Incisional hernias occur at sites in the abdomen where surgery has been performed in the past.They occur following between 10 and 15% of abdominal operations and so, because abdominal surgery is so common, this means a large number of people suffer this sort of hernia.
Symptoms of incisional hernia
Incisional hernias present with a bulge at the site of a previous incision. The majority (75%) will appear within two years of surgery. This may be not be painful but most people suffer at least some discomfort. The bulge may disappear when lying down and may not be as obvious when waking in the morning. Sometimes an incisional hernia causes pain which is related to eating. Symptoms can be worsened when coughing, sneezing, or when taking exercise.Small hernias usually contain fat or the natural fatty apron in the abdominal cavity (omentum). When they become larger they may contain intestine which leads to the risk of becoming stuck (incarceration), having it’s blood supply restricted (strangulation) or blocking the bowel (intestinal obstruction). These complications require emergency surgery.
Causes of incisional hernia
Incisional hernias are a consequence of some kind of wound failure following previous surgery. They may have been a wound infection at the time of surgery. Sometimes they occur next to a colostomy or an ileostomy (parastomal hernia)
Treatment of incisional hernia
Small incisional hernias which cause few symptoms do not always need surgery. They are at low risk of incarceration, obstruction or strangulation. However, incisional hernias often increase in size and then require treatment. It is sometimes possible to control the symptoms by means of a specially fitted corset, but often surgery is required.
Incisional hernia repairs are carried out under general anaesthetic. These can be complex operations depending on the specific hernia. If not operated on by surgeons experienced in incisional hernia repair, there can be a high recurrence rate. The Berkshire Hernia Centre offers different approaches;
1. The conventional (or open) approach involves re-opening the original incision and repairing the weakness in the abdominal wall with either non- dissolving sutures or a nylon mesh. The incision is closed with an invisible dissolving stitch.
2. A laparoscopic (keyhole) repair is carried out from within the abdomen. Very small incisions are made in the abdominal wall to enable specialist keyhole instruments to be inserted. These are then used to repair the weakness and insert a nylon mesh.
Your surgeon will discuss these options with you.
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery – with any of your regular medications). You will see your surgeon and the anaesthetist before your operation.
After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Some people are discharged home later the same day.
You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol may be necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have discomfort after surgery, and this depends on the size and complexity of the hernia that has been repaired. It may be more painful for longer if you have had an open procedure. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for three weeks. You may drive a car when you are able to perform an emergency stop safely.You should be back to full activities by six weeks. There are no stitches to be removed.You will be seen for follow-up six weeks following your surgery.
Risks of surgery
There are very few potential complications.You may develop some bruising around the wound which can take a while to settle. If the wound swells, becomes more painful and hot, or starts to discharge, you may have a wound infection and should contact the Berkshire Hernia Centre or your General Practitioner. There is risk of recurrence which depends on the nature of the hernia that has been repaired.