Incisional Hernia: Information & Doctors Specializing in Incisional Hernias

An incisional hernia often occurs in the area of the surgical scar following open abdominal surgery. In severe cases, parts of the intestine can become trapped, leading to a life-threatening intestinal obstruction. An incisional hernia is always treated surgically. Here you will find further information as well as a selection of doctors and centers specializing in incisional hernias.

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Quick Overview:

What is an incisional hernia? During open abdominal surgery, the connective tissue of the abdominal wall is cut. Although it grows back together later, a weak spot remains at this site. When intra-abdominal pressure is high, the contents of the abdominal cavity can protrude through this weak spot at the scar.
Prevalence: This is a common late complication of open abdominal surgery. One in five patients develops an incisional hernia, amounting to approximately 50,000 cases annually. In most cases, an incisional hernia occurs within one year of surgery.
Risk factors: A wound infection in the area of the scar, impaired wound healing, and repeated surgeries through the same incision site increase the likelihood of an incisional hernia, as do obesity, smoking, cancer, and other pre-existing conditions.
Symptoms: Symptoms do not always occur. A pulling pain in the area of the scar is an early sign. A visible and palpable bulge typically appears later.
Diagnosis: The doctor diagnoses an incisional hernia through a physical examination. In some cases, an ultrasound, a CT scan, or a colonoscopy is required to confirm the diagnosis.
Treatment: Surgery is always necessary. There are various surgical methods available, and the choice depends on the individual situation.

An incisional hernia, also known as a scar hernia, is a hernia of the abdominal wall involving internal organs or soft tissues. It occurs in the area of the surgical scar following a previous open abdominal surgery (laparotomy).

The scar at this site represents a weak spot in the abdominal wall. If it cannot withstand the pressure inside the abdominal cavity, a gap in the abdominal wall (hernia orifice) can form here. Through this hernial orifice, organs from the abdominal cavity (hernial contents) can slip outward. This causes a sac-like protrusion of the peritoneum (hernial sac) to bulge outward.

An incisional hernia can range in size from a few millimeters to 30 centimeters.

Prevalence of Incisional Hernias

An incisional hernia is a common late complication following open abdominal surgery. Approximately one in five patients (20 percent) who have undergone abdominal surgery develop an incisional hernia in the area of the surgical scar.

In about 50 percent of cases, an incisional hernia occurs within the first year after surgery. According to the Federal Statistical Office, approximately 50,000 incisional hernias are surgically treated in Germany each year.

Causes and Risk Factors of Incisional Hernias

An incisional hernia is caused by a lack of strength and elasticity in the abdominal wall at the site of a surgical scar. It is preceded by open abdominal surgery (laparotomy).

Risk factors that can increase the likelihood of an incisional hernia forming immediately after abdominal surgery include, among others

wound infections,
wound healing disorders,
bleeding in the surgical area,
poor general health and nutritional status of the patient, as well as
repeated surgeries through the same surgical incision.

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

In addition,

severely obese patients, long-term smokers, and patients suffering from conditions such as

cancer,
peritonitis,
diabetes mellitus, or
general anemia

are at greater risk of developing an incisional hernia.

The trigger for an incisional hernia is often increased pressure inside the abdomen, which can occur, for example, due to constipation or a chronic cough.

Symptoms of an Incisional Hernia

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

Initially, an incisional hernia usually manifests as a pulling pain in the area of the scar, which is particularly noticeable

when coughing,
when straining (e.g., during a bowel movement), and
during physical exertion

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

An incisional hernia is usually harmless. However, in the worst-case scenario, it can cause a life-threatening bowel obstruction that requires immediate surgical treatment.

Diagnosis of an Incisional Hernia

An incisional hernia is usually diagnosed through a physical examination, during which the doctor palpates the surgical scar with their 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 confirmed.

In some cases, such as in severely obese patients or with very small incisional hernias, further tests may be necessary. To confirm the diagnosis and assess the extent of the hernia, tests such as

ultrasound,
computed tomography, and
colonoscopy

be used.

Treatment of Incisional Hernias

An incisional hernia grows larger over time, and there is a risk that portions of the intestine could become strangulated. Therefore, an incisional hernia should always be treated surgically as part of hernia surgery.

Surgery for an incisional hernia should be performed no sooner than 3 to 6 months after the initial abdominal surgery. During the procedure, the hernial sac is first reduced back into the abdominal cavity. The surgeon then permanently closes the hernial defect using sutures or a synthetic mesh.

The surgery can be performed either as an open surgical procedure or using minimally invasive laparoscopic or endoscopic techniques.