Incisional Hernia: Information & Doctors Specializing in 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.

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.

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.

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.

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.

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.