Incisional Hernias
What is an incisional hernia?
Incisional hernias are a special kind of abdominal wall hernia that occur near prior surgical incisions where prior surgery has weakened the abdominal wall, or where infection in a healing surgical incision causes breakdown of the wound closure. About 25 to 30 percent of patients will develop an incisional hernia when a wound infection occurs after abdominal surgery.al hernia which is higher up on the abdomen between the belly button and the chest.
What causes an incisional hernia?
Incisional hernias can often occur without any events, as an incision in your connective tissue weakens the natural defenses for hernia prevention. Having said that, there are several risk factors for developing a hernia after a previous surgery:
Some of the common risk factors of developing an incisional hernia are believed to include:
Chronic cough
Chronic constipation
Wound infection
Diabetes
Connective Tissue Disorder
Complications from surgery
How do I know if I have an incisional hernia?
You may notice a bulge near your previous incisions which can be soft and may be reducible. You may also have associated symptoms such as:
Pain or soreness near your incision
Bulging near your incision
Discomfort while straining or lifting
Burning or gurgling sensation near the incision
When Should I be Concerned?
If you are having severe pain by your incision or bulge, redness, or signs of a bowel obstruction such as inability to have a bowel movement associated with nausea or vomiting, you may need surgical evaluation immediately, as the contents of the hernia may be stuck.
How is an incisional hernia diagnosed?
The most common way incisional hernias are diagnosed is through a physical exam during a visit with a physician. You may not even have any symptoms but may have an obvious bulge. Sometimes if your hernia is large or more complex, you may need medical images to see it better such as a CT scan or ultrasound.
What are my options for repair?
Unlike naturally occuring hernias, incisional hernias are less predictable and have a higher likelihood of complications, and should be repaired if possible.
The 3 main reasons a hernia should be fixed electively are:
To improve symptoms due to a hernia
To prevent progression of the hernia to a larger, more difficult to treat condition
To avoid the need for an emergency intervention and prevent risks of the intestines being trapped or ”choked” within the hernia
The goal in fixing an incisional hernia is to reduce the hernia “sac”, or the lining of the belly which goes through the hernia defect, and then cover the opening to prevent fat or organs from going through the defect again. This can be fixed through an old-fashioned surgical incision in your groin (known as an open approach) or using minimally-invasive options–either laparoscopically or robotically–to create several small incisions on either your left or right flank.
How does an open incisional hernia repair work?
Unlike other naturally occuring hernias, there are many different approaches to an incisional hernia repair. An open repair usually entails an incision which encompasses the previous incision. Then the muscles of the abdominal wall are restored to their normal anatomic position and the area is reinforced with a mesh. Any loose skin is removed as well.
How does a laparoscopic or robotic incisional hernia repair work?
Small incisions are made on either the right or left side of your belly and your belly is filled with carbon dioxide gas. This allows your surgeons to work with a wide viewing area. A small flap of the lining of your abdominal wall is made in order to place the mesh. Reconstruction and closure of the hernia is then performed Then the area is covered with a mesh and secured into place. The flap is closed and the gas is sucked out.
While these approaches require additional high-level of expertise, they also provide the benefits of reduction in pain, faster functional recovery, better cosmetic results, and faster return to work and exercise. However for larger incisional hernias, an open approach may be more likely and may be safer.
What is abdominal wall reconstruction surgery?
Abdominal wall reconstruction is the practice of taking a dysfunctional abdominal wall due to hernia disease and putting it back together using advanced surgical techniques. Abdominal wall reconstruction is reserved for large, more complex, or recurrent hernias.
What to expect from complex incisional hernia surgery (abdominal wall reconstruction)
Immediately after surgery
You may have some mild upper abdominal or shoulder pain after surgery if it was done robotically or laparoscopically which can be normal since surgeons use carbon dioxide to fill your abdomen during surgery and this can get trapped. The gas is absorbed over the next 1-2 days but can be very uncomfortable in certain circumstances. Walking around and taking deep breaths can help absorb this air and reduce pain. However, if your pain is severe in nature and will not go away, or if you are concerned about a heart attack, let us know so that we can perform an appropriate workup. If your surgery was done open, there would not be this trapping of gas.
You may have a feeling that it is difficult to swallow, and you may have a sore throat. The sore throat sensation is typically from intubation, or possibly even a gastric tube, depending on the procedure. This sensation goes away within a day. If your swallowing or sore throat becomes worse, let your doctor know.
You may feel that your breathing is difficult. Again, this may be from pain, or the surgery, but if you feel this is getting worse then alert your doctor.
During your post-surgery hospital stay (If you require admission)
You will arrive in the Post-Anesthesia Care Unit (PACU) after your procedure, and as you wake up the nurses will check that you are tolerating liquids and will discharge you home when appropriate.
Due to the nature of this surgery, you may be in the hospital anywhere from 1-4 days or even more depending on how complex the hernia is.
During your stay you should walk or move about at least once every 2 hours along with a nurse or family member
You will be given a small, handheld device called an incentive spirometer to help you take slow, deep breaths. These breathing exercises help your lungs recover from surgery. Use your incentive spirometer ten times every hour. If you’re watching TV, a good approach is to use it during each commercial break.
For pain control, we will attempt to use non-opioid therapy, however in larger cases this may be impossible due to pain from large incisions. You may start with a PCA (Patient controlled anesthesia) where you press a button to deliver pain medicine. From there we move to IV pain medicine, then oral pain medicine, and by that point you should be ready for discharge.
We will also give you medicine to help with blood clots (heparin or lovenox injection), medicine for nausea, as well as forms of medicine you were taking at home
Leaving the hospital
At discharge, you will receive any appointments and prescriptions as necessary. It’s a good idea to have someone stay with you during recovery.
When you arrive home
Remove loose rugs and cords that can be tripped over in your home.
Do not consume any mind-altering medications or sleep aids without first speaking to your nurse or surgeon. These include: benedryl, klonopin, clonazepam, lorazepam, valium, diazepam, Ativan, flexeril, soma etc.
If you are concerned that you may have a fever, or feel like you have the chills, take your temperature with your home thermometer. Anything over 100.4 F is considered a fever and anything less than that is normal for your body’s recovery. There is no need to take your temperature if you feel well.
You should aim to drink 1.5-2 liters (6-8 full glasses) of fluid (preferably water) daily. You should remain out of bed at least 6 hours during the day and walk around your home hourly while awake.
The reappearance of bowel movements might take up to 5 days after the surgery. Remember that walking is the most important factor in return of bowel function.
Follow up after surgery
Your surgeon will want to see you back for a follow-up visit 2-3 weeks after your procedure. If everything is normal there may not be a need to return again unless there is an issue.
While you should feel like your usual self after 6-8 weeks, your body will still be healing from the surgery for about a year. If you overdo it with physical activity and get a recurrence of some mild pain, reduce the inflammation with ice, Tylenol (if possible) and rest. If pain persists, make an appointment with your surgeon, or call your nurse. If you are worried, they are worried.
Complications after surgery
Complications of incisional hernia repair can include but are not limited to:
Seromas (fluid build-up) where the hernia used to be
These appear/feel like a walnut or lime; they may feel like an old “hernia”
More common in large hernias
Usually cause no symptoms and resolve without interventions
May last up to 90 days
Wound infection, wound dehiscence (falling apart), abscess
Bleeding
Chronic pain
Hernia recurrence
When to call the office
Please call your doctor’s office if you are experiencing any of the following:
Fever >100.4 which is sustained on 2 different readings. Temperatures less than this are normal after surgery, as the body heats up as it is healing
Redness surrounding incisions, drainage from incisions
Bleeding from your incisions that will not stop with pinpoint pressure (hold pinpoint pressure for 10 minutes first).
Vomiting or persistent nausea which does not go away with time
Inability to urinate more than 6-8 hours after surgery
We typically recommend trying to stand in a hot shower for 15-20 minutes
Severe abdominal pain unrelieved by prescription medications or increasing in intensity
Large amount bruising or discoloration over incisions or flanks
Some bruising around the cuts or in the genital area is not abnormal
If you feel that you are getting worse each day instead of better
When to go to the ER
Please call 911 and go to the nearest ER for the following:
Chest pain
Fainting spells
Shortness of breath or difficulty breathing
Trouble speaking, weakness on one side of your body or both, changes in your vision
Please let your surgeon know once this has happened in case there is a surgical problem
Next Steps
If you’re dealing with an incisional hernia, the Hernia Experts are here for you.
Our team is highly experienced in all the most advanced treatment options.
After your procedure, our surgeons and office staff will be with you every step of the way.
To set up a consultation, please call us at (212) 305-5947 or use our online appointment request form. We look forward to answering your questions and meeting your hernia care needs.