Incisional hernia: information & incisional hernia doctors

An incisional hernia (incisional hernia) often occurs after open abdominal surgery in the area of the surgical scar. In severe cases, parts of the intestine can become trapped and lead to a life-threatening intestinal obstruction. An incisional hernia is always treated surgically. Here you will find further information and selected incisional hernia doctors and centers.

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Brief overview:

What is an incisional hernia? During open abdominal surgery, the connective tissue of the abdominal wall is severed. Although it later grows back together, a weak point remains here. If the abdominal pressure is high, the contents of the abdominal cavity can leak out through the weak point at the scar.
Frequency: This is a common late complication of open abdominal surgery. Every fifth patient suffers an incisional hernia, which amounts to around 50,000 cases per year. An incisional hernia usually occurs within a year of the operation.
Risk factors: A wound infection in the area of the scar, wound healing disorders, repeated procedures via the same access increase the likelihood of an incisional hernia, as do obesity, smoking, cancer and other pre-existing conditions.
Symptoms: Symptoms do not always occur. Drawing pains in the area of the scar are a first indication. A visible and palpable protrusion typically appears later.
Diagnosis: The doctor diagnoses an incisional hernia by physical examination. In some cases, an ultrasound examination, CT scan or colonoscopy is required to confirm the diagnosis.
Treatment: Surgery is always necessary. There are various methods, the choice of which depends on the individual situation.

An incisional hernia, also known as an incisional hernia, is a hernia of the abdominal wall. It occurs after a previous open abdominal operation (laparotomy) in the area of the surgical scar.

At this point, the scar represents a weak point in the abdominal wall. If it cannot withstand the pressure in the abdominal cavity, a gap can form in the abdominal wall (hernial orifice). Organs in the abdominal cavity (hernial contents) can slip out through this hernial orifice. This causes a sac-like protrusion of the peritoneum (hernia sac) to bulge outwards.

An incisional hernia can be between a few millimetres and 30 centimetres in size.

Frequency of incisional hernia

Incisional hernia is a common late complication after open abdominal surgery. Around one in five patients (20 percent) who have undergone abdominal surgery suffer an incisional hernia in the area of the surgical scar.

In around 50 percent of cases, an incisional hernia occurs within the first year after the operation. According to the Federal Statistical Office, a total of around 50,000 incisional hernias are operated on in Germany every year.

Causes and risk factors of incisional hernia

The cause of an incisional hernia is the lack of strength and elasticity of the abdominal wall in the area of a surgical scar. It is preceded by open abdominal surgery (laparotomy).

The risk factors that can promote the formation of an incisional hernia directly after abdominal surgery include

Wound infections,
Wound healing disorders,
Bleeding in the surgical area,
a poor general and nutritional condition of the patient and
repeated operations via the same surgical access.

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Surgical scars in the abdominal area represent a weak point in the abdominal wall © thorstenstark | AdobeStock

In addition

severely overweight patients, long-term smokers and patients suffering from diseases such as

cancer,
peritonitis,
diabetes mellitus or
general anaemia

are more at risk of suffering an incisional hernia.

The trigger for an incisional hernia is often increased pressure in the abdominal cavity, which can occur, for example, with constipation or chronic coughing.

Symptoms of incisional hernia

An incisional hernia may or may not cause symptoms. Whether symptoms occur, what type they are and how severe they are depends on the type and size of the incisional hernia.

Initially, an incisional hernia usually manifests itself as pulling pain in the area of the scar, which is mainly felt

when coughing,
when pressing (e.g. during bowel movements) and
during physical exertion

occur.

Later, a visible and palpable bulge typically appears in the area of the scar. It can be easily pushed back into the abdominal cavity. It increases in size over time.

An incisional hernia is usually harmless. In the worst case, however, it can cause a life-threatening intestinal obstruction that requires immediate surgical treatment.

Diagnosis of incisional hernia

An incisional hernia is usually diagnosed by a physical examination during which the doctor palpates the surgical scar by hand. If the doctor can feel a hernial orifice and a hernial sac that can be pushed back into the abdominal cavity, the diagnosis is already confirmed.

In individual cases, for example in severely overweight patients or in the case of very small incisional hernias, further examinations may be necessary. For a reliable diagnosis and assessment of the extent of the hernia, for example

are used.

Treatment of incisional hernia

An incisional hernia becomes larger over time and there is a risk that parts of the bowel will become trapped. An incisional hernia should therefore always be treated surgically as part of hernia surgery.

Incisional hernia surgery should be performed at the earliest 3 to 6 months after the original abdominal operation. The hernia sac is first moved back into the abdominal cavity. The surgeon then closes the hernial orifice permanently using a suture technique or a synthetic mesh.

The operation can be performed either as part of an open surgical procedure or minimally invasively using laparoscopic or endoscopic surgical procedures.