Incisional hernia

Question 1

What is incisional hernia?

Answer 1

• protrusion of the contents of a cavity (usually the abdomen) through a previously made incision in the compartment’s wall.

Question 2

What is the Px of Incisional hernia?

Answer 2

1. Abdominal wall layers interrupted surgical incision
2. continuity is disrupted > structurally weakened
3. If RF presents > contents of abdomen can herniate through weak spot

Question 3

What are the RF of incisional hernia?

*answer ranked by relative risk

Answer 3

• Emergency surgery
• Wound type
• BMI >25
• Midline incision
• Wound infection
• Pre-operative chemotherapy
• Intra-operative blood transfusion
• Advancing age
• Pregnancy
• Other less common risk factors
  
  • chronic cough, diabetes mellitus, steroid therapy, smoking, and connective tissue disease.

Question 4

What are the CF of Incisional Hernia?

Answer 4

• non-pulsatile, reducible, soft and non-tender swelling at site of surgical wound.
• If incarcerated
  
  • painful, tender, and erythematous.
• If bowel obstruction present
  
  • abdominal distention, vomiting, and/or absolute constipation.

Question 6

What Ix would you order for incisional hernia?

Answer 6

• clinically diagnosed
• Ultrasound*or CT imaging

Question 7

How would you Mx incisional hernia?

Answer 7

• majority asymptomatic > conservative
• Surgical
  
  • suture repair
  • laparoscopic mesh repair
  • open mesh repair.

Question 8

What are the cx of incisional hernia?

Answer 8

• recurrence
• pain
• bowel injury
• seroma formation