Incisional Hernia

Question 1

What is an incisional hernia?

Answer 1

A hernia that occurs through a previously made incision in the abdominal wall
Occur after an operation and are a common complication of abdominal surgery

Question 2

What is a hernia?

Answer 2

Protrusion of a viscus or part of a virus through the wall of the cavity in which it is contained

Question 3

Why does incisional hernia occur?

Answer 3

Layers of abdominal wall are normally strong
Act to maintain integrity of the abdominal cavity
Surgical incision interrupts these layers and are weakened
Increased intra-ado pressure and/or risk factors mean contents of abdomen can herniate into weakness

Question 4

What are complications of hernia?

Answer 4

Incarceration (hernia is irreducible), strangulation (blood supply to herniated organ is compromised), bowel obstruction

Question 5

What are risk factors for incisional hernia following abdominal surgery?

Answer 5

Emergency surgery
Wound type
BMI>25
Midline incision
Wound infection
Pre-operative chemotherapy
Intra-Operative blood transfusion
Advancing age
Pregnancy
DM, smoking, chronic cough

Question 6

What are clinical features of incisional hernia

Answer 6

Non-pulsatile, reducible, soft and no-tender swelling at or near site of previous surgical wound

OE mass is palpable near site of surgical incision, may be reducible, assess for any signs of bowel ischaemia such as rebound tenderness or involuntary guarding

Question 7

Features of incarcerated hernia Strangulated hernia?

Answer 7

Painful, tender and erythematous.
If there is bowel obstruction - abdominal distention, vomiting, absolute constipation

Rebound tenderness, involuntary guarding

Question 8

What investigations can be done for hernia?

Answer 8

Clinical diagnosis

USS/CT to investigate

Question 9

What is the management of an incisional hernia?

Answer 9

Watchful waiting for small symptomatic hernias
Surgery for patents clinically fit enough for surgery - size of hernia, clinical features, patients age and comorbidity and preference taken into account

Suture repair, laparoscopic mesh repeat, open mesh repair.

Question 10

What is the prognosis of incisional hernias?

Answer 10

Considerable risk of life-threatening complications - incarceration and strangulation
Recurrence rates are high
Chronic pain