go to see their doctor, or he doesn’t send them to hospital. So yes – they are fairly common.
What happens if I leave my incisional hernia?
If you leave a hernia it will get bigger. The hole will get bigger and the swelling will get bigger as more intestine pushes out through the hole. There is aching discomfort and an unsightly appearance.
Are incisional hernias dangerous?
They can be. Occasionally a portion of bowel will become trapped in the hernia, and the blood supply to that bit of bowel may be interrupted or blocked. This is called strangulation, and is very dangerous. The portion of bowel will lose its blood supply and become gangrenous, a serious life threatening situation.
What should I do – what are my options?
The best option is surgical repair of the hole or defect. If this is not feasible (see below) a corset may help matters, but this is a second best option.
What is the best way to repair an incisional hernia?
The first thing you should know is that in general the results of repairing an incisional hernia using a “conventional technique” i.e. sewing the edges together terrible. Over half will come back – sometimes worse – larger – than before. The stitches cut out , possibly with a bad wound infection and other complications as well.