Incisional Hernia Flashcards

1
Q

What is an incisional hernia?

A

A protrusion of the contents of a cavity, usually the abdomen, through a previously made incision in the compartment’s wall

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2
Q

When do incisional hernias occur?

A

After an operation

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3
Q

How common are incisional hernias?

A

Extremely common, with a prevalence of 5% after 1 year and 25% after 2 years

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4
Q

How does surgery affect the anterior abdominal wall?

A

The layers of the anterior abdominal wall are normally strong, and act to maintain the integrity of the abdominal cavity, however once they are interrupted by a surgical incision, their continuity is disrupted and they are structurally weakened

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5
Q

What contributes to the development of an incisional hernia?

A

Increased intra-abdominal pressure or certain risk factors

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6
Q

What complications can occur with an incisional hernia?

A
  • Incarceration
  • Strangulation
  • Bowel obstruction
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7
Q

What are the main risk factors for incisional hernias?

A
  • Emergency surgery
  • Wound type
  • BMI >25
  • Midline incision
  • Wound infection
  • Pre-op chemotherapy
  • Intra-op blood transfusion
  • Advancing age
  • Pregnancy
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8
Q

What are the less common risk factors for incisional hernias?

A
  • Chronic cough
  • Diabetes mellitus
  • Steroid therapy
  • Smoking
  • Connective tissue disease
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9
Q

What is the characteristic clinical feature of an incisional hernia?

A

Non-pulsatile, reducible, soft and non-tender swelling at or near the site of a previous surgical wound

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10
Q

How might an incarcerated incisional hernia present?

A

Painful, tender, and erythematous

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11
Q

How might an incisional hernia causing bowel obstruction present?

A

With symptoms of abdominal distention, vomiting, and/or absolute constipation

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12
Q

What may be found on examination on incisional hernia?

A

Mass palpable at or near the site of surgical incision, may be reducible

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13
Q

What should be assessed for on examination for incisional hernia?

A

Any signs of bowel ischaemia, such as rebound tenderness or involuntary guarding

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14
Q

What are the differential diagnoses of incisional hernias?

A

Not many tbh, but consider other causes of abdominal lymph such as lipoma

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15
Q

How is a diagnosis of incisional hernia usually made?

A

Clinical basis, with no lab or imaging studies required

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16
Q

What can be used to investigate an incisional hernia if the diagnosis is unclear?

A

Ultrasound or CT imaging

17
Q

What are the options for management of incisional hernia?

A

Should be considered on case-by-case basis

Majority are managed conservatively, but some may need surgery

18
Q

When is surgery indicated for an incision hernia?

A

Patients with painful hernias who are clinically fit enough for surgery

19
Q

What should be taken into account when deciding the best management for an incisional hernia?

A
  • Size of hernia
  • Clinical features
  • Patients age and co-morbidities
  • Preferences
20
Q

What techniques can be used to repair an incisional hernia?

A
  • Suture repair (for very small hernias)
  • Laparoscopic mesh repair
  • Open mesh repair
21
Q

What are the common complications of incisional hernia repair?

A
  • Pain
  • Bowel injury
  • Serum formation
22
Q

What % of incisional hernias will incarcerate?

A

6-15%

23
Q

What % of incisional hernias will strangulate?

A

2%

24
Q

Is the recurrence rate after repair of incisional hernias high?

A

Yes

25
Q

What is a recognised but poorly understood complication of incisional hernia repair?

A

Chronic pain

26
Q

What is the occurrence of chronic pain after incisional hernia repair?

A

10-20%

27
Q

What is thought to cause chronic pain after incisional hernia repair?

A

Combination of mesh inflammation, nerve damage and entrapment, and tension in mesh